# Patent

## Title
Implantable electro-medical device programmable for improved operational life

## Abstract

A device for electrically stimulating one or more anatomical target sites in a patient and for use in the treatment of a plurality of biological conditions of the patient. The device has a pulse generator providing electrical stimulation to the anatomical target sites; a power source for powering the pulse generator; stimulator electrodes connected to the pulse generator for stimulating the anatomical target sites; one or more optional sensing electrodes for monitoring physiological parameters with reference to the anatomical target sites; and a microprocessor programmed to vary a plurality of therapy protocol parameters governing the electrical stimulation to thereby modify operational life parameters of the power source.

## Background
CROSS-REFERENCE
The present application relies on U.S. Patent Provisional No. 62/080,793, filed on Nov. 17, 2014, for priority and is hereby incorporated by reference in its entirety.


FIELD
This invention relates generally to an electro-medical device for electrical stimulation of one or more anatomical target sites to treat a plurality of biological conditions. More particularly, this invention relates to an electro-medical device that is programmable for improved operational life with reference to a plurality of desired treatment stimulations or protocols.
BACKGROUND
Electrical stimulation has been suggested for use in the treatment of biological conditions of patient's, such as, obesity and GERD. The treatment typically involves placing stimulator electrodes, of an electro-medical device, at or near an anatomical site in the patient by endoscopic, surgical or radiological procedures. The operational life of such electro-medical devices is contingent upon the service life of the battery or energy source powering the device. The service life of the energy source is in turn affected by the electrical stimulation regimen and therefore a plurality of parameters governing the regimen.
Therefore, there is a need for an electro-medical device that can be programmed for desired or improved operational life benefits in relation to the electrical stimulation or therapy regimen parameters.
SUMMARY
The following embodiments and aspects thereof are described and illustrated in conjunction with systems, tools and methods, which are meant to be exemplary and illustrative, not limiting in scope.
The present specification discloses a device for electrical stimulation of one or more anatomical target sites in a patient and for use in the treatment of a plurality of biological conditions of the patient, said device comprising: a pulse generator providing electrical stimulation to said one or more anatomical target sites, wherein said electrical stimulation comprises a stimulation current; a power source for powering said pulse generator; at least one stimulator electrode connected to said pulse generator for stimulating said one or more anatomical target sites; and, a microprocessor programmed to vary a plurality of therapy protocol parameters governing the electrical stimulation to thereby modify operational life parameters of the power source, wherein the therapy protocol parameters and the operational life of the power source are associated according to the following relations:



  
    
      
        L
        BAT
      
      =
      
        
          
            CAP
            BAT
          
          ·
          
            eff
            USE
          
        
        
          I
          BAT
        
      
    
    ,
    where
  




  
    
      I
      BAT
    
    =
    
      [
      
        
          
            
              [
              
                
                  (
                  
                    
                      eff
                      TH
                    
                    ·
                    
                      I
                      TH
                    
                    ·
                    
                      
                        
                          V
                          TH
                        
                        +
                        
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                          OH
                        
                      
                      
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                        BAT
                      
                    
                    ·
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                +
                
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              ]
            
            ·
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          ⁢
          
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              -
              
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        +
        
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      ]
    
  



wherein effTH is a function of an output stimulation circuit current divided by an input stimulation circuit current; wherein ISOH is equal to an amount of current required to run the device and not including the stimulation current; wherein LBAT is a function of power source service life; wherein CAPBAT is a function of power source capacity; wherein effUSE is a function of a usable efficiency of power source; wherein IBAT is a function of power source current; wherein ITH is a function of a level of current exiting the device from an output terminal; wherein VTH is a function of a level of voltage at an output terminal of the device; wherein VOH is a function of an overhead output voltage; wherein VBAT is a function of a power source voltage; wherein PRF is a function of a pulse repetition frequency; wherein PW is a function of a pulse width; wherein DCTH is a function of a duty cycle; wherein ISLP is a function of sleep current; and wherein ITM is a function of average telemetry current.
Optionally, the power source is a battery. The battery may be rechargeable or non-rechargeable. The operational life parameters of the battery may comprise battery capacity, usable efficiency of battery due to end of life efficiency, and battery current.
Optionally, the power source is a capacitor.
The therapy protocol parameters, for an electrical stimulation pulse train, may comprise: number of pulses, shape of pulses, interval between pulse train repetitions, duration of a pulse, timing and amplitude of pulses, amperage to be provided to said one or more anatomical target sites, potential to be provided to said one or more anatomical target sites, and duty cycles.
Optionally, the device further comprises at least one sensor for monitoring at least one physiological parameter of said patient. The microprocessor may modify said therapy protocol parameters based upon physiological information sensed by said at least one sensor.
The present specification also discloses a device for electrical stimulation of one or more anatomical target sites in a patient and for use in the treatment of a plurality of biological conditions of the patient, said device comprising: a pulse generator providing electrical stimulation to said one or more anatomical target sites; a power source for powering said pulse generator; at least one stimulator electrode connected to said pulse generator for stimulating said one or more anatomical target sites; a microprocessor programmed to vary a plurality of therapy protocol parameters governing the electrical stimulation to thereby modify operational life parameters of the power source, wherein the therapy protocol parameters and the operational life of the power source are associated according to the following relations:



  
    
      
        L
        BAT
      
      =
      
        
          
            CAP
            BAT
          
          ·
          
            eff
            USE
          
        
        
          I
          BAT
        
      
    
    ,
    where
  




  
    
      
        I
        BAT
      
      =
      
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                    (
                    
                      
                        eff
                        TH
                      
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                      ·
                      
                        
                          
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                    SOH
                  
                
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              ·
              D
            
            ⁢
            
              
            
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    ;
  



and,

at least one sensor connected to said microprocessor for sensing at least one physiological parameter of said patient; wherein effTH is a function of an output stimulation circuit current divided by an input stimulation circuit current; wherein ISOH is equal to an amount of current required to run the device and not including the stimulation current; wherein LBAT is a function of power source service life; wherein CAPBAT is a function of power source capacity; wherein effUSE is a function of a usable efficiency of power source; wherein IBAT is a function of power source current; wherein ITH is a function of a level of current exiting the device from an output terminal; wherein VTH is a function of a level of voltage at an output terminal of the device; wherein VOH is a function of an overhead output voltage; wherein VBAT is a function of a power source voltage; wherein PRF is a function of a pulse repetition frequency; wherein PW is a function of a pulse width; wherein DCTH is a function of a duty cycle; wherein ISLP is a function of sleep current; and wherein ITM is a function of average telemetry current.

