• 专利附录
  • 专利说明
  • 权利要求
  • 类似技术
  • 同族专利
  • 引用文献
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    • 专利摘要:
    A device for the deep stimulation of a brain comprises: - a probe (16) having a transparent distal portion, traversed by a channel (28) open at a proximal end of the probe, and comprising electrodes (20a, 20b, 20c , 20d) fixed on the distal portion of the probe and electrical terminals (22a, 22b, 22c, 22d) attached to a proximal portion of the probe; an electrical box comprising an open channel at its two ends, and housing electrical terminals in contact with the terminals (22a, 22b, 22c, 22d) of the probe; and an extension cord fixed to the housing and connected to the terminals of the housing. The channel of the housing is open at the other end thereof and the device further comprises: a waveguide (50) housed at least partly in the central channel (28) of the probe, up to the portion distal of the probe; and an emitter box adapted to be connected to the waveguide (50) for the injection of a predetermined wavelength.
    公开号:FR3036623A1
    申请号:FR1554789
    申请日:2015-05-28
    公开日:2016-12-02
    发明作者:Claude Chabrol；Alim-Louis Benabid
    申请人:Commissariat a lEnergie Atomique CEA；Commissariat a lEnergie Atomique et aux Energies Alternatives CEA；
    IPC主号:
    专利说明:

    [0001] FIELD OF THE INVENTION The invention relates to the field of implantable devices in a human or animal brain, and more particularly to the field of devices performing deep brain brain stimulation, particularly for the treatment of neurodegenerative diseases such as Parkinson's disease.
    [0002] STATE OF THE ART The deep brain stimulation of a brain, more commonly known as "deep brain stimulation" (DB S), consists in stimulating electrically by low-current pulses of the parts of the human brain that control the movements, and more particularly the thalamus. , the subthalamic nucleus and / or the globus pallidus, which allows the patient a better control of his movements. This stimulation is used successfully in the treatment of Parkinson's disease, tremor, OCD or dystonia.
    [0003] In practice, and with reference to FIG. 1, two sets of electrodes 10 are implanted in the brain for the electrical stimulation of the latter, each of these sets being disposed at the end of a flexible, elongate body made of a biocompatible material, also called "DBS" probes. Implantation of a probe consists in opening the patient's cranial box, penetrating the probe through the trephination performed until its distal end is placed at the desired location, with the help of the real-time brain imaging (CT, MRI,) and three-dimensional reconstruction of the brain. During this operation, the patient is under local anesthesia to practice tests on the effectiveness of the stimulation. Once the probes are in place, the patient is then placed under general anesthesia, and an extension 12 of each probe is housed under the scalp and the neck skin for the connection of the probes to a battery-powered electrical stimulator 14 housed under the skin. patient in subclavicular position. In what follows, the term "distal" refers to a portion or an end of an element, intended to be in contact with the area to be treated. The term "proximal" refers to a portion or end of the element, opposite to the distal portion or end and usually intended for connection of the element with a stimulator.
    [0004] Numerous DBS probes have been so designed, for example by the companies MedscapeO, Medtronics0, BostonScientic0, etc. With reference to FIGS. 2 to 4, a DBS probe 16 usually comprises: a cylindrical, elongated probe body electrically insulating and flexible 18, of a small diameter, typically 1.3 mm, this probe body may be a single tube (MEDTRONIC) or a multi lumen tube (Boston Scientific); an assembly 20 of electrical stimulation electrodes 20a, 20b, 20c, 20d disposed in a distal portion of the body 18, and an assembly 22 of supply contacts 22a, 22b, 22c, 22d disposed in a proximal portion of the The electrodes 20a, 20b, 20c, 20d, often four in number, take the form of electrically conductive cylinders enveloping an outer surface of the probe body 18. The latter also comprises a hollow tube 26 at its center, and empty of material, which extends over its entire length of the body 18, and whose diameter is usually 0.45 to 0.55mm in diameter to allow the introduction during surgery of a metal stiffener of 0.3 0.35mm in diameter.
