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    Pat 6111911

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    Pat 6111911

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    3 views19 pages

    US2012078325A1

    Uploaded by

    nthung115
    Pat 6111911

    Copyright:

    © All Rights Reserved
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    co») United States c2) Patent Application Publication —(o) Pub. No.: US 2012/0078325 Al Lee et al. US 2012007832541 201 (43) Pub, Date: Mar. 29, 2012 os) 03) (6) IDENTIFYING COMBINATIONS OF ELECTRODES FOR NEUROSTIMULATION THERAPY laventors: Michael "T. Lee, Minnetonka, MN (US); Steven M. Goetz, Noch (Oaks, MN (US): Nathan A. Torgerson, Andover, MN (US) Assignee: Medtronic, Ine. Minneapolis, MN (ws) Appl.No: 13/810,136 Filed Dec. 2, 2011 Related US. Application Data Continuation of application No. 11/404,069, fled on Apr. 13, 2006, which i a division of application No. 4,194, filed on Apr. 25,2003, now Pt, No, 7.463, ~~ Publication Classification (2006.01) 607/89; 07/2 ABSTRACT A programmer allows a clinician to identify combinations of clectrodes from within an cleetrode set implanted in a patient that enable delivery of desirable neurostimlaton therapy by ‘an implantable medical device. The programmer executes at eleeimde combination search algorithm to seleet eombina tions of electrodes ta testin a non-random order. Acooding to algorithms consistent with the invention, the programmer ‘ay frst identify a positon of fist cathode for subsequent combinations, and then select electrodes from the set 0 test with the first cathode as anodes or addtional eathodes based fom the proximity of the electrodes tothe first eathode, The programmer may store information for each combination tested, and the information may facilitate the identification of desirable electeode combinations by the elinician. The clin cian may create neurostimolation therapy programs that include identified desirable program combinations. cm Nw sea N08 a Patent Application Publication Mar. 29, 2012 Sheet 1 of 10 US 2012/0078325 Al ~\ hy Nie 1607 | 168 FIG. 1 Patent Application Publication © Mar. 29, 2012 Sheet 2 of 10 US 2012/0078325 Al 40H E+ gop 406 ae) 40F 40N 40E 40M 400 a 4c —— ER sox 40B (40g 40a 401 16a~ [168 FIG. 2 Patent Application Publication — Mar. 29, 2012 Sheet 3 of 10 US 2012/0078325 Al *) USER INTERFACE 52 TELEMETRY PROCESSOR INPUT/OUTPUT 62 50 84 MEMORY 54 TESTED COMBINATION PROGRAMS INFORMATION 60 58 SEARCH ALGORITHMS 56 FIG. 3 Patent Application Publication Mar. 29, 2012 Sheet 4 of 10 US 2012/0078325 Al 70 IDENTIFY ELECTRODE SET CONFIGURATION | 72 SELECT SEARCH ALGORITHM BASED ON CONFIGURATION x 74 EXECUTE SEARCH ALGORITHM TO SELECT ELECTRODES AND COMBINATIONS TO TEST y 7 STORE INFORMATION RELATING TO EACH uy COMBINATION TESTED y 78 PRESENT LIST OF TESTED COMBINATIONS | 80 CREATE PROGRAMS INCLUDING IDENTIFIED COMBINATIONS FIG. 4 Patent Application Publication Mar. 29, 2012 Sheet 5 of 10 US 2012/0078325 Al START ¥ 90 IDENTIFY INITIAL POSITION WITHIN: ELECTRODE SET = 92 TEST ELECTRODE AT INITIAL POSITION AS. FIRST CATHODE 94 EST ADDITIONAL ELECTRODES AS FIRST CATHODE? Yes} 96 ~\ TEST NEXT ELECTRODE BASED ON PROXIMITY AS FIRST CATHODE 98 L__»| IDENTIFY FIRST CATHODE TEST ADDITIONAL ELECTRODES AS FIRST ANODE? 102 TEST NEXT ELECTRODE BASED ON PROXIMITY AS FIRST ANODE 104 L_+| IDENTIFY FIRST ANODE FIG. 5A Patent Application Publication Mar. 29, 108- YES Y TRY ADDITIONAL ANODE? 2012 Sheet 6 of 10 US 2012/0078325 Al 106 TEST AN UNDESIGNA} ADDITIONAL ANODE B. TED ELECTRODE AS JASED ON PROXIMITY 14 TEST ADDITIONAL ADDITIONAI NO. TRY ADDITION: YES Y ELECTRODES AS L ANODE? IAL CATHODE? 112 No. TEST AN UNDESIGNA\ ADDITIONAL CATHODE TED ELECTRODE AS BASED ON PROXIMITY No TEST ADDITIONAL ADDITIONAL NO. ELECTRODES AS CATHODE? DONE? YES 116 118 FIG. 5B Patent Application Publication ON Mar. 29, 2012 Sheet 7 of 10 US 2012/0078325 Al 12 10 14 FIG. 6B 1: cpaierk! \ 13, 8 | 9 9 4) 5 5 - | 1 1 2 | 3 3 6 | 7 7 10 | 11 "1 14 | 15 15 FIG.6A [6 | 13 [4 | 9 | 2 | 5 + | 3 | 1 ls | 7 | 7 | "1 FIG. 6C FIG. 6D Patent Application Publication OY 11 FIG. 6G Mar. 29, 2012 Sheet 8 of 10 Us 2012/0078325 AI mn fF 3 1 + 2 4 6 TN FIG. 6F 11 10 7 + 4 - | 3 1 2 5 6 8 9 FIG. 6H Patent Application Publication © Mar. 29, 2012 Sheet 9 of 10 US 2012/0078325 Al ma 221 ON 11 10 11 7 6 8 4 2 + | 5 - + 4 3 1 Es 3 8 5 1 2 12 9 6 7 14 13 9 10 