Optionally, the power source is a battery. The battery may be rechargeable or non-rechargeable. The operational life parameters of the battery may comprise battery capacity, usable efficiency of battery due to end of life efficiency, and battery current.
Optionally, the power source is a capacitor.
The therapy protocol parameters, for an electrical stimulation pulse train, may comprise: number of pulses, shape of pulses, interval between pulse train repetitions, duration of a pulse, timing and amplitude of pulses, amperage to be provided to said one or more anatomical target sites, potential to be provided to said one or more anatomical target sites, and duty cycles.
The present specification also discloses a system for electrical stimulation of one or more anatomical target sites in a patient and for use in the treatment of a plurality of biological conditions of the patient, said system comprising: a pulse generator providing electrical stimulation to said one or more anatomical target sites; a power source for powering said pulse generator; at least one stimulator electrode connected to said pulse generator for stimulating said one or more anatomical target sites; and, a microprocessor programmed to vary a plurality of therapy protocol parameters governing the electrical stimulation to thereby modify operational life parameters of the power source, wherein the therapy protocol parameters and the operational life of the power source are associated according to the following relations:



  
    
      
        L
        BAT
      
      =
      
        
          
            CAP
            BAT
          
          ·
          
            
              (
              eff
              )
            
            USE
          
        
        
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          BAT
        
      
    
    ,
    where
  




  
    
      I
      BAT
    
    =
    
      [
      
        
          
            
              [
              
                
                  (
                  
                    
                      eff
                      TH
                    
                    ·
                    
                      I
                      TH
                    
                    ·
                    
                      
                        
                          V
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                        +
                        
                          V
                          OH
                        
                      
                      
                        V
                        BAT
                      
                    
                    ·
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                  SOH
                
              
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            ·
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          ⁢
          
            
          
          ⁢
          
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            SLP
          
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              -
              
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                ⁢
                
                  
                
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        +
        
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      ]
    
  



wherein effTH is a function of an output stimulation circuit current divided by an input stimulation circuit current; wherein ISOH is equal to an amount of current required to run the device and not including the stimulation current; wherein LBAT is a function of power source service life; wherein CAPBAT is a function of power source capacity; wherein effUSE is a function of a usable efficiency of power source; wherein IBAT is a function of power source current; wherein ITH is a function of a level of current exiting the device from an output terminal; wherein VTH is a function of a level of voltage at an output terminal of the device; wherein VOH is a function of an overhead output voltage; wherein VBAT is a function of a power source voltage; wherein PRF is a function of a pulse repetition frequency; wherein PW is a function of a pulse width; wherein DCTH is a function of a duty cycle; wherein ISLP is a function of sleep current; and wherein ITM is a function of average telemetry current.
Optionally, the power source is a battery. The battery may be rechargeable or non-rechargeable.
Optionally, the power source is a capacitor.
Optionally, the system further comprises at least one sensor for monitoring at least one physiological parameter of said patient. The microprocessor may modify said therapy protocol parameters based upon physiological information sensed by said at least one sensor.
The aforementioned and other embodiments of the present invention shall be described in greater depth in the drawings and detailed description provided below.



BRIEF DESCRIPTION OF THE DRAWINGS
These and other features and advantages of the present invention will be appreciated, as they become better understood by reference to the following detailed description when considered in connection with the accompanying drawings, wherein:
FIG. 1 is a block diagram illustration of an electro-medical device in accordance with an embodiment;
FIG. 2 shows exemplary therapy protocol parameters;
FIG. 3 is a flow chart illustrating the steps involved in one embodiment of setting a maximum power source capacity and optimizing one or more of the other operational parameters of an electro-medical device using the equations of the present specification;
FIG. 4 is a flow chart illustrating the steps involved in one embodiment of setting a desired, minimum, or maximum power source capacity and optimizing one or more of the other operational parameters of an electro-medical device using the equations of the present specification;
FIG. 5 is a flow chart illustrating the steps involved in one embodiment of setting a desired, minimum, or maximum amount of current required to run the device, and not including the stimulation current, and optimizing one or more of the other operational parameters of an electro-medical device using the equations of the present specification;
FIG. 6 is a flow chart illustrating the steps involved in one embodiment of setting a desired, minimum, or maximum useable efficiency of power source and optimizing one or more of the other operational parameters of an electro-medical device using the equations of the present specification;
FIG. 7 is a flow chart illustrating the steps involved in one embodiment of setting a desired, minimum, or maximum level of current existing the device from an output terminal and optimizing one or more of the other operational parameters of an electro-medical device using the equations of the present specification;
FIG. 8 is a flow chart illustrating the steps involved in one embodiment of setting a desired, minimum, or maximum level of voltage at an output terminal of the device and optimizing one or more of the other operational parameters of an electro-medical device using the equations of the present specification;
FIG. 9 is a flow chart illustrating the steps involved in one embodiment of setting a desired, minimum, or maximum level of an overhead output voltage and optimizing one or more of the other operational parameters of an electro-medical device using the equations of the present specification;
FIG. 10 is a flow chart illustrating the steps involved in one embodiment of setting a desired, minimum, or maximum level of battery or power source output voltage and optimizing one or more of the other operational parameters of an electro-medical device using the equations of the present specification;
FIG. 11 is a flow chart illustrating the steps involved in one embodiment of setting a desired, minimum, or maximum level of sleep current and optimizing one or more of the other operational parameters of an electro-medical device using the equations of the present specification; and
FIG. 12 is a flow chart illustrating the steps involved in one embodiment of setting a desired, minimum, or maximum level of average telemetry current and optimizing one or more of the other operational parameters of an electro-medical device using the equations of the present specification.