    [0005] An assembly 28 of electrically insulated leads 28a, 28b, 28c, 28d is wound around the tube 26, respectively welded to the electrodes 20a, 20b, 20c, 20d and the contacts 22a, 22b, 22c, 22d, and embedded in the material. of the probe body 18. The wires 28a, 28b, 28c, 28d typically have a diameter in the range of 1001.1m to 1501.1m. The distal end of the probe body 18 is further closed by a hemispherical plug 30 inserted into the hollow tube. 26. The contacts 22a, 22b, 22c, 22d are generally also cylinders enveloping a proximal outer surface of the probe body 18, and respectively connected to the conductor wires 28a, 28b, 28c, 28d, but their size and spacing may be different from those of the electrodes 20a, 20b, 20c, 20d. Referring to FIGS. 5 and 6, the electrical connection of a DBS 16 probe consists in introducing the proximal portion thereof, provided with contacts 22a, 22b, 22c, 22d, in the channel of an electrical box 32, comprising internal contacts / terminals which respectively contact the contacts 22a, 22b, 22c, 22d of the probe. The housing 32 is extended by wired extension 34, provided with contacts 36 at a proximal portion for connection to a connection 38 of an electrical stimulator 40.
    [0006] In parallel with the deep electrical stimulation of the brain, there is a growing interest in deep optical stimulation of the brain, particularly with visible-red or near-infrared radiation, for the treatment of the same diseases as treated by electrical stimulation, as described for example in the article "Red and NIR light dosimetry in the deep human brain" by A Pitzschke et al., Phys. Med. Biol. 60 2921, 2015. This new approach induces in particular the development of new probes provided, in distal position, with optical outputs, generally based on specific polymer materials which must have both the desired optical emission properties and biocompatibility.
    [0007] Electrical stimulation only compensates for lack of dopamine by exciting STN, but has no therapeutic effect on Parkinson's disease, which continues to evolve. The results observed on preclinical tests show that optical stimulation provides cell protection for SNc cells whose degeneration causes Parkinson's disease. The combination of the two modes of stimulation would provide cellular protection and thus stop the disease, while reducing the symptoms (akinesia, rigidity, tremor ...) by stimulating the STN in patients already in an advanced phase of the disease . It is therefore not excluded to combine the two approaches to stimulate the same area of the brain to treat a particular disease, for example Parkinson's disease. However, this involves multiplying the number of probes implanted in the brain, which is difficult to envisage. Alternatively, it is possible to design probes that each include two sets of electrodes in a distal position, a set of electrodes for electrical stimulation, and a set of electrodes for optical stimulation. However, this assumes a large optoelectronic emission zone of the probe, and thus possibly a treatment that is too selectively spatially selective, besides multiplying the conductive wires to be provided in the probe. It is also possible to seek to design electrodes which are suitable for both types of stimulation, electrical and optical, and which are also biocompatible. However, the difficulty involved in the development of such electrodes is easy to understand. SUMMARY OF THE INVENTION The object of the invention is to provide a device for deep optoelectrical stimulation of a brain which is of simple design. To this end, the subject of the invention is a device for the deep stimulation of a brain, comprising: a stimulation probe comprising: an elongated body traversed by a central channel empty of material extending between a portion distal and a proximal end of the probe, the central channel being open at said proximal end and the distal portion of the body being adapted to transmit a predetermined wavelength; o electrodes attached to an outer surface of the body in the distal portion of the probe for electrical stimulation of the brain; electrical terminals each comprising a portion fixed on an external surface of the body in the proximal portion of the probe and connected to the electrodes for their power supply; an electrical box comprising a channel in which electrical terminals are housed, said channel being open at one of its ends to receive the proximal portion of the probe so as to bring into contact the electrical terminals of the probe and the electrical terminals. the case; and 15 - an extension cord attached to the electrical box and connected to the electrical terminals of the housing. According to the invention: the channel of the electrical box is open at the other of its ends; And the device further comprises: a waveguide capable of guiding the predetermined wavelength, housed at least partly in the central channel of the body of the probe, and extending to the distal portion; the probe for the illumination of the brain through it; and a transmitting housing adapted to be connected to a proximal end of the waveguide for injection therein of the predetermined wavelength. In other words, the invention is based on the finding of the inventors that DBS probes of the state of the art can be modified simply to also implement optical stimulation. Indeed, a DBS probe has a central channel that is not used for electrical stimulation, the body material of the probe (eg, silicone, or polyurethane) is usually transparent to wavelengths. interest for optical stimulation, and electrical stimulation electrodes do not cover the entire distal portion of the probe, especially its end, thus leaving a surface for optical emission. In addition, the diameter of the channel of the probes of the state of the art is compatible with the diameter of certain optical fibers suitable for wavelength transport for optical stimulation.