FIG. 61 FIG. 6J FIG. 6K Patent Application Publication Mar. 29, 2012 Sheet 10 of 10 US 2012/0078325 Al 230 IDENTIFY NEW COMBINATION TO TEST | 232 RAMP AMPLITUDE AT FIRST RATE OF AMPLITUDE INCREASE pl, RECEIVE FIRST INDICATION FROM USER y DECREASE AMPLITUDE BY PERCENTAGE AND RAMP AT SECOND RATE OF AMPLITUDE INCREASE 236 ¥ RECEIVE SECOND INDICATION FROM USER 238 ¥ 240 STORE AMPLITUDE AT TIME OF SECOND INDICATION 1 242 RECEIVE AND STORE RATING INFORMATION FOR TESTED COMBINATION FIG.7 US 2012/0078325 Al IDENTIFYING COMBINATIONS OF ELECTRODES FOR NEUROSTIMULATION ‘THERAPY [0001] This application i a continuation of US. applica- tion Ser. No. 11/404,069, filed Apr. 13, 2006, which is a divisional of US. application Set No. 10/424,194, fled Ape 25,2008, the entire contents of bathof which ar incorporated herein by eferene, ‘TECHNICAL FIELD 10002] The invention relates to neurostimulation therapy ‘and, more particularly, to selection andl configuration of elec- trodes used o deliver neurstimulation therapy to a patient BACKGROUND 0003] implantable mdical devices maybe usedodlver hearossiatoa therapy to ptents to eat a vanty of Symptons or condtns such chron pi, em, Paki tons den, cpl teomtinecs, or astoparesi An implanable metic deve may deliver neuostinlaon therapy vias that inclneelectode cated potato thesia eon, pve nen storie, ovithn cheba ofan. Ingenen,theimplantble mee device v= es neuostinlation thmpy inthe for of lea puss 000s] clinician may select values ora number of pro- tgamnable parameter in oreo defie the neti ton therapy toe delivered to apt. For example, the clinician may sleet an ampli, which my be cures or toliageamplide and pulse width for a stimulation wave form to be delivered tthe patente well as area which the pales arto he delivered tthe pata. The clini my slkosele a parameter priclar elses within an les treet to bus to delve th pulses andthe poles of ihe selected locos. group of preter values maybe referred to as a program in the sense that they drive the: nerostimulationtherpy to be delivered othe palin [0005] |The process of selecting values for the parameters that provide adequsteresuliscanbe time consuming and zy rea get dal of wal and eror before a bet progran is diseovered, The best” program may be a progam lai berries of linia eficacy vers side ells experi enced andpover consumption tan ther programs est. As ® orion he over prt selsn proces he ‘ssof electing lcroes an the olresoftlecodes an be patclrytime-consming ad tedioos. Te lini ‘Sta may need tall posible conbintons of ected ‘within thst implanted ne patent ora sigicant prion thereof, inorder 0 enti “best ombraton of eee tod nd thie polres, n somes, th eli may test combinations by manually specifying each combination tolet asl on inton or sme syntatie metiodology. and recording notes on the eleacy at side ells of each Combination fer dry of mln i tht ombins ton Inks mane, he niin able llr compare and felt fom he tested combinations, Asan example a ingthemogntaleofsoch a, plane metal devices ‘commonly delve spinal cord simulation thespy (SCS) 0 Mar. 29, 2012 patient via two leads that include eight electrodes per lead and provide well over one million potential electrode combina tions SUMMARY [0006] In general, the invention is directed 1 techniques, that may be employed by a programming device to allow a clinician or patient to identify combinations of electrodes from withinan electrode set implanted in a patient that enable delivery of desirable neurostimlation therapy by an implant- tile medical deviee. The programmer may’ execute an elee- twode combination search algorithm to select combinations of electrodes to test in a non-random order. By selecting com- binations in @ non-random order, the programmer may allow the clinician or patient to more quickly identity desirable electrode combinations {0007} "According to algorithms consistent with the inven ‘ion the programmer may identify a position ofa first cathode clectrode fr subsequent combinations, and thea select elec- trodes from the electmode sett test with the first cathode as ‘anodes or additional cathodes based on the proximity of the ‘electrodes tothe first cathode. The programmer may identify first position within he eloctadeset, which may bea central positon within the elects sot, and control the implantable ‘medial device to test the electeode located at that position as the first cathode, The programmer