DETAILED DESCRIPTION
The present invention is directed towards a plurality of operational or therapy protocol parameters with battery parameters for improved or enhanced operational life of a programmable implantable electro-medical device for the treatment of a plurality of biological conditions. The electro-medical device, including macrostimulators or microstimulators, typically employs stimulator electrodes which can be implanted with minimal invasiveness at or near a treatment or stimulation site.
The electro-medical device can be used to treat a plurality of biological conditions and achieve a plurality of different therapeutic objectives: treatment of GERD (gastroesophageal reflux disease); treatment of diurnal GERD; treatment of nocturnal GERD; reducing the frequency of transient lower esophageal relaxation (tLESR) events; reducing acid exposure during tLESR events; normalizing a patient's LES (lower esophageal sphincter) function; treatment of hypotensive LES; increasing resting or baseline LES pressure; treating a patient to normalize esophageal pH; treating a patient to normalize esophageal pH when in the supine position; treating a patient to prevent damage to the patient's lower esophageal sphincter caused by acid reflux; treatment of supine position induced GERD; treatment of activity-induced GERD; prevention of supine position induced GERD; prevention of activity-induced GERD; treating a patient to mitigate damage to the patient's lower esophageal sphincter caused by acid reflux; treating a patient to stop progression of damage to the patient's lower esophageal sphincter caused by acid reflux; treating a patient to minimize transient relaxations of the patient's lower esophageal sphincter; modifying or increasing LES pressure; modifying or increasing esophageal body pressure; modifying or improving esophageal body function; modifying or improving esophageal sensation induced by the refluxate; modifying or improving the volume of refluxate; modifying or improving the clearance of the refluxate; reducing incidents of heartburn; modifying or improving esophageal acid exposure; increasing lower esophageal tone; detecting when a patient swallows; detecting when a patient is eating; treating a gastrointestinal condition of a patient; treating a patient to minimize the patient's consumption of certain solids or liquids; reducing patient symptoms associated with GERD wherein such reduction is measured by an improvement in a patient quality of life survey and wherein an improvement is calculated by having a patient provide a first set of responses to the quality of life survey prior to treatment and having a patient provide a second set of responses to the quality of life survey after the treatment and comparing the first set of responses to the second set of responses; treating a patient for any of the above-listed therapeutic objectives with the additional requirement of avoiding tissue habituation, tissue fatigue, tissue injury or damage, or certain adverse reactions, including, but not limited to, chest pain, difficulty in swallowing, pain associated with swallowing, heartburn, injury to surrounding tissue, or arrhythmias.
The electro-medical device may be implanted within a plurality of anatomical target sites or regions to achieve one or more of the therapeutic objectives described above. Treatment/target sites, or implantation sites, include: the lower esophageal sphincter; proximate the LES or in the vicinity of the LES, wherein proximate or in the vicinity of the LES is defined as +/−3 cm from the LES; the esophageal body; the upper esophageal sphincter (UES); within, proximate to, or in the vicinity of the gastro-esophageal junction; the esophagus, including esophageal body, LES, and UES; proximate the esophagus or in the vicinity of the esophagus, wherein proximate or in the vicinity of the esophagus is defined as +/−3 cm from the esophagus; at or within the stomach; in direct contact with or +/−3 cm from the gastric wall, including the anterior antrum, posterior antrum, anterior corpus, posterior corpus, lesser curvature, greater curvature, anterior fundus, and posterior fundus; in direct contact with or +/−3 cm from the nerves supplying the LES or gastro-esophageal junction; in direct contact with or +/−3 cm from the nerves supplying the esophageal body; in direct contact with or +/−3 cm from the nerves supplying the UES; or in direct contact with or +/−3 cm from the nerves supplying the esophagus, including the esophageal body, LES, and UES.
The present specification is directed towards multiple embodiments. The following disclosure is provided in order to enable a person having ordinary skill in the art to practice the invention. Language used in this specification should not be interpreted as a general disavowal of any one specific embodiment or used to limit the claims beyond the meaning of the terms used therein. The general principles defined herein may be applied to other embodiments and applications without departing from the spirit and scope of the invention. Also, the terminology and phraseology used is for the purpose of describing exemplary embodiments and should not be considered limiting. Thus, the present invention is to be accorded the widest scope encompassing numerous alternatives, modifications and equivalents consistent with the principles and features disclosed. For purpose of clarity, details relating to technical material that is known in the technical fields related to the invention have not been described in detail so as not to unnecessarily obscure the present invention.
In one embodiment, the electro-medical device may be a conventional pulse generator, a miniature pulse generator, or a microstimulator.
In one embodiment, any electro-medical device, including a macrostimulator or microstimulator, can be programmed to achieve improved or enhanced operational life of the device while implementing a plurality of desired operational or therapy protocols. It should be appreciated that the relationship/association of operational or therapy protocol parameters with battery parameters, in accordance with an aspect of the present invention, are implemented in an electro-medical device, such as a macrostimulator or microstimulator, having a plurality of electrodes, or at least one electrode, including, but not limited to, unipolar or bipolar electrodes, an energy source, such as a battery, and a microprocessor which stores a plurality of programmatic instructions wherein the instructions, when executed by the device, execute the stimulation therapies while achieving optimized and/or improved operational life of the device.
It should be appreciated that the relationships/associations of operational or therapy protocol parameters with battery parameters described herein, for desired or improved operational life of the battery or electro-medical device, can be used with a plurality of different electro-medical devices, including those electrical stimulation devices disclosed in U.S. patent application Ser. Nos. 13/975,162, 13/661,483, 13/041,063, 13/041,114, 13/447,168, 12/359,317, and 13/463,803, U.S. Pat. Nos. 6,901,295, 6,591,137, 6,774,153, 6,826,428, 7,738,961, 8,447,403, 8,447,404, 8,538,534, and 8,160,709, and PCT Application Numbers PCT/US11/27243 and PCTUS13/56520, all of which are herein incorporated by reference.
FIG. 1 shows an embodiment of an electro-medical device 100 wherein a plurality of stimulator electrodes 105 is provided for placement at or near a treatment or stimulation site. A pulse generator 110 is provided for stimulation of the stimulator electrodes 105 and corresponding portion of the treatment or stimulation site. The pulse generator 110 is connected to a power source 115 for supplying a source of power. The pulse generator 110 is further connected to the stimulator electrodes 105 by wires 106 for applying electrical stimulus to the electrodes 105. Alternatively, the stimulator electrodes 105 may be coupled to the pulse generator 110 in a wireless fashion using an RF link, an ultrasonic link, a thermal link, a magnetic link, an electromagnetic link or an optical link.
The power source 115 can be either a direct current source or an alternating current source. The number of stimulator electrodes 105 is determined by a number of factors, including the size of the electrodes, their power and the size of the desired placement area.
In one embodiment, the pulse generator 110 is controlled by a microprocessor 120 for applying the electrical stimulus for periods of variable duration and variable power/frequency, so as to produce a plurality of treatment stimulations/therapies. In another embodiment, the device does not include a microprocessor.
Additionally or optionally sensing electrodes 125 may be electrically connected by wires 126 to the microprocessor 120. Alternatively, the sensing electrodes 125 may be in wireless communication with the microprocessor 120. The sensing electrodes 125 may be selected to sense one or more physiological parameters with reference to a plurality of anatomical target sites, regions or areas. For example, during a treatment regimen for obesity and/or GERD, while applying electrical stimulation to the upper esophageal sphincter (UES) the sensing electrodes 125 may be placed in the esophagus to sense physical parameters such as esophageal peristalsis, pH, pressure, temperature and impedance. Upon sensing appropriate changes in esophageal peristalsis, pH, pressure, temperature and/or impedance, the electrical stimulation in the upper esophageal sphincter may be initiated so as to contract the upper esophageal sphincter and impede passage of food from the oropharynx into the esophagus, thereby increasing the time of mastication, reducing the food intake and, preferably, increasing stimulation of the satiety centre. In one embodiment, the device 100 does not include sensing electrodes and comprises simply a stimulating arrangement.
The stimulator electrodes 105 may be placed by endoscopic, surgical or radiological procedures.
The stimulus may be triggered by a transmitter (not shown) external to a patient's body, similar to a remote transmitter for a cardiac pacemaker.
In one embodiment, the device 100 is designed as a ‘micro’ device with all the major components—the stimulator electrodes 105, the sensor electrodes 125, the microcontroller 120, the pulse generator 110 and the power source 115 integrated into a single unit, for easy deployment at any desired location in a patient's body. The microdevice contains an outer shell made of a biocompatible, hermetically sealed material such as glass, ceramic, metal, or polymers. For this purpose, any material may be selected that keeps moisture out yet allows radiofrequency/electromagnetic or magnetic energy to pass through. The outer shell may also be constructed of an acid corrosion resistant material such as a suitable inert polymer. Examples of such materials include: those from the polyolefin family such as HDPE (high density polyethylene), LLDPE (linear low density polyethylene), and UHMWPE (ultra high molecular weight polyethylene); fluoropolymer materials like PTFETM (poly tetrafluoroethylene), FEPTM (fluorinated ethylene propylene) and others; polymethylpentene, and polysulfones; and, some elastomers such as thermoplastic polyurethanes and C-Flex type block copolymers that are stable in acidic environments. Additionally, the outer shell may be constructed of an acid corrosion resistant metal such as platinum, gold, tantalum, titanium, or suitable alloys thereof.
The microdevice may be coated with an antimicrobial agent such as an antibiotic or antifungal agent to prevent infection at the time of implantation. Additionally, the microdevice may be coated with an immunosuppressent such as a steroid, cyclosporine, tacrolimus, azathioprine, mycophenolate mofetil, muromonab CD-3, or antithymocyte globulin to prevent rejection.
In one embodiment, the device 100 has a local energy source 115, such as a battery, that has one or more of the following characteristics: the energy source 115 is rechargeable and has a recharge frequency of once per day for 15 minutes, once per week for approximately 60 minutes, once per month, or once per year; comprises lithium ion battery technology; comprises solid state battery technology; comprises lithium polymer battery technology; comprises super capacitor technology; is not rechargeable; and, is not rechargeable and/or has an implant life of at least one year. In one embodiment, a power management unit is used to convert output voltage from the power supply 115 to the specified level of operating voltage of the microprocessor 120 (and its peripherals).
In one embodiment, the energy source 115 comprises an external power source coupled to the device 100 via a suitable means, such as RF link. In another embodiment, the energy source 115 comprises a self-contained power source utilizing any suitable means of generation or storage of energy. Examples of such a power source include a primary battery, a replenishable or rechargeable battery such as a lithium ion battery, an electrolytic capacitor, and a super- or ultra-capacitor, etc. In case the self-contained energy source is replenishable or rechargeable, any suitable means of replenishing or recharging the power source may be used, such as an RF link, an optical link, a thermal link, or any other energy-coupling link.
In accordance with an aspect of the present specification, the electro-medical device 100 provides enhanced/improved operational life benefits through optimized operational or therapy protocol parameters. To enable improved or desired operational life benefits of the device 100, the present specification associates the operational or therapy protocol parameters of the device 100 to a plurality of battery or power source parameters, such as battery service life, capacity, or current, in accordance with the following equations:




  
    
      
        
          L
          BAT
        
        =
        
          
            
              CAP
              BAT
            
            ·
            
              eff
              USE
            
          
          
            I
            BAT
          
        
      
    
    
      
        Equation
        ⁢
        
          
        
        ⁢
        A
      
    
  




Where:

    
    
        LBAT [Hr]=battery or power source service life in hours (Hr)
        CAPBAT [mAHr]=battery or power source capacity in milliamps hours (mAHr)
        effUSE [%]=usable efficiency of battery or power source due to end of life efficiency (before battery or power source voltage drops too low), allowable depth-of-discharge, or similar events or combination of events.
        IBAT [mA]=battery or power source current (current at the battery or power source terminals) in milliamps (mA), where:
    
    






  
    
      
        
          I
          BAT
        
        =
        
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                      (
                      
                        
                          eff
                          TH
                        
                        ·
                        
                          I
                          TH
                        
                        ·
                        
                          
                            
                              V
                              TH
                            
                            +
                            
                              V
                              OH
                            
                          
                          
                            V
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                        ·
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                ·
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                TH
              
            
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                      TH
                    
                  
                
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              TM
            
          
          ]
        
      
    
    
      
        Equation
        ⁢
        
          
        
        ⁢
        B
      
    
  




Where:

    
    
        effTH [%]=a general efficiency term for therapy, i.e. (output stimulation circuit current)/(input stimulation circuit current)×100%;
        ITH [mA]=therapy current (current exiting the electro-medical device output terminal);
        VTH [V]=therapy voltage (voltage at the electro-medical device output terminal);
        VOH[V]=overhead output voltage (on a constant current output system there is usually the internal voltage that is at least 0.5-2V higher than the output voltage to keep the internals operating in the correct range);
        VBAT [V]=battery or power source voltage (average voltage at the battery terminals);
        PRF [Hz]=therapy pulse repetition frequency in hertz (Hz);
        PW [s]=therapy pulse width in second(s);
        ISOH [mA]=stimulation overhead current (there is often a non-scalable power loss associated with the output driver circuitry, thus not part of effTH), i.e. the amount of current dedicated to run the stimulation circuity and which does not include the actual stimulation current itself;
        DCTH [%]=therapy duty cycle (average operation time);
        ISLP [mA]=sleep current (power when the device is in an “off” state, but is still capable of doing background tests, watchdog, or other basic monitoring); and
        ITM [mA]=average telemetry current (can be high depending on telemetry protocol).
    
