Patent Description:
Various types of neurostimulators are known in the art. In the field of neurostimulators for the stimulation of the hypoglossal nerves, the following provide some examples.

<CIT> describes an implant unit that may include a flexible carrier, at least one pair of modulation electrodes on the flexible carrier, and at least one implantable circuit in electrical communication with the at least one pair of modulation electrodes. The at least one pair of modulation electrodes and the at least one circuit may be configured for implantation through derma on an underside of a subject's chin and for location proximate to terminal fibers of the medial branch of the subject's hypoglossal nerve, such that an electric field extending from the at least one pair of modulation electrodes can modulate one or more of the terminal fibers of the medial branch of the hypoglossal nerve.

<CIT> describes an implant unit configured for implantation into a body of a subject and may include an antenna configured to receive a signal. The implant unit may also include at least one pair of modulation electrodes configured to be implanted into the body of the subject in the vicinity of at least one nerve to be modulated, the at least one pair of modulation electrodes being configured to receive an applied electric signal in response to the signal received by the antenna and generate an electrical field to
modulate the at least one nerve from a position where the at least one pair of modulation electrodes does not contact the at least one nerve.

The following provides for an example of an activation tool used to active a neurostimulator during the surgical procedure. <CIT> describes an implant unit delivery tool having an implant tool and an implant activator. The implant tool may be configured to retain an implant unit during an implantation procedure in which the implant unit is fixated to tissue. The implant activator may be associated with the implant tool. Additionally, the implant activator may be configured to selectively transfer power to the implant unit during the implantation procedure to cause modulation of at least one nerve in the body of a subject prior to final fixation of the implant unit to the tissue. Documents <CIT>, <CIT>, <CIT> and <CIT> also disclose known surgical implants.

In one aspect of the disclosed subject matter, there is disclosed a surgical implant. The surgical implant in accordance with this aspect comprises:.

Any one of the following embodiments may apply to any one of the aspects of the disclosed subject matter, alone or in combination:.

In another aspect of the disclosed subject matter there is disclosed an implant unit activation device, comprising: a main body comprising an implant activator and an axially displaceable adaptor configured to displace relative the main body, the implant activator having a power source and being configured to wirelessly transfer energy from the power source to an implant unit during implantation of the implant unit into the body of a subject to cause stimulation of at least one nerve in the body of the subject; and wherein the axial displacement of the adaptor allows adjusting of the amount of energy received by the implant unit.

The amount of energy may be adjusted directly through the implant unit activation device.

In yet another aspect, there is provided a method of positioning and activating a neurostimulation implant device, the method comprising:.

In one embodiment the implant may be configured for treatment of obstructive sleep apnea and the location of implantation may be in the vicinity of the hypoglossal nerve. In accordance with this embodiment the neurostimulation device may be configured to modulate at least one branch of the hypoglossal nerves.

The second amount may be greater or equal to the first amount of power.

The second amount may be equal to or less relative the first amount of power.

In order to better understand the subject matter that is disclosed herein and to exemplify how it may be carried out in practice, embodiments will now be described, by way of non-limiting examples only, with reference to the accompanying drawings, in which:.

Examples of the presently disclosed subject matter relate generally to a surgical implant configured for modulating a nerve through the delivery of energy. Nerve modulation, or neural modulation, includes inhibition (e.g. blockage), stimulation, modification, regulation, or therapeutic alteration of activity, electrical or chemical, in the central, peripheral, or autonomic nervous system. Nerve modulation may take the form of nerve stimulation, which may include providing energy to the nerve to create a voltage change sufficient for the nerve to activate, or propagate an electrical signal of its own. As referred to herein, modulation of a nerve may include modulation of an entire nerve and/or modulation of a portion of a nerve. In patients with obstructive sleep apnea (OSA), for example, a primary target response of nerve stimulation may include contraction of a tongue muscle in order to move the tongue to a position that does not block the patient's airway, the cause of obstruction in OSA. While the examples of the disclosed subject matter will be discussed in relation to OSA, it will be appreciated that the features of the the disclosed subject matter can be applied to surgical implant for nerve modulation for other conditions in mammalian bodies, mutatis mutandis. It will be further appreciated, that the presently disclosed subject matter is directed to the surgical implant, and the implant can be activated by an activator unit provided with a power source either applied externally or implanted in the body of the subject. In one example, the external activation unit for the implant is disclosed in other applications and patents to the applicant.

<FIG> and <FIG> illustrate an example of the surgical implant in accordance with the disclosed subject matter. The implant may be formed of any materials suitable for implantation into the body of a patient. The implant in accordance with the disclosed subject matter is at least partially encapsulated in a biocompatible material. The implant may be substantially encapsulated at least in one layer of a biocompatible polymer including at least one of silicone, phenyltrimethoxysilane (PTMS), polymethyl methacrylate (PMMA), parylene C, polyimide, liquid polyimide, laminated polyimide, epoxy, polyether ether ketone (PEEK), liquid crystal polymer (LCP), KAPTON, or combinations thereof. In addition, the implant may be encapsulated at least in one layer of a biocompatible polymer, and include one or more additional layer covering portions thereof. It will be appreciated that the implant may include ceramic material, thermoplastic material such as ULTEM, or other compatible materials.