    [0008] Thus, by introducing an optical fiber into the central channel of a DBS probe to the distal end thereof, a modified probe is obtained which, on its distal portion, is capable of emitting electrical stimulation by means of the electrodes and optical emission at least by the distal end of the probe. However, the electrical connection of a DBS probe of the state of the art is invariably made by means of an extension which obstructs the central channel, so that, as it is, it is not possible to introduce a waveguide (eg an optical fiber) in the probe channel and connect this waveguide. According to the invention, the connection of the DBS probe is modified to release the channel of the electrical box by deporting the extension cord attached to the housing. The channel of the housing being released, it can therefore introduce the waveguide and allow the connection of the waveguide with a light emitting source.
    [0009] According to embodiments, the device comprises one or more of the following features: the distal portion of the waveguide and the distal portion of the probe have a length of between 2 millimeters and 10 millimeters; The wavelength between 670 nanometers and 1070nm, and preferably 670 and 810nm and the optical power emitted by the distal portion of the waveguide is less than or equal to 10 milliwatts, in particular for the treatment of Parkinson's disease ; the waveguide is an optical fiber of the HCS type (for the English expression "hard-cladsilica") having a silica core of diameter between 125 micrometers and 300 micrometers, a coating (or "clad") of diameter less than or equal to 151.1m and a sheath (or "buffer") of diameter less than or equal to 5001.1m, or any other waveguide (silicone, PMMA, Silica-silica) of diameter less than or equal to 5001.1m.
    [0010] The invention also relates to an electrical extension for connection with a deep stimulation probe of a brain, said probe comprising an elongate body and electrical terminals attached to an outer surface of a proximal portion of the probe body. said electrical extension comprising: an electrical box comprising: a channel open at a first and a second end, the channel being adapted to receive the proximal portion of the body of the probe when it is introduced through the first end of the channel ; Electrical contacts housed in the channel of the electrical box and able to come into contact with the terminals of the probe when the proximal portion thereof is introduced into the channel of the box by the first end of the channel; and an extension cord comprising electrical conductors connected to the electrical contacts of the housing, said extension cord being fixed to the housing without obstructing the second end of the channel of the housing. Such an extension makes it possible to connect a DBS probe while leaving its central channel free. Advantageously, this extension is universal since it can supply a DBS probe, whether or not it is associated with a waveguide. Advantageously, a plug, e.g. silicone, is used to plug the central channel if it is not used to house a waveguide. The stopper may be a septum molded together with the connector body or a snap-fit piece therein. The invention also relates to a method for testing the optical operation of a first and a second stimulation device of the type previously described, the probes of the two devices being pre-implanted in the brain with their distal portions housed in a zone of the brain to be treated, the method comprising: - injecting radiation of predetermined wavelength into the waveguide of the first device by the proximal end of the waveguide and measuring said radiation at the proximal end of the waveguide of the second device; injecting the same radiation into the waveguide of the second device by the proximal end of the waveguide and measuring said radiation at the proximal end of the waveguide of the first device; and - to diagnose the optical operation of the set of probes and waveguides housed in it as a function of the measurements.