    


A therapy which requires a lower amount of energy increases service life of the battery 115 and therefore the long-term functionality of the electro-medical device 100. Accordingly, the microprocessor 120 can be programmed using the Equations A and B such that the device 100 produces electrical pulses of varying shape, duration and frequency so as to produce the desired stimulation or therapeutic effect while enabling optimization and/or improvement of the operational life of the device 100 (or the battery 115). In one embodiment, for example, using Equations A and B, the microprocessor 120 can be programmed to continuously provide a pulse train of 3 mA, 200 μsec pulses at a rate of 20 Hz (i.e. no duty cycle) with a minimum operational battery life of 5 years. Thus, as would be appreciated by persons of ordinary skill in the art, the operational battery life and therefore of the device can be varied and approximately set to a desired level by varying the operational or therapy protocol parameters.
The output of the device 100, as controlled by the microcontroller 120, can be programmed to vary a plurality of operational or therapy protocol parameters, such as: the number of pulses in a pulse train; the shape of pulses in a pulse train; the interval between pulse train repetitions; the duration of each pulse; the timing and amplitude of pulses in trains; the desired amount of amperage to be provided to an anatomical target site; and, the desired amount of potential to be provided to an anatomical target site, depending upon the load and the current produced.
In addition, the electrical stimulus can be provided continuously or intermittently. For example, one time or more per hour may be suitable in some circumstances.
In various embodiments, the electrical stimulus in the stimulator electrodes 105 may have any shape necessary to produce the desired result, including a square, rectangular, sinusoidal or saw-tooth shape.
In one embodiment, the device 100 can be allowed to engage in automated “on/off” duty cycles that can range, for example, from 1 millisecond to 24 hours. During the “on” period, stimulation is applied for a long enough period to enable recruitment of adequate nerves and/or muscle fibers to achieve a desired pressure, function or effect. The desired “on” period is patient specific and is preferably calculated based on the time required to change a pressure or function of an anatomical target site, such as the LES, from a baseline pressure or function to a desired therapeutic pressure or function plus additional time to maintain the therapeutic pressure (maintenance time) or function. For example, the maintenance time ranges from 1 second to 12 hours. The “off” period is preferably set in order to prevent development of tolerance or muscle fatigue, to improve device functionality, and to optimize energy consumption from the energy source/battery. The desired “off” period ranges, for example, from 1 second to 24 hours. The desired “off” period is patient specific and calculated based on the time required to change a pressure or function of an anatomical target site, such as the LES, from the desired therapeutic pressure or function to a baseline pressure or function plus optional additional time to maintain the baseline pressure (relaxation time) or function. For example, the relaxation time ranges from 1 second to 12 hours.
As an example, the operational or therapy protocol parameters, which are effectuated through an electrical pulse, may comprise any of the variable ranges detailed in the table 200 of FIG. 2. Accordingly, the operational life of the battery and therefore of the electro-medical device can be advantageously estimated for further optimization with reference to the therapy protocol parameters. For example, in one embodiment, an electro-medical device is implanted in a patient with the goal of providing at least one more year of operational life after having already operated for a predefined amount of time with a predefined set of parameters. In this example, using the equations above, Lbat is set to 8,760 hours for the goal of one year and the stimulation parameters, including pulse width, pulse frequency, and pulse amplitude are left unchanged with the intention of only changing the duty cycle (DCth). The equations are then rearranged to solve for DCth. Once DCth is calculated, the electro-medical device can be reprogrammed to adjust the duty cycle to reflect the new value.
In one embodiment, a maximum power source capacity for the device is set (CAPBAT). Additionally, a minority, and preferably only one, of the remaining parameters (effTH, ISOH, LBAT, effUSE, IBAT, ITH, VTH, VOH, VBAT, PRF, PW, DCTH, ISLP, and ITM) is subject to optimization or modification, with the remainder being a fixed value. Using the maximum power source capacity value and the other fixed values, the minority, or preferably one, of the parameters subject to optimization of modification is then determined using Equations A and B. FIG. 3 is a flow chart illustrating the steps involved in one embodiment of setting a maximum power source capacity and optimizing one or more of the other operational parameters of an electro-medical device using the equations of the present specification. At step 302, the maximum power source capacity (CAPBAT) for the device is set. At step 304, one or more of the other parameters (effTH, ISOH, LBAT, effUSE, IBAT, ITH, VTH, VOH, VBAT, PRF, PW, DCTH, ISLP, and ITM) is determined to be subject to optimization/modification. Then, at step 306, fixed values for the remaining parameters are set. Using equations A and B of the present specification, the one or more other parameters subject to optimization/modification is optimized at step 308.
In one embodiment, a desired, minimum, or maximum power source capacity for the device is set (CAPBAT). Additionally, a minority, and preferably only one, of the remaining parameters (effTH, ISOH, LBAT, effUSE, IBAT, ITH, VTH, VOH, VBAT, PRF, PW, DCTH, ISLP, and ITM) is subject to optimization or modification, with the remainder being a fixed value. Using the desired, minimum, or maximum power source capacity value and the other fixed values, the minority, or preferably one, of the parameters subject to optimization of modification is then determined using Equations A and B. FIG. 4 is a flow chart illustrating the steps involved in one embodiment of setting a desired, minimum, or maximum power source capacity and optimizing one or more of the other operational parameters of an electro-medical device using the equations of the present specification. At step 402, the desired, minimum, or maximum power source capacity (CAPBAT) for the device is set. At step 404, one or more of the other parameters (effTH, ISOH, LBAT, effUSE, IBAT, ITH, VTH, VOH, VBAT, PRF, PW, DCTH, ISLP, and ITM) is determined to be subject to optimization/modification. Then, at step 406, fixed values for the remaining parameters are set. Using equations A and B of the present specification, the one or more other parameters subject to optimization/modification is optimized at step 408.
In one embodiment, a desired, minimum, or maximum amount of current required to run the device and not including the stimulation current is set (ISOH). Additionally, a minority, and preferably only one, of the remaining parameters (effTH, CAPBAT, LBAT, effUSE, IBAT, ITH, VTH, VOH, VBAT, PRF, PW, DCTH, ISLP, and ITM) is subject to optimization or modification, with the remainder being a fixed value. Using the desired, minimum, or maximum amount of current required to run the device, and not including the stimulation current, value and the other fixed values, the minority, or preferably one, of the parameters subject to optimization of modification is then determined using Equations A and B. FIG. 5 is a flow chart illustrating the steps involved in one embodiment of setting a desired, minimum, or maximum amount of current required to run the device, and not including the stimulation current, and optimizing one or more of the other operational parameters of an electro-medical device using the equations of the present specification. At step 502, the desired, minimum, or maximum amount of current required to run the device (ISOH), and not including the stimulation current, is set. At step 504, one or more of the other parameters (effTH, CAPBAT, LBAT, effUSE, IBAT, ITH, VTH, VOH, VBAT, PRF, PW, DCTH, ISLP, and ITM) is determined to be subject to optimization/modification. Then, at step 506, fixed values for the remaining parameters are set. Using equations A and B of the present specification, the one or more other parameters subject to optimization/modification is optimized at step 508.
In one embodiment, a desired, minimum, or maximum useable efficiency of power source is set (effUSE). Additionally, a minority, and preferably only one, of the remaining parameters (effTH, ISOH, CAPBAT, LBAT, IBAT, ITH, VTH, VOH, VBAT, PRF, PW, DCTH, ISLP, and ITM) is subject to optimization or modification, with the remainder being a fixed value. Using the desired, minimum, or maximum useable efficiency of power source value and the other fixed values, the minority, or preferably one, of the parameters subject to optimization of modification is then determined using Equations A and B. FIG. 6 is a flow chart illustrating the steps involved in one embodiment of setting a desired, minimum, or maximum useable efficiency of power source and optimizing one or more of the other operational parameters of an electro-medical device using the equations of the present specification. At step 602, the desired, minimum, or maximum useable efficiency of power source (effUSE) for the device is set. At step 604, one or more of the other parameters (effTH, CAPBAT, LBAT, IBAT, ITH, VTH, VOH, VBAT, PRF, PW, DCTH, ISLP, and ITM) is determined to be subject to optimization/modification. Then, at step 606, fixed values for the remaining parameters are set. Using equations A and B of the present specification, the one or more other parameters subject to optimization/modification is optimized at step 608.