may then test sxtional electrodes from within the set a the first cathode in an order based on proximity to the fist cathode [008] The prograsmer may receive input trom the elini- cian o patient indicating which tested eletrode is the fist cathode, and then contro the implantable medical device to test other electrodes of the set in combination with the fist cathode. Undesignated electrodes may be tested as anodes ‘and additonal cathodes in an order based on proximity tothe first cathode. In some cases, only asubset ofthe undesignated electrodes may be tested to avoid testing redundant electrode combinations, ie, electrode combinations that would pro- «duce substantially the same current low as an electrode com- bination already teste. {0009} The programmer may store information for each combination tested, and the information may fecilitate the identification of desirable electrode combinations by the cli- nici. For example, the programmer may presenta list of tested combinations an theirassociated information, andthe list may be ordered according tothe information. The elini- cian may create neurostimlation therapy programs that include identified desirable program combinations. [0010] In one emboxtiment, the invention is directed 10 a method in which a first electde of a sot of electrodes implanted ina patents selected to be inched in a combi- nation of elecdes for use in delivery of weurostimulation to the patient. The first electrode may be a eathode for the combination. A sequence of additional electrodes ofthe sett test forinclusion in the combination i automatically selected ceording to locations ofthe additional electrodes relative to the frst electrode, The additional electrodes may be teste for inclusion of one of the addtional electrodes as an anode for the combination [0011] Inanother embodiment, the invention is directed to a computer-readable medium containing instructions. The insiructions cause a programmable processor to select fist clectzde of set of electrodes implanted ia a patent to include in a combination of electrodes for use in delivery of neurostiaulation tothe patient, The instructions also cause a US 2012/0078325 Al processor to automatically select a sequence of additional ‘electrodes within these o test for inclusion inthe eombina- tion according to locations of the additional electrodes rela- tive to the fist electrode. [0012] In another embodiment, the invention is directed to adevice that includes a processor. The processor selects ist ‘electrode of a set of electrodes implanted in a patient to include in a combination of electrodes for delivery of neuro- stimulation therapy to the patiet, The processor also auto- matically selects a sequence of addtional electrodes to test for inclusion i the combination aovording to locations ofthe ditional electrodes relative tothe frst electrode. The device may be a peogramming device associated with one of acini- in an the patient [0013] In anotherembodiment, the invention is directed to ‘a method comprising executing # search algorithm to contol an implantable medical devee to test combinations of elee- trodes in. an onder that i based on the proximity othe elee- trodes ofthe combinations toa central position within the set, and storing information identifying atleast one ofthe tested ‘combinations as part of a neuostimulation therapy program, that defines neurostimulation therapy to be delivered to the patient by the implantable medical device. [0014] In another embodiment, the invention is directed to 4 computer-readable medium containing instructions. The instructions cause a programmable proeessor to execute & search algorithm to contol an implantable medical devie to test combinations of electrodes i an order that is based on the proximity of the electrodes of the combinations to a central positon Within the st, and store information identifying at least one ofthe tested combinations as part ofa neurostim- lation therapy program that defines neurostimulation therapy to be delivered to the patient by the implantable medical device, [0015] In anotherembodiment, the inventions directed to ‘8 device comprising a processor. The processor executes a Sear algorithm 10 contol an implantable medical device 10 ‘est combinations of electexes in an order that is based on the proximity of the electrodes of the combinations to a central positon within th set, aad stores information