    [0011] As previously described, prior art DBS probes can be simply modified to also perform optical stimulation, including DBS probes that are already implanted in a patient. It is thus possible to update already implanted probes, without having to remove them, by introducing into their respective central channel waveguides (e.g., optical fibers), providing the new connector according to the invention. However, it must be ensured that the optical fibers have been introduced and that the optical operation of the modified probes is in line with expectations. Now, by nature, a waveguide is also able to capture radiation at its ends. Thus, by activating the optical emission of the first probe (respectively of the second probe) and deactivating the emission of the second probe (respectively of the first probe), the latter thus detects by its distal end the radiation of the first probe (respectively of the second probe), the optical radiation thus collected propagating towards the proximal end of the probe where it is measured for analysis. The optical operation of the probes can therefore be diagnosed with the DBS probes still implanted. BRIEF DESCRIPTION OF THE FIGURES The invention will be better understood on reading the description which will follow, given solely by way of example, and made with reference to the appended drawings, in which: FIG. 1 is a diagrammatic view of probe, connectors and stimulators for deep electrical stimulation of a human brain; FIG. 2 is a schematic perspective view of a DBS probe of the state of the art; FIG. 3 is a schematic view of a distal portion of the DBS probe of FIG. 1; FIG. 4 is a schematic view of the electrical stimulation electrodes of the DBS probe and of the conductive wires feeding the electrodes; FIGS. 5 and 6 are diagrammatic views of the various components used for the deep electrical stimulation, respectively before their connection and after their connection; Fig. 7A is a schematic perspective view of a DBS probe into which an optical fiber is inserted according to the invention and Fig. 7B is an enlarged view of the distal portion of the DBS probe of Fig. 7A; - Figure 8 is a schematic view of an electrical connection box according to the invention for connection to the proximal portion of a DBS probe provided with electrical contacts; FIG. 9 is a schematic view illustrating a system for deep opto-electrical stimulation of a brain according to the invention; FIGS. 10A and 10B are diagrammatic views illustrating first and second variants integrating the connection of an optical extension cable to an emitter box forming part of the system of FIG. 9; FIGS. 11 to 15 illustrate a method of leveling a pair of DBS probes implanted in a patient to confer on them the function of optical stimulation, FIG. 14 illustrating more particularly a method for testing the optical correct functioning of the probes. modified: 3036623 8 - Figure 16 is a schematic view illustrating a preferred embodiment of the transmitter housing provided with a radiation detection function; and FIGS. 17A and 17B illustrate the alternation of activation and deactivation of the illumination function of the optoelectrical probes according to the invention making it possible to automatically test the operation thereof once the patient has the system according to the invention. DETAILED DESCRIPTION OF THE INVENTION Referring to FIGS. 7A and 7B, a DBS probe 16, for example as described in connection with FIGS. 2 to 4, comprises a body 18 and a hemispherical cap 30 made of a material transparent to a radiation of interest, that is to say allowing at least 95% of the radiation, for example transparent to a red wavelength or near infrared. For example, the body 18 is made of polyurethane, silicone, or epoxy which has a high optical transmission ratio of red and near infrared while having a refractive index (of 1.43 for example silicone) ) close to that of the cerebrospinal fluid (equal to 1.38). The probe 16 is also associated with an optical fiber 50 inserted in and up to the end of the central channel 28 of the probe, the end of the optical fiber 50, advantageously previously cleaved, thus being in contact with the tip. central channel. The fiber 50 can therefore emit the electromagnetic radiation at the portion of the probe 16 intended for electrical stimulation of the brain, and in particular at least through the plug 30.
    [0012] Especially in the treatment of Parkinson's disease, and as illustrated in FIG. 7B, the central channel 28 extends beyond the last electrical stimulation electrode 20d a distance sufficient to cause the distal end of the channel, and thus the plug 30 through which the illumination is performed, is positioned in the SNc 30 of the patient while the electrode 20d is positioned in the STN of the patient. In particular the distance d is included for this purpose between 15mm and 20mm. Advantageously, the length e of the light-emitting plug 30 is between 2 and 5 mm in order to locally illuminate the SNc portion of the substancia nigra.
    [0013] A length of a few millimeters of light scattering makes it possible to improve the uniformity of illumination of a large area.