In one embodiment, a desired, minimum, or maximum level of current exiting the device from an output terminal is set (ITH). Additionally, a minority, and preferably only one, of the remaining parameters (effTH, ISOH, CAPBAT, LBAT, effUSE, IBAT, VTH, VOH, VBAT, PRF, PW, DCTH, ISLP, and ITM) is subject to optimization or modification, with the remainder being a fixed value. Using the desired, minimum, or maximum level of current exiting the device from an output terminal value and the other fixed values, the minority, or preferably one, of the parameters subject to optimization of modification is then determined using Equations A and B. FIG. 7 is a flow chart illustrating the steps involved in one embodiment of setting a desired, minimum, or maximum level of current existing the device from an output terminal and optimizing one or more of the other operational parameters of an electro-medical device using the equations of the present specification. At step 702, the desired, minimum, or maximum level of current exiting the device from an output terminal (ITH) is set. At step 704, one or more of the other parameters (effTH, CAPBAT, LBAT, effUSE, IBAT, VTH, VOH, VBAT, PRF, PW, DCTH, ISLP, and ITM) is determined to be subject to optimization/modification. Then, at step 706, fixed values for the remaining parameters are set. Using equations A and B of the present specification, the one or more other parameters subject to optimization/modification is optimized at step 708.
In one embodiment, a desired, minimum, or maximum level of voltage at an output terminal of the device is set (VTH). Additionally, a minority, and preferably only one, of the remaining parameters (effTH, ISOH, CAPBAT, LBAT, effUSE, IBAT, ITH, VOH, VBAT, PRF, PW, DCTH, ISLP, and ITM) is subject to optimization or modification, with the remainder being a fixed value. Using the desired, minimum, or maximum level of voltage at an output terminal of the device value and the other fixed values, the minority, or preferably one, of the parameters subject to optimization of modification is then determined using Equations A and B. FIG. 8 is a flow chart illustrating the steps involved in one embodiment of setting a desired, minimum, or maximum level of voltage at an output terminal of the device and optimizing one or more of the other operational parameters of an electro-medical device using the equations of the present specification. At step 802, the desired, minimum, or maximum level of voltage at an output terminal of the device (VTH) is set. At step 804, one or more of the other parameters (effTM, ISOH, CAPBAT, LBAT, effUSE, IBAT, ITH, VOH, VBAT, PRF, PW, DCTH, ISLP, and ITM) is determined to be subject to optimization/modification. Then, at step 806, fixed values for the remaining parameters are set. Using equations A and B of the present specification, the one or more other parameters subject to optimization/modification is optimized at step 808.
In one embodiment, a desired, minimum, or maximum level of an overhead output voltage is set (VOH). Additionally, a minority, and preferably only one, of the remaining parameters (effTM, ISOH, CAPBAT, LBAT, effUSE, IBAT, ITH, VTH, VBAT, PRF, PW, DCTH, ISLP, and ITM) is subject to optimization or modification, with the remainder being a fixed value. Using the desired, minimum, or maximum level of an overhead output voltage value and the other fixed values, the minority, or preferably one, of the parameters subject to optimization of modification is then determined using Equations A and B. FIG. 9 is a flow chart illustrating the steps involved in one embodiment of setting a desired, minimum, or maximum level of an overhead output voltage and optimizing one or more of the other operational parameters of an electro-medical device using the equations of the present specification. At step 902, the desired, minimum, or maximum level of an overhead output voltage (VOH) of the device is set. At step 904, one or more of the other parameters (effTM, ISOH, CAPBAT, LBAT, effUSE, IBAT, ITH, VTH, VBAT, PRF, PW, DCTH, ISLP, and ITM) is determined to be subject to optimization/modification. Then, at step 906, fixed values for the remaining parameters are set. Using equations A and B of the present specification, the one or more other parameters subject to optimization/modification is optimized at step 908.
In one embodiment, a desired, minimum, or maximum level of battery or power source voltage is set (VBAT). Additionally, a minority, and preferably only one, of the remaining parameters (effTM, ISOH, CAPBAT, LBAT, effUSE, IBAT, ITH, VTH, VOH, PRF, PW, DCTH, ISLP, and ITM) is subject to optimization or modification, with the remainder being a fixed value. Using the desired, minimum, or maximum level of battery or power source voltage value and the other fixed values, the minority, or preferably one, of the parameters subject to optimization of modification is then determined using Equations A and B. FIG. 10 is a flow chart illustrating the steps involved in one embodiment of setting a desired, minimum, or maximum level of battery or power source output voltage and optimizing one or more of the other operational parameters of an electro-medical device using the equations of the present specification. At step 1002, the desired, minimum, or maximum level of battery or power source output voltage (VBAT) of the device is set. At step 1004, one or more of the other parameters (effTH, ISOH, CAPBAT, LBAT, effUSE, IBAT, ITH, VTH, VOH, PRF, PW, DCTH, ISLP, and ITM) is determined to be subject to optimization/modification. Then, at step 1006, fixed values for the remaining parameters are set. Using equations A and B of the present specification, the one or more other parameters subject to optimization/modification is optimized at step 1008.
In one embodiment, a desired, minimum, or maximum level of sleep current is set (ISLP). Additionally, a minority, and preferably only one, of the remaining parameters (effTH, ISOH, CAPBAT, LBAT, effUSE, IBAT, ITH, VTH, VOH, VBAT, PRF, PW, DCTH, and ITM) is subject to optimization or modification, with the remainder being a fixed value. Using the desired, minimum, or maximum level of sleep current value and the other fixed values, the minority, or preferably one, of the parameters subject to optimization of modification is then determined using Equations A and B. FIG. 11 is a flow chart illustrating the steps involved in one embodiment of setting a desired, minimum, or maximum level of sleep current and optimizing one or more of the other operational parameters of an electro-medical device using the equations of the present specification. At step 1102, the desired, minimum, or maximum level of sleep current (ISLP) of the device is set. At step 1104, one or more of the other parameters (effTH, ISOH, CAPBAT, LBAT, effUSE, IBAT, ITH, VTH, VOH, VBAT, PRF, PW, DCTH, and ITM) is determined to be subject to optimization/modification. Then, at step 1106, fixed values for the remaining parameters are set. Using equations A and B of the present specification, the one or more other parameters subject to optimization/modification is optimized at step 1108.
In one embodiment, a desired, minimum, or maximum level of average telemetry current is set (ITM). Additionally, a minority, and preferably only one, of the remaining parameters (effTH, ISOH, CAPBAT, LBAT, effUSE, IBAT, ITH, VTH, VOH, VBAT, PRF, PW, DCTH, and ISLP) is subject to optimization or modification, with the remainder being a fixed value. Using the desired, minimum, or maximum level of average telemetry current value and the other fixed values, the minority, or preferably one, of the parameters subject to optimization of modification is then determined using Equations A and B. FIG. 12 is a flow chart illustrating the steps involved in one embodiment of setting a desired, minimum, or maximum level of average telemetry current and optimizing one or more of the other operational parameters of an electro-medical device using the equations of the present specification. At step 1202, the desired, minimum, or maximum level of average telemetry current (ITM) of the device is set. At step 1204, one or more of the other parameters (effTH, ISOH, CAPBAT, LBAT, effUSE, IBAT, ITH, VTH, VOH, VBAT, PRF, PW, DCTH, and ISLP) is determined to be subject to optimization/modification. Then, at step 1206, fixed values for the remaining parameters are set. Using equations A and B of the present specification, the one or more other parameters subject to optimization/modification is optimized at step 1208.
The above examples are merely illustrative of the many applications of the system of present invention. Although only a few embodiments of the present invention have been described herein, it should be understood that the present invention might be embodied in many other specific forms without departing from the spirit or scope of the invention. Therefore, the present examples and embodiments are to be considered as illustrative and not restrictive, and the invention may be modified within the scope of the appended claims.