The surgical implant, generally designated <NUM>, comprises a substantially planar central body portion <NUM> having a top side <NUM> and a bottom side <NUM>; two adjustable wing portions 132A and 132B; connecting members 134A and 134B (in the illustrated example, each connecting member comprising two elements 136A and 136B as will be further described hereinafter). The connecting members extending respectively from opposite sides of the central body portion <NUM>, each of the connecting members is configured for flexibly connecting each one of the two wing portions 132A and 132B to said central body portion <NUM> at opposite sides thereof.

While the description provides for the structural features of the disclosed surgical implant, in accordance with the disclosed subject matter the implant further comprises
electronic components configured to stimulate a nerve when implanted in a subject in a location that permits it to modulate a nerve (e.g. as seen in <FIG>) as will be discussed, without being in a direct contact with the nerve to be modulated/stimulated. When used to stimulate a nerve for the treatment of obstructive sleep apnea, the implant unit <NUM> may be placed on a genioglossus muscle so as to neuromodulate a hypoglossal nerve, which at least partially may extend within the muscle. In one example, due to the structure of the surgical implant, its flexibility and the degrees of freedom of the connecting members and the wing portions, it allows for neuromodulation of nerve branches otherwise not accessible as these are either extending within the muscle tissue or are branched out such that only emitting of electrical filed over an area covering the respective branches of the nerve will permit neuromodulating of the nerve, such as the terminal branches of the hypoglossal nerve.

For example, implant may include an antenna a (seen e.g. in <FIG> and <FIG>) and associated electronic circuit and components mounted onto or integrated with central body portion (<NUM>, details not shown). The antenna a may include any suitable antenna known to those skilled in the art that may be configured to send and/or receive signals and power. The antenna may include any suitable size, shape, and/or configuration accommodated by the dimensions of the implant. The size, shape and/or configuration may be determined by the patient anatomy, the placement location of the implant unit, the amount of energy required to neuromodulate the nerve, etc. Suitable antennas may include, but are not limited to, a long-wire antenna, a patch antenna, a helical antenna, PCB antenna, etc..

Implant may additionally include a plurality of field-generating implant electrodes generally designated e (e.g. <FIG>, <FIG>, <FIG>). The electrodes e may include any suitable shape and/or orientation on the implant unit so long as the electrodes may be configured to generate an electric field in the body of a patient. Implant electrodes may also include any suitable conductive material (e.g., copper, silver, gold, platinum, iridium, platinum-iridium, platinum-gold, conductive polymers, etc.) or combinations of conductive (and/or noble metals) materials. In some embodiments, for example, the electrodes may include short line electrodes, circular electrodes, and/or circular pairs of electrodes. As shown in <FIG>, electrodes e may be located on the wing portions connected by connecting wires W to the electronic components and the antenna on the central body portion.

The electrodes e, however, may be located on any portion of wing portions. The connecting wires are configured to extend through the connecting members and are sized and shaped to be encapsulated therein. In accordance with an example, the wires W extend in designated channels. In accordance with yet an example, the wires may extend in designated reinforced channels. In accordance with some examples, the connecting members are provided with designated channels (not shown) configured to retain the connecting wires in place and further facilitating the flexibility of the connecting members without braking or damaging the wires and their respective connections to the components on the central body portion and the respective electrode. The implant may further include circuit components <NUM> and any other required components facilitating the antenna to receive the energy and transmitting this energy for the electrodes to emit the electric filed to the nerves. In the illustrated example, the implant does not comprise a power source. The implant in the illustrated example is activated externally. It will be appreciated that other means of activating the implant can be envisioned, either externally or internally. The implant unit can be activate using wifi, RF, IR or Bluetooth technologies.

Implant electrodes e may be spaced apart by about a distance of about <NUM> to <NUM>. In other embodiments, the electrodes may be spaced apart by a distance of approximately up to <NUM>. In accordance with yet an example, the distance may be approximately <NUM>-<NUM> measured between the internal edges of the electrodes. To protect the antenna, electrodes, circuit components, and connecting wires from the environment within a patient's body, implant may include a protective coating that encapsulates the implant <NUM>. In some embodiments, the protective coating may be made from a flexible material to enable bending thereof, such as silicone. The encapsulation material of the protective coating may also resist humidity penetration and protect against corrosion. The surgical implant is substantially sealed and impervious to fluid. The term "substantially sealed implant" as used herein refers to the condition of having a sufficiently low unintended leakage and permeation rate under given fluid flow or pressure conditions. It will be appreciated that the first pair of electrodes and the second pair of electrodes may be partially covered at their periphery with the encapsulating material, having at least a portion thereof exposed however sealing the implant such that no fluid will enter or exit through the seal surrounding the open window of the electrodes. For example, the first pair of electrodes and the second pair of electrodes are partially embedded within the encapsulating material and comprise an outer layer of encapsulating material extending thereover and leaving at least a portion thereof exposed to the environment.