identifying at least one ofthe tested combinations as part of neurostim- lation therapy’ program that defines neuostimlation therapy to be delivered to the patient by the implantable medical device, [0016] The invention may provdea number of advantages. For example, the invention may allow a clinician to more ‘Quickly identily desirable electrode combinations, reducing the overall amount of time the clinician spends programming nneurostimulation therapy fora patient. In contrast to existing neurostimulation programming systems that present clec- trode combinations in a random order and idiosyneratic search methodologies employed by clinicians, programmer secording tothe invention may selec electrode combinations inasystematic manner es in an order such that electrode ‘combinations that are more likely to enable desirable therapy are selected earlier in the search. Consequently, the clinician may be able to end the search before all poteatial electrode ‘combinations have been tested if one or more desirable com- binations have already been identifies. [0017] Even ifa clinician elects to tet all potential elec- trode combinations, e, if'the electrode st is small enough to make testing all electrode combinations practical, the invention may reduce the time required to identify desirable ‘lecirade combinations by automating seletion of each new Mar. 29, 2012 combination 0 test. The iavention may also avoid testing ‘eclundant combinations, i, combinations that are substan- tially equivalent to combinations already tested, Avoiding redundant combinations may further reduce the amount of time required for the search, {0018} Adaitionally the invention may improve the search processby collectingamplitud information, and rating infor- ‘mation that is entered by the clinician or patient, for each combination tested, A programmer according othe invention ‘may preseat a list of tested electrode combinations to the clinician, ordered according to one or bath of the amplitude ‘and rating information, allowing the clinician to more easily identify ang select desirable combinations. A. bracket of untested electrode combinations that are similar to identified clectrde combinations may be used to eeate programs that ‘re provided tothe patent Providing bracket programs tothe patient allows the patient to experiment with the programs to “finely tune” the neurostimulation therapy provided by the implantable medical device without quiring the clinician to be involved {0019} The details of one of more embodiments of the invention ae set forth inthe accompanying drawings and the description below. Othe Features, objec, and advantages of the invention will be appareat fom the description and draw- ngs, aod from the esis. BRIEF DESCRIPTION OF DRAWINGS [0020] FIG. 1 isa diagram illustrating an example system, or programming and delivering neurostimulation therapy. [0021] "FIG. 2isadiagramistratingan example electrode st that may be implanted within the patient [0022] FIG. 3 isa block diagram illustrating an example progrimming device that allows a user to identify desirable electrade combinations for neurostimulation therapy po- rams. [0023] FIG. 4 is « ow diggram illustrating an example ‘method that may be employed by a programming device to select and execute an eleetrxle combination search algorithm according to te invention. [024] FIGS. §4 and SB are flow diagrams illustrating an ‘example electrode combination search algorithm that may be executed by a programming device [0025] FIGS. 64-6K are diagrams illustrating example ‘matrices tha illustrate positions within exemplary electrode set configurations and orders in which electrodes within such clectrode sets may he tested according to electrode combina tion search algorithms consistent with the invention [0026] FIG. 7 is « flow diogram illustrating an example method that may be employed by a programming device to ‘estan electrode combination according to the invention. DETAILED DESCRIPTION [0027] FG. 1 isa diagram illustrating an example system 10 for programming neurostinmlation therapy for and deliv- ering neurostimulation therapy 10 a patient 12. System 10 ‘includes an implantable medical device (IMD) 14 that dliv- es neurostmilaton therapy o patient 12 IMD 14 may bean ‘implantable pulse generator, and may deliver neurostiaula- ‘ion therapy to patient 12 in the form of electrical pulses. [0028] IMD 14 delivers neurostimulation