## Claims

1. A device for electrical stimulation of one or more anatomical target sites in a patient and for use in treating a plurality of biological conditions of the patient, said device comprising:
a pulse generator providing electrical stimulation to said one or more anatomical target sites, wherein said electrical stimulation comprises a stimulation current;
a power source for powering said pulse generator;
at least one stimulator electrode connected to said pulse generator, wherein said at least one stimulator electrode is configured to apply said electrical stimulation to said one or more anatomical target sites; and,
a microprocessor programmed to vary a plurality of therapy protocol parameters governing the electrical stimulation to thereby modify operational life parameters of the power source, wherein the therapy protocol parameters and the operational life of the power source are associated according to the following relations:




  
    
      
        L
        BAT
      
      =
      
        
          
            CAP
            BAT
          
          ·
          
            eff
            USE
          
        
        
          I
          BAT
        
      
    
    ,
    where
  




  
    
      I
      BAT
    
    =
    
      [
      
        
          
            
              [
              
                
                  (
                  
                    
                      eff
                      TH
                    
                    ·
                    
                      I
                      TH
                    
                    ·
                    
                      
                        
                          V
                          TH
                        
                        +
                        
                          V
                          OH
                        
                      
                      
                        V
                        BAT
                      
                    
                    ·
                    PRF
                    ·
                    PW
                  
                  )
                
                +
                
                  I
                  SOH
                
              
              ]
            
            ·
            D
          
          ⁢
          
            
          
          ⁢
          
            C
            TH
          
        
        +
        
          
            I
            SLP
          
          ·
          
            (
            
              1
              -
              
                D
                ⁢
                
                  
                
                ⁢
                
                  C
                  TH
                
              
            
            )
          
        
        +
        
          I
          TM
        
      
      ]
    
  


wherein effTH is a function of an output stimulation circuit current divided by an input stimulation circuit current; wherein ISOH is equal to an amount of current required to run the device and not including the stimulation current; wherein LBAT is a function of power source service life; wherein CAPBAT is a function of power source capacity; wherein effUSE is a function of a usable efficiency of power source; wherein IBAT is a function of power source current; wherein ITH is a function of a level of current exiting the device from an output terminal; wherein VTH is a function of a level of voltage at an output terminal of the device; wherein VOH is a function of an overhead output voltage; wherein VBAT is a function of a power source voltage; wherein PRF is a function of a pulse repetition frequency; wherein PW is a function of a pulse width; wherein DCTH is a function of a duty cycle; wherein ISLP is a function of sleep current; and wherein ITM is a function of average telemetry current.

2. The device of claim 1, wherein said power source is a battery.

3. The device of claim 2, wherein said battery is rechargeable.

4. The device of claim 2, wherein said battery is non-rechargeable.

5. The device of claim 2, wherein the operational life parameters of the battery comprise battery capacity, usable efficiency of battery due to end of life efficiency, and battery current.

6. The device of claim 1, wherein said power source is a capacitor.

7. The device of claim 1, wherein said therapy protocol parameters for an electrical stimulation pulse train comprise: number of pulses, shape of pulses, interval between pulse train repetitions, duration of a pulse, timing and amplitude of pulses, amperage to be provided to said one or more anatomical target sites, potential to be provided to said one or more anatomical target sites, and duty cycles.

8. The device of claim 1, further comprising at least one sensor in data communication with said microprocessor, wherein the at least one sensor is configured to monitor at least one physiological parameter of said patient.