As seen in <FIG>, each one of the two connecting members is constituted by two parallelly extending arched elongated elements 136A and 136B, each extending at an angle and hingedly from the central body <NUM>, such that the connecting members are integrally formed with and extend from the central body portion, allowing for at least one degree of freedom, as will be discussed. Such a connecting may be through a hinge which may be a living hinge, integral hinge, segmented hinge, etc. The arched elongated segments extend from the side edge <NUM> and project above the top side <NUM> of the central body portion <NUM>, as best seen in <FIG>, with the wing portions 132A and 132B, each integrally formed with and extending from the opposite ends of the elongated segments. These elongated segments in accordance with the example, house the connecting wires W extending from the components contained in the central body portion to the respective electrodes e disposed on the wing portions 132A and 132B. the wires are provided in a configuration that will allow their deformation without disconnection from the main body or the electrodes. For examples the wire may be in excess, e.g. undulation, coiled etc. It will be appreciated, that while in the exemplified implant <NUM>, each connecting member comprises two separate segments, in accordance with the disclosed subject matter, the connecting member may be a single segment. In accordance with another example, the two separate members may be connected with a connecting layer therebetween, either continuously, leaving no opening between the arched elongated segments, or with a non-continuous, layer, interconnecting the segments.

As further seen in <FIG>, each one of the two wing portions is integrally articulated to the respective elongated segments (extension members) extending between the central body portion and the two wing portions.

The connecting member may be a flexible element configured to deform in at least one direction. The connecting member can be of a unitary thickness or as exemplified and best seen in <FIG> of thickness decreasing from the portion closest to the area of connection with the central body designated H to thickness designated h at the portion closer to the wing portions. The decrease in thickness can be gradual (as shown) or alternatively provided in segments. Such decrease in thickness provides for flexibility of the connecting members and allows for degrees of freedom both to the connecting members and the movement of the wing portions. The connecting members are configured to endure strain, particularly due to being bent, folded, or stretched, without breaking or suffering permanent injury. "Flexible" as used herein may or may not include the further properties of being resilient or elastic. Deformation could refer to at least one parameter change, e.g. change of length, thickness etc. in a pre-specified space.

The connecting members allow several degrees of freedom to the two wing portions as best illustrated in <FIG> and <FIG>. The connecting members are configured with flexibility along the length thereof and at least at points designated C, B and A, where point C designates the section at the connection of the elongated segment to the central body portion, point B designates the segment at around the center of the arch of the elongated member and point A designates the segment integrally connecting the elongated members to the wing portions. Thus as seen in <FIG> at point B the elongated segment is allowed to deform and open the arch and move the wing portion at an angle α which can be between <NUM> degrees and up to <NUM> degrees. In other examples, the angle α can extend between -<NUM> (e.g. in a direction towards the bottom side <NUM>) to <NUM> degrees, or as shown at about <NUM> degrees. The wing portion can pivot at point A at angle δ which can be between <NUM> degrees to about <NUM> degrees. In other examples, the angle can extend between -<NUM> (e.g. towards the bottom side <NUM>) to <NUM> degrees, or as illustrated up to <NUM> degrees. It will be appreciated that while the angular displacement has been shown separately for each of the points a combination of displacement is allowed and the wing portions can be angled in combination with the angular or other deformation of the connecting members. In accordance with disclosed subject matter and illustrated example, <NUM> degrees is the resting position of the element which has the degree of freedom to change position(s).

As further seen in <FIG>, the wing portions can be displaced in the direction of arrow X (e.g. horizontally), arrow Z (vertically) or arrow Y (angularly, e.g. inwards the central portion or outwardly therefrom, where the wing portions can flex towards or away from each other). Such flexibility along multitude of dimensions, allow positioning of the implant and in particular its wing portions over the treated muscle, in a saddle like position and conform to the dimensions of the muscle, which may be different from subject to subject. The disposition of the wing portion is further defined by angle β which provide for an angle between the edge <NUM> of the wing and the horizontal plane extending through the central body portion. The angle β can be between about <NUM> degrees to <NUM> degrees, and in the illustrated example is between <NUM> to <NUM> degrees.

As already discussed, the surgical implant may be formed from a unitary elastomeric material. To allow anchoring of the implant in its designated position the implant may be provided with anchoring arrangements. In the disclosed example, the anchoring arrangement is in the form of suturing holes (e.g. <NUM>, <NUM>). As the implant is made of an elastomeric material, to reinforce the suturing holes, the implant may be provided with anchoring elements made of a material configured to withstand the forces acting on the implant and the sutures, e.g. during the tongue movement. Such a material can be e.g. a PEEK, ceramic, titanium etc..

As seen in <FIG> the suturing holes <NUM> can be provided at the wing portions at the desired location. In addition, other anchoring elements can be provided at the central body portion, e.g. adjacent the edges thereof as seen in <FIG> designated as <NUM>. It will be appreciated that other configurations for anchoring the implant are envisioned and while for example the central body portion comprises four such holes, only few or none of these can be provided. In addition, the positioning of the suture holes on the wing portions as illustrated in the accompanying drawings are for illustration purposes only and other shapes, configurations and positions thereof are envisioned. Other types of anchoring arrangements are envisioned, such as adhesives, staples etc, as disclosed herein. The central body portion