therapy o patient, 12 via leads 16A and 168 (collectively “leads 16") Leads 16 ‘may, as shown in FIG. 1, beimplantedproximsteto the spinal cord 18 of patent 12, and IMD 14 may deliver spial cord US 2012/0078325 Al stimulation (SCS) therapy to patient 12 in order to, for ‘example, reduce pain experienced by patent 12. However, the invention isnot ited to the configuration of leads 16 shown in FIG. Lor the delivery of SCS therapy. For example, ‘one or more leads 16 may extend frm IMD 14 t the bra (oot shown) of patient 12, and IMD 14 may deliver deep brain stimlation (DBS) therapy w patient 12 o, for example, teat teemor or epilepsy. As frther examples, one or moee leads 16 may’be implanted proximate tothe pelvie nerves (nt shown) ‘orstomach (notshown),and IMD 14 may deliverneurostimu- lation therapy to treat incontinence or gastroparess. [0029] IMD 14 deliversnevrostimulation therapy t patient 12 according to one or more neuostimulation therapy pro- grams. neurostimulation therapy program may include val- ucs for @ number of parameters, and the parameter values fine the neurostimulation therapy dolivered according to that program. In embodiments where IMD 14 delivers en- rostimulation therapy in the form of eleteical pulses, the parameters may include pulse voltage or current amplitudes, pulse width, pulse rats, and the like. Further, each of leads 16 includes electrodes (oot shown in FIG. 1), and te param- ‘ters for a program may include information identifying Which electrndes have heen selected for delivery of pulses ‘seconing o the program, and the polarities ofthe selected ‘electrodes. 10030] _ selected subst of the electrodes located on Teads 16 and the polarities of the electrodes of the subset collee- tively define an “electrode combination.” Electrode comt nations refer to combinations of singe or multiple eathode ‘electrodes and single or multiple anode electrodes. Stim tion current flows between the cathodes and anodes fo dliv- ‘ery of neuostimulation therapy. [0031] System 10 also includes a programmer 20, Pro- rammer 20 may, as shown in FIG. 1, bea handel comput- ing device. Programmer 20 includes a display 22, such as LCD of LED display, to display information to @ user Pro- ‘grammer 20 may also include a Keypad 24, which may be tsed by a user {0 interact with programmer 20. In some ‘embodiments, display 22 may bea touch sereen display, and user may interact with programmer 20 via display 22. A user ‘may'also interaet with programmer 20 using peripheral point- ing devices, such as a stylus o mouse. Keypad 24 may take the form of an alphanumeric keypad ora reduced set of keys ‘associated with particular funetions. 10032] clinician (aot shown) may use programmer 20.0 program neurostimulation therapy for patieat 12. In paticn- lag, the clinician may use programmer 20 to create neuro- stimulation therapy programs. s part of the program creation process, programmer 20 allows the clinician o identify elee- trade combinations that enable IMD 14 to deliver neuro- stimolation therapy that s desirable in tems of, for example, symptom relief, coverage area relative to symptom ates, and side effects, Programmer 20 may aso allow the clinician to identify electrode combinations that enable IMD 14 w deliver ‘effective neurstimulation therapy with desirable device per- formance characteristics, eg, low battery consumption. 10033] Programmer 20 controls IMD 14 to test electrode ‘combinations inorder allow aclnician to identify desirable ‘combinations in an efficent manner. As will be described in reat detail below, programmer 20 may solect electrode combinations 10 test based! on an electrode combination search algorithm. Ia particular, according to such an algo- rithm, programmer 20 may ist contol IMD 14 to test one oF more elecirodes to ideatify the electrode which wil set ws a Mar. 29, 2012 first cathode electrode and then contol IMD 14 to test com- binations that include the first cathode in anonder thats based ‘onthe proximity of other electrodes inthe combination tothe fist cathode [0034] By controling IMD 14 to test electrode combina tions in such an order, programmer 20 may'allow theclinician to more quickly identify desirable electrode combinations, reducing the overall amount of time the clinician spends programming newrostimolation therapy for patient 12. In contrast lo existing neurostimlaton programming systems that present electrode