    [0014] The optical fiber 50 is, for example, a multimode HCS ("hard-clad silica") fiber having a core 56 with a diameter of less than 500 microns, for example between 125 and 300 microns, coated with a sheath 58, for example an optical fiber of reference K200 / 230 Polymer Cladded Fiber of the company LEONI MER OPTICS. Such fibers have the advantage of being biocompatible and also allow high quality optical guidance, even when curved. Advantageously, the optical fiber may undergo mechanical treatment, for example the sheath 58 may be treated by sanding, on a distal portion or localized along the fiber, so as to form holes exposing its core 56, which makes it possible to increase the emission area of the fiber, or to decouple part of the light locally and in particular to allow a determined percentage of the light flux to be emitted between the inter-electrode spaces of the probe 16. other solutions such as laser marking of p. Structures within the fiber provide the same effect of locally extracting a percentage of the light power. For the electrical connection of the contacts 22a, 22b, 22c, 22d, an electrical box 60, as shown in FIG. 8, is provided. The housing 60 comprises an electrically insulating body 62 made of a biocompatible material traversed by a cylindrical channel 64 of diameter slightly smaller than the diameter of the proximal portion of the probe 16. The channel 64 comprises cylindrical electrical contacts 66a, 66b, 66c, 66d defining for example an internal channel surface 64, and whose dimensions and spacing correspond to the dimensions and spacing of the contacts 22a, 22b, 22c, 22d. Thus, when the proximal portion of the probe 16 is introduced into the channel 64, the contacts of the probe and of the channel respectively come into contact, the probe being then locked in position by a locking piece 68 of the housing 60. The elements to be described correspond, for example, to the extension model 37083 manufactured by Medtronics.
    [0015] Advantageously, lead wires 70a, 70b, 70c, 70d are respectively connected to contacts 66a, 66b, 66c, 66d and housed in the thickness of body 62. This allows for an extension cord 72, which is attached to housing 60 while not obstructing the opening 74 of the channel 64, opposite the opening 76 through which is inserted the DBS probe. The housing 60 and the extension 72 thus form an electrical extension for connecting the DBS probe to a stimulator, which allows insertion of the optical fiber into the central channel of the DBS probe and its connection to an optical connector.
    [0016] Referring to Fig. 9, the connection of the DBS probe and the optical fiber inserted therein comprises: for deep electrical stimulation, the electrical extension 60, 72 connected to an electrical stimulator 40; 5 - for the deep optical stimulation, an optical waveguide extension 80 axially retaining the optical fiber 50 in the channel of the electrical connection box 60, a transmitter box 82 to which the extension cord 80 is connected and comprising a source of emission 84 capable of injecting into the extension 80 the radiation 86 at the wavelength of interest, in particular at 670 nanometers. For example, the emission source 84 comprises a laser diode (for example a reference laser diode HL6756MG from Thorlabs Inc.), LED ("Light-Etnitting Diode", for example a reference LED SMT670 of the Epitex), OLED ("Organic Light-Etnitting Diode") or VCEL ("vertical-cavity surface-emitting laser"). An extension cord 88 attached to the transmitter housing 80 is also provided for connection of the emission source 84 with an optical stimulator 90 which controls the operation of the latter. The extension cord 80 and the optical fiber 50 comprise, for example at their respective connection end, connectors for fiber optic recovery, as is known in the art. For example, a proximal portion of the fiber 50 is glued into a concentric channel machined in a ceramic ferrule or steel calibrated in diameter (eg standard diameters between 1.25 and 2.5mm) to ensure good positioning repeatability when the connection in a coupling optical crossing (receptacle) on a laser source.
    [0017] Advantageously, the optical stimulator 90 is a conventional neurostimulator, e.g., a stimulator of identical structure to the stimulator 40 used for electrical stimulation. Indeed, as is known per se, this type of stimulator delivers programmable control signals and electrical supply voltages / currents to terminals to which is connected the extension cord 72. A stimulator can thus be programmed in to send signals to the electrodes alternately or at the same time as the control of the light source 84. Alternatively, a single stimulator is provided to control the electrical and optical stimulation, this stimulator being equipped with a connector for the extension cord 72 and a connection for the optical extension 80.
    [0018] The optical stimulator 90 controls in particular the optical power of the source, so as to obtain on the distal portion of the DBS probe, the desired optical power. More particularly, for a wavelength of 670 nm, the power is selected less than 10mW, which limits the heating of the brain area, as described in the document "High Resolution MR-Thermometry is The following elements have been described as being made of biocompatible materials: Reinhart, F., et al, Society for Neuroscience Annual Meeting, November 2014. For example, the electrically insulating materials are made of silicone, polyurethane, Kapton®, etc., and the electrically conductive materials are nickel-cobaltchromium-molybdenum alloy, in particular an alloy sold under the reference "MP35N®" by the company Carpenter Technology Corp., Pennsylvania, USA.
    [0019] Advantageously, the optical stimulator 90 comprises a static electrical discharge protection circuit, or "ESD" circuit ("Electrostatic Discharge"), in particular when the emission source 84 is a laser diode, a VCSEL, or a microLED that are sensitive to electric shocks.