9. The device of claim 8, wherein said microprocessor modifies said therapy protocol parameters based upon physiological information sensed by said at least one sensor.

10. A device for electrical stimulation of one or more anatomical target sites in a patient and for use in treating a plurality of biological conditions of the patient, said device comprising:
a pulse generator providing electrical stimulation to said one or more anatomical target sites;
a power source for powering said pulse generator;
at least one stimulator electrode connected to said pulse generator, wherein said at least one stimulator electrode is configured to apply the electrical stimulation to said one or more anatomical target sites;
a microprocessor programmed to vary a plurality of therapy protocol parameters governing the electrical stimulation to thereby modify operational life parameters of the power source, wherein the therapy protocol parameters and the operational life of the power source are associated according to the following relations:




  
    
      
        L
        BAT
      
      =
      
        
          
            CAP
            BAT
          
          ·
          
            eff
            USE
          
        
        
          I
          BAT
        
      
    
    ,
    where
  




  
    
      
        I
        BAT
      
      =
      
        [
        
          
            
              
                [
                
                  
                    (
                    
                      
                        eff
                        TH
                      
                      ·
                      
                        I
                        TH
                      
                      ·
                      
                        
                          
                            V
                            TH
                          
                          +
                          
                            V
                            OH
                          
                        
                        
                          V
                          BAT
                        
                      
                      ·
                      PRF
                      ·
                      PW
                    
                    )
                  
                  +
                  
                    I
                    SOH
                  
                
                ]
              
              ·
              D
            
            ⁢
            
              
            
            ⁢
            
              C
              TH
            
          
          +
          
            
              I
              SLP
            
            ·
            
              (
              
                1
                -
                
                  D
                  ⁢
                  
                    
                  
                  ⁢
                  
                    C
                    TH
                  
                
              
              )
            
          
          +
          
            I
            TM
          
        
        ]
      
    
    ;
  



and,
at least one sensor connected to said microprocessor, wherein the at least one sensor is configured to sense at least one physiological parameter of said patient;
wherein effTH is a function of an output stimulation circuit current divided by an input stimulation circuit current; wherein ISOH is equal to an amount of current required to run the device and not including the stimulation current; wherein LBAT is a function of power source service life; wherein CAPBAT is a function of power source capacity; wherein effUSE is a function of a usable efficiency of power source; wherein IBAT is a function of power source current; wherein ITH is a function of a level of current exiting the device from an output terminal; wherein VTH is a function of a level of voltage at an output terminal of the device; wherein VOH is a function of an overhead output voltage; wherein VBAT is a function of a power source voltage; wherein PRF is a function of a pulse repetition frequency; wherein PW is a function of a pulse width; wherein DCTH is a function of a duty cycle; wherein ISLP is a function of sleep current; and wherein ITM is a function of average telemetry current.

11. The device of claim 10, wherein said power source is a battery.

12. The device of claim 11, wherein said battery is rechargeable.

13. The device of claim 11, wherein said battery is non-rechargeable.

14. The device of claim 11, wherein the operational life parameters of the battery comprise battery capacity, usable efficiency of battery due to end of life efficiency, and battery current.

15. The device of claim 10, wherein said power source is a capacitor.

16. The device of claim 10, wherein said therapy protocol parameters for an electrical stimulation pulse train comprise: number of pulses, shape of pulses, interval between pulse train repetitions, duration of a pulse, timing and amplitude of pulses, amperage to be provided to said one or more anatomical target sites, potential to be provided to said one or more anatomical target sites, and duty cycles.

17. A system for electrical stimulation of one or more anatomical target sites in a patient and for use in treating a plurality of biological conditions of the patient, said system comprising:
a pulse generator providing electrical stimulation to said one or more anatomical target sites;
a power source for powering said pulse generator;
at least one stimulator electrode connected to said pulse generator, wherein the at least one stimulator electrode is configured to apply said electrical stimulation to said one or more anatomical target sites; and,
a microprocessor programmed to vary a plurality of therapy protocol parameters governing the electrical stimulation to thereby modify operational life parameters of the power source, wherein the therapy protocol parameters and the operational life of the power source are associated according to the following relations:




  
    
      
        L
        BAT
      
      =
      
        
          
            CAP
            BAT
          
          ·
          
            eff
            USE
          
        
        
          I
          BAT
        
      
    
    ,
    where
  




  
    
      I
      BAT
    
    =
    
      [
      
        
          
            
              [
              
                
                  (
                  
                    
                      eff
                      TH
                    
                    ·
                    
                      I
                      TH
                    
                    ·
                    
                      
                        
                          V
                          TH
                        
                        +
                        
                          V
                          OH
                        
                      
                      
                        V
                        BAT
                      
                    
                    ·
                    PRF
                    ·
                    PW
                  
                  )
                
                +
                
                  I
                  SOH
                
              
              ]
            
            ·
            D
          
          ⁢
          
            
          
          ⁢
          
            C
            TH
          
        
        +
        
          
            I
            SLP
          
          ·
          
            (
            
              1
              -
              
                D
                ⁢
                
                  
                
                ⁢
                
                  C
                  TH
                
              
            
            )
          
        
        +
        
          I
          TM
        
      
      ]
    
  


wherein effTH is a function of an output stimulation circuit current divided by an input stimulation circuit current; wherein ISOH is equal to an amount of current required to run the device and not including the stimulation current; wherein LBAT is a function of power source service life; wherein CAPBAT is a function of power source capacity; wherein effUSE is a function of a usable efficiency of power source; wherein IBAT is a function of power source current; wherein ITH is a function of a level of current exiting the device from an output terminal; wherein VTH is a function of a level of voltage at an output terminal of the device; wherein VOH is a function of an overhead output voltage; wherein VBAT is a function of a power source voltage; wherein PRF is a function of a pulse repetition frequency; wherein PW is a function of a pulse width; wherein DCTH is a function of a duty cycle; wherein ISLP is a function of sleep current; and wherein ITM is a function of average telemetry current.

18. The system of claim 17, wherein said power source is a battery.

19. The system of claim 18, wherein said battery is rechargeable.

20. The system of claim 18, wherein said battery is non-rechargeable.

21. The device of claim 17, wherein said power source is a capacitor.

22. The system of claim 17, further comprising at least one sensor in data communication with the microprocessor, wherein the at least one sensor is configured to monitor at least one physiological parameter of said patient.

23. The system of claim 22, wherein said microprocessor modifies said therapy protocol parameters based upon physiological information sensed by said at least one sensor.