combinations in a random onder an ‘idiosynoratie search methodologies employed by clinicians, programmer 20 may select electzode combinations to tst in anorder such that electrode combinations that are moe likely tw enable desirable therapy are selected earlier ithe search, Consequently, the clinician may be able to end the search beforeal potential elecirade combinations havebeen tested ‘one or more desirable combinations have already been iden- ‘ified, saving the amount clinician and patient time required achieve an eflicacions electrode combination, [0038] Even ifthe clinician elects to tet all potential eloc- ‘rode combinations, if the electrode set is small enough to make testing all electrode combinations practical, pro- trammer 20 may reduce the time required to identify desie- able electrode combinations by automating selection ofeach new combination to test. Additionally, programmer 20 may Jmproverthe search process by collecting amplitude and ating information for each combination tested. s willbe described in greater detail below, programmer 20 may preseat alist of clectrnde combinations tothe clinician, ordered according to ‘ne orboth ofthe amplitude and rating information, allowing the clinician to more easily dently and seloct desirable com- binatons [0036] Inorder to control IMD 14 to test electrode combi- nations, programmer 20 may communicate with IMD 14 via telemetry techniquesknown inthe art For example, program- ‘mer 20 may communicate with IMD 14 via an RF telemetry head (not shown). Information identifying desirable combi- nations of electrodes identified by the clinician may be stored spar of neurostimolation therapy programs. Neurstimula- ‘ion therapy programs ereated by the clinician using program- ‘met 20 may be transmitted to IMD 14 via telemetry, andlor ‘ay'be trasmitted to another programmer (nt shown), e.g. ‘patient programmer, that s used by patient 12 contol the delivery of neuostimulation therapy by IMD 14, [0037] FIG. 2 is block diagram illustrating an example configuration of leads 16. Inthe example configuration, lead 164 includes electrodes 404-H, and lead 16B includes elec- ‘wodes 401-P. Flectrodes 404-P (collectively “electrodes 0”) ‘may be rng electrodes. [0038] Electrodes 40 collectively form an electrode set 42 Jmplanted within patieat 12. Asshown in FIG. 2,eletrode set 42 includes eight electrodes on each of the two leads 16, which, as shown in FIG. 1, are implanted suc that they are substantially parallel to each other and spinal cord 18, on substantially opposite sides of spinal cord 18, at approxi- ‘mately the same height relative to spinal cod 18, and oriented such tat the distal ends of lead 16 are higher relative to the spinal cord than the proximal ends of leads 16. Therefore, the iMlustrated configuration of electrode se 42 may be described as a two-by-cight, side-by-side, upwardly oriented configu- {0039} Such a configuration is commonly wsed to provide SSCS therapy. However programmer 20 may be used i iden- US 2012/0078325 Al lify desirable combinations of electrodes within electrode seis that are configured in any way, and used to provide any type ncurostimulation therapy. For example, a single lead inchading four or eight electrodes, two leas including four ‘electrodes per lead, in-line leads, andolfet leads allofwhich may be oriented in any manner relative to patient 12, provide ‘electrode set configurations that may be searched! By pro ‘grammer 20 [0040] IMD 14 (FIG. 1) may deliver neurostimulation via ny combination of electrodes 40. IMD 14 may indepen- dently activate each electrode 40 of et 42 to ct. a8 a cathode ‘or anode for a combination, and each combination will, include at lest oe cathode and atleast one anode, In some ‘embodiments, combination may include a single electrode 40 acting asthe eathode, with a can of IMD 14, i, the IMD. housing ating as the anode forthe combination, [0041] -Inanclectrode combination, electrons flow from the ‘one or more electdes veting as anodes forthe combination to the one or more electrodes acting as cathodes for the ‘combination. The current between anodes and cathodes may stimulate neurons between and proximate to the anodes and cathodes. Generally speaking, an electrode combination ‘enables desirable neurostimulation therapy’ when cuereat is livered in a direction and with an intensity suiient to stimulate specific neuroas ora sulficient number