    [0020] Referring to FIGS. 10A and 10B, according to a first variant (FIG. 10A), the extension 80 optically connecting the emitter box 82 to the optical fiber 50 is immovably fixed to the housing 82. According to a second variant (FIG. 10B) , the extension is removably attached to the housing 82, and comprises, for example, a nozzle 92 which is hermetically sealed to the fluids in a complementary base 94 25 of the housing 80, which makes it possible to facilitate an assembly procedure during surgery, and perform a test of the proper functioning / positioning of the optical fiber when it is inserted into the DBS probe, as will be described hereinafter. A method of updating a pair of DBS probes already implanted in a brain, for example of a human patient, to impart the illumination function to them is now described in connection with FIGS. 11 to 15. . In Fig. 11, a DBS probe 16 is illustrated as implanted in the patient, and thus connected to the electrical extension 32, 34, and the stimulator 40. The method therefore consists, in a first step, in operating the patient in order to be able to remove the electrical extension 32, 34 and the stimulator 40 if the latter is not compatible with the optical update (FIG. 12), while leaving in place the DBS 16 probe.
    [0021] In a next step (FIG. 13), the distal portion of the DBS probe is introduced into the central channel of an electrical box 60 according to the invention and locked in position. An optical fiber 50 is then inserted into the central channel of the DBS probe 16 through the channel of the housing 60, until the fiber reaches the distal end of the probe. An optical extension 60, advantageously the removable variant described in connection with FIG. 10B, is then connected to the optical fiber 50 or is already assembled with the optical fiber 50 when it is inserted into the central channel of the DBS probe. Once this operation is performed for the two implanted DBS probes, a test method 10 of their good optical operation is then implemented. More particularly (FIG. 14), the optical extensions 80 of the two DBS probes 16 are connected to a first and a second terminal 102, 104 of a test device 100. The latter comprises a source of emission 106 making it possible to inject the radiation at the wavelength of the treatment in the optical extension connected to the first input 102, and an optical detection circuit 108, for example based on the photodiode, which measures the amount of radiation received by the extender 80 connected to the second input 104. The radiation emitted by the DBS probe connected to the first input 102 thus diffuses through the area of the treated brain 110, and a part of the scattered radiation is collected by the optical fiber inserted in the other DBS probe . The radiation thus collected is transported to the detection circuit of the test device 100, where it is measured. Once this measurement is made, the connection of the extensions 80 to the test device 100 is reversed to make a second measurement, and the two measurements obtained are analyzed to determine the proper optical operation of the DBS probes. For example, it is judged that this operation is satisfactory when each of the measurements is greater than a predetermined threshold. Advantageously, this analysis is performed automatically by the optical detection circuit 108 which comprises for this purpose a microprocessor-based processing unit.
    [0022] If the optical functioning of the DBS probes is established, the process of updating them continues (FIG. 15) by the replacement of the electrical stimulator 40 with a stimulator 112 configured for both optical stimulation and electrical stimulation. the electrical and optical extensions 72, 80 are connected to the stimulator 112, and the stimulator 112 is turned on.
    [0023] Referring to FIG. 16, which schematically illustrates a pair of optoelectric stimulation probes according to the invention and their respective emitter box 82, the emitter box 82 of each of the probes also implements a function of 3036623 13 detection of electromagnetic radiation. In particular, the housing 82 comprises an emitter source 84, an optic 114 focusing the radiation of the source 84 on the optical extender 80 to inject the radiation therein, a photodetector 116 and a semi-transparent mirror. The mirror passes radiation emitted from the source 84, as illustrated in the upper part of FIG. 16, and deflects a portion of the radiation coming from the extension cord 80 towards the photo-detector 116, as illustrated in the lower part of FIG. As a variant, the optical fiber has a numerical aperture (eg equal to 0.37) greater than the injection angle in the extension (eg equal to 0.2). The beam emitted by the extension cord 80 is thus wider than the beam focused on the extension cord 80. The casing 82 then comprises a mirror 118, for example an annular mirror, which does not interfere with the focused light beam on the optical extender 80 while being located in the beam emitted by the extension 80. The portion of the emitted beam incident on the mirror 118 is then redirected to the photodetector 116.