of specific neurons talleviatea symptom without causing unacceptable side effects, Further, an electrode combination enables desit- able neurostimulation therapy when the symptom is allovi- sted without resorting to undesirably high pulse amplitndes [0042] As mentioned above, programmer 20 selects indi- Vidual electrodes 40 or electrode combinations totesttoallow «clinician to identify desirable electrode combinations ‘acconing to an electrode search algorithm. Programmer 20, may select an appropriate search algorithm based on the ‘configuration of eloctade set 42, and may select eloctrades 440 or electrode combinations based on the selected search ‘algorithm, Programmer 20 coatrols IMD 14 to testa selected ‘electrode 40 or electrode combination by controling IMD 14 to deliver neurostinulation via the selected electrode 40.07 ‘combination. [0043] Programmer 20 may fist control IMD 14 otestone ‘or more af electrodes 40 individually to identify the indi- Vidual electrode or electrodes 40 which will act as a fist cathode, Generally, clinician implants leads 16 in location such thatthe center of electrode sot 42s proximate to an area that the clinician believes should he stimulated in onder to alleviate symptoms. Therefore, programmer20 may test elec- trodes 40 as the first cathode in an onder such that electrodes 40 located centrally within electrode set 42, eg. electrodes, 40D-E and 40L-M illustrated ia FIG. 2, are tested before peripherally located electrodes. Ifthe clinician's estimation ‘of the target region is inaccurate, programmer 20 will con- tinue to test individval electrodes 40 in such an order uatilone ‘of the electrodes 40 that enables desirable neurostimulation therapy when activated as the first cathode is identifies. ni- tially locatinga frst cathode provides “coarse” optimization ‘of electode combinations, allowing programmer 20 and the clinician to quickly identify the general area to which neuro- Stimlation therapy should be delivered. [0044] Programmer 20 may then contol IMD 14 to test ‘electrode combinations that include the fist cathode. Pro- ‘grammer 20 may control IMD 14 to ty different ones of ‘electrodes 40s the fist anode ina poir with the first cathode, snd may add additional anodes and or cathodes, Programmer Mar. 29, 2012 20: contol MD 14to test remaining electrodes 405s fist ands, nl kitional anos or ethos, ina orr tha i tased on the proximity ofthe remaining electrodes 40 tothe electrode stings the first cathode forth eles om bination, The order may be based on decreasing proximity af theremining elec 40 tothe electrode acing asthe fist cathe. eletrdes wil be ested in oder of neetsing distance from the fist extode. [0045] Generally, elected combinations that include cathodes and anodes in closer proximity may be more likely to enable desinble neurostimulation therapy. Therefore, by testing elec combinations nan oder base on sere ing proximity ofthe other electodes 40, rogranmer 20 provides a “ine” optimization of elcrode combinations, tloing te clinician to moe quickly ken eloctode com binaions that ensble more desirsble -neurosimoltion therapy than the inal combinstion inca the fist ah ode and the fist location of the fist anode. With this approach, the search for electrode combinations may proceed ita ptr or “orbit” in close proximity about an intally selected cathode or eathdes, an then extend outvard ino nore distant rbitas the search contin. [00s] FIG. 3 is «block diagram isang an example conflation of programmer 20. clinician may inert with processor $0 via auser interface 2 inorder enify clesradecombinatonsas deseo hersn. User intrfnc82 tay include play 2 and keypad 24, and may als inchde 2 tovch seen or peripheral pointing devices as decribed above Processor Sb may also provide agape serine face (GUD vi wer imerace 8210 frat interaction with a enc, Proceso 80 my ince a microprocessor, a controler a DSP-anASIC, an FGA, dserte logic othe ke [0047] Clinician programmer 20 so inclodes @ memery 54, Memory $4 may inl program nstuctons ht when execute by processor St, eae eliican programme 20%0 perform the fintons ascribed to clinician progrmmer 20 hersin,forexample,pocestormay exes sected onc oF eleciede combination seach algorithms 86 stored within memory 4 to sl nvidia elects 40 or elcid Combinations to test wo allow the eiian wo identify ds able elect combinations. [0048] _Aswillbedesried in eater dtl below poces- Sor $0 may collect information relating to tested electrode combinstons $8, and soe the infomation in memory 88 for Inter tiv and review bythe clinician to fala en fication of desinble cletode combinations, Neurosis don therapy progans 60 crested by the ciniian may be stored in memory 84 an information ientiying leo Combinctions selected bythe clniciantobe ilized foroneof programs 60 may be sions a part ofthe program within Imemory 84, Memory 54 may include any oli non-vol Gl fed, removable, magnet, otal, o electcal mesa, sochss a RAM, ROM, CD-ROM, bard ik, removable mage nticik, memory cards sticks, NVRAM, EEPROM ash momo, and the ike [0049] Processor $0 contals IMD 14 totes selected ini vial elocodes 40 or electrode combinations, y contol ling IMD 14 odtivernurostimalation heap to potent 12 via the selected individ lected 40oreletrode combi ‘tions vina elem rei 62 Processor 80 may inns programs 6 created bythe clinician to IMD 14 vi ee Sicit 62, of to another programmer used bythe patient contol delivery ofeurostimlaion thenpy via inpuvoutpt US 2012/0078325 Al circuitry 64, VO circuiny 64 may include tansocivers for Wireless communication appropriate ports for wired commu nicationor communication via removable electrical medi, or appropriate drives for communication via removable mag netic or optical media, 10050] FIG. 4 is @ fow diagram illustating an example ‘method that may be employed by programmer 20 to select ‘and exeeute an electrode combination search algoritha, sccording othe invention. Programmer 2 and more speci cally processor $0 of programmer 20, identifies a configura tion of electrode set 42 (70), and selects an electtode comt natin search algorithm $6 besed on the configuration (72) MulipleslgorthmsS6 may be available forselectioninorder to allow programmer 20 addeess differences between clec- trode configurations, eg., different numbers of leads and ‘electrodes per leads, However, each of algorithms 56 may ‘employ the common search methodology that was discussed above, andisilustated by FIGS. A and SB discussed below. 10051] Programmer 20 may identify the configuration of ‘loctzode set 42 by, for example, receiving input from the clinician via user interface $2 indicating the configuration. In ‘other embodinients, information ideaiiying the configura tion of electrode set 42 may be stored in memory 84 or a memory of IMD 14 at implant. In such embodiments, pro- grammer 20 may retrieve the information from memory 540r, from IMD 14 via telemetry circuit 62 10052] Programmer 20 then, as will be described in greater esa below, executes the selected search algorithm to select individual electrodes 40 and electrode combinations to test (74), When a combination i tested, programmer 20 may, as ‘will also be described in greater detail below, store informa- tion $8 relating to that combination in memory $4. The infor- mation may include amplitude information, andlor rating information provided by one or both of the elnician and patient 12 0053] Programmer 20 may present a list of tested cont nations to the clinician via display 22 (78). The lst may inchude the information relating to each combination, and in some embodiments, may be ordered aovording to informa- tion. The list may facilitate identification of one or more desirable electrode combinations bythe clinician, The li cian may create neurostimulation therapy programs 60 that, include identified electrode combinations (80), and program- ‘mer 20 may store information identiying the electrode com- binations selected by the clinician within programs 60 in memory 4. In some embodiments, programmer 20 may automatically let electrode combination for inclusion in programs 60 based on the information, [0054] FIGS. $A and $B are ow diagrams Mustang an ‘example electrode combination search algorithm that may be ‘executed by programmer 20.s shown in FIG.8A, program= rer 20 identifies an inital position within electode set 42 (00) snd controls IMD 14 to testanclectre 40 located atthe initial postion as the first cathode (92). As discussed above, the intial position may bea central position within electrode Sef 42, and programmer 20 may identify a central position within set 42 Based on the configuration of set 42. For ‘example, programmer 20 may initially control IMD 141 test, ‘electrode 40E (FIG, 2)s the first cathode, Alternatively, the

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