    [0024] The photodetector 116 is also connected to the stimulator 112 through the extension 88 connecting the housing 82 to the stimulator 112. The latter is then configured to process the measurement delivered by the photodetector 116 to determine if the detected radiation conforms to a good one. operation.
    [0025] Thus, by deactivating the illumination of a probe, it is possible to test the good functioning of the other probe, in a manner similar to that described with reference to FIG. 14, and to do the same for the another probe, as shown in Figures 18A and 18B. The optical correct operation of the probes can thus be tested at any time in the patient, automatically, and without resorting to any surgical operation. Specific embodiments of the invention have been described. Of course, many variants are possible, in particular concerning connections, extensions, etc.
    [0026] In particular, the following characteristics can be introduced, alone or in combination: to limit the light losses and the risk of breakage of the waveguide (eg optical fiber), a "probe stop" imposing a minimum radius of curvature to the probe in its proximal portion placed at the level of the trepanation; - Protective tooling of the waveguide output of the optical-electrical base, and for centering between the fiber and the central channel of the DBS probe during the introduction of the device is used; In order to facilitate the insertion of the optical fiber, and particularly the passage of a bend, a hemispherical tip, for example a ball, is produced at the distal end of the fiber by the deposition of a crosslinkable adhesive. by UV irradiation followed by UV crosslinking. This operation is feasible using a tool compatible with a surgical block intervention in the case where it is necessary to precisely adjust the length of the probe by cleaving the fiber which leaves a straight end and therefore does not facilitate not insertion into a channel. The tooling allows an automatic deposit of the glue and a "secure" crosslinking; by electric arc (fiber welder 10 prior to insertion of the optical fiber into the DBS probe, the injection into the central channel of the probe of a liquid silicone, implantable over the long term, of high index refraction, which reduces reflection losses at the end of the probe and limit the risk of infiltration of physiological fluids.
    权利要求:
    Claims (6)
    [0001]
    REVENDICATIONS1. Device for the deep stimulation of a brain, comprising: - a stimulation probe (16) comprising: o an elongate body (18) traversed by an empty central channel of material (28) extending between a distal portion and an end proximal to the probe (16), the central channel (28) being open at said proximal end and the distal portion of the body (18) being adapted to transmit a predetermined wavelength; o electrodes (20a, 20b, 20c, 20d) attached to an outer surface of the body (18) in the distal portion of the probe for electrical stimulation of the brain; and o electrical terminals (22a, 22b, 22c, 22d) attached to an outer surface of the body (18) in the proximal portion of the probe and connected to the electrodes (20a, 20b, 20c, 20d) for their power supply; - an electrical box (60) comprising a channel (74) in which electrical terminals (66a, 66b, 66c, 66d) are housed, said channel (74) being open at one end to receive the proximal portion of the probe so as to bring into contact the electrical terminals (22a, 22b, 22c, 22d) of the probe and the electrical terminals (22a, 22b, 22c, 22d) of the electrical box (60); and - an extension cord (72) fixed to the electrical box (60) and connected to the electrical terminals (66a, 66b, 66c, 66d) of the box (60), characterized in that: - the channel (74) of the electrical box ( 60) is open at the other end; - And in that the device further comprises: o a waveguide (50) adapted to guide the predetermined wavelength, housed at least partly in the central channel (28) of the body (18) of the probe extending to the distal portion of the probe for illumination of the brain therethrough; and o a transmitter box (82) adapted to be connected to the proximal end of the waveguide (50) for injection therein of the predetermined wavelength.
    [0002]
    2. Device for the deep stimulation of a brain according to claim 1, characterized in that the distal portion of the waveguide and the distal portion of the probe have a length of between 2 millimeters and 5 millimeters. 3036623 16
    [0003]
    Device for the deep stimulation of a brain according to claim 1 or 2, characterized in that the wavelength is between 670 nanometers and 1070 nanometers, and preferably between 670 nanometers and 810 nanometers, and in that the power The optical radiation emitted by the distal portion of the waveguide is less than or equal to 10 milliwatts.
    [0004]
    4. Device for the deep stimulation of a brain according to claim 1, 2 or 3, characterized in that the waveguide is an optical fiber of the HCS type having a silica core of diameter between 125 micrometers and 300 micrometers . 10
    [0005]
    5. An electrical extension (60, 72) for connection to a deep brain stimulation probe (16), said probe comprising an elongate body (18) and electrical terminals (22a, 22b, 22c, 22d) attached to an outer surface of a proximal portion of the body of the probe, said electrical extension comprising: - an electrical box (60) comprising: an open channel (74) at a first and a second end, the channel (74) being adapted to receive the proximal portion of the body of the probe when it is introduced through the first end of the channel; electrical terminals (66a, 66b, 66c, 66d) housed in the channel (74) of the electrical box (60) and able to come into contact with the terminals (22a, 22b, 22c, 22d) of the probe when the portion proximal thereof is introduced into the channel (74) of the housing (60) by the first end of the channel; - and an extension cord (72) comprising electrical conductors (70a, 70b, 70c, 70d) connected to the electrical terminals (66a, 66b, 66c, 66d) of the housing (60), said extension cord being fixed to the housing without obstructing the second end of the box channel.
    [0006]
    6. A method of testing the optical operation of a first and a second stimulation device according to any one of claims 1 to 4, the probes of the two devices being pre-implanted in the brain with their distal portion housed in an area of the brain to be treated, the method comprising: - injecting radiation of a predetermined wavelength into the waveguide of the first device by the proximal end of the waveguide and measuring said radiation at the proximal end of the waveguide of the second device; Injecting radiation of the same wavelength into the waveguide of the second device through the proximal end of the waveguide and measuring said radiation at the proximal end of the waveguide of the first device; ; and - to diagnose the optical operation of the set of probes and waveguides housed therein as a function of the measurements.
    类似技术:
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    同族专利:
    公开号 | 公开日
    CA2987063A1|2016-12-01|
    FR3036623B1|2017-05-19|
    EP3302687A1|2018-04-11|
    CN107847738B|2020-11-24|
    CN107847738A|2018-03-27|
    EP3302687B1|2021-04-28|
    AU2016266881B2|2020-03-26|
    JP6749345B2|2020-09-02|
    US20180154152A1|2018-06-07|
    WO2016189216A1|2016-12-01|
    JP2018516116A|2018-06-21|
    US10702697B2|2020-07-07|
    AU2016266881A1|2017-12-14|
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    法律状态:
    2016-05-27| PLFP| Fee payment|Year of fee payment: 2 |
    2016-12-02| PLSC| Search report ready|Effective date: 20161202 |
    2017-05-30| PLFP| Fee payment|Year of fee payment: 3 |
    2018-05-28| PLFP| Fee payment|Year of fee payment: 4 |
    2019-05-31| PLFP| Fee payment|Year of fee payment: 5 |
    2020-05-30| PLFP| Fee payment|Year of fee payment: 6 |
    2021-05-31| PLFP| Fee payment|Year of fee payment: 7 |
    优先权:
    申请号 | 申请日 | 专利标题
    FR1554789A|FR3036623B1|2015-05-28|2015-05-28|DEVICE FOR DEEP ELECTRICAL AND OPTICAL STIMULATION OF THE BRAIN|FR1554789A| FR3036623B1|2015-05-28|2015-05-28|DEVICE FOR DEEP ELECTRICAL AND OPTICAL STIMULATION OF THE BRAIN|
    EP16729020.4A| EP3302687B1|2015-05-28|2016-05-12|Device for deep electrical and optical brain stimulation|
    JP2017561331A| JP6749345B2|2015-05-28|2016-05-12|Devices for electrical and optical deep brain stimulation|
    PCT/FR2016/051124| WO2016189216A1|2015-05-28|2016-05-12|Device for deep electrical and optical brain stimulation|
    AU2016266881A| AU2016266881B2|2015-05-28|2016-05-12|Device for deep electrical and optical brain stimulation|
    CN201680043782.4A| CN107847738B|2015-05-28|2016-05-12|Device for deep brain electrical and optical stimulation|
    CA2987063A| CA2987063A1|2015-05-28|2016-05-12|Device for deep electrical and optical brain stimulation|
    US15/575,191| US10702697B2|2015-05-28|2016-05-12|Device for deep electrical and optical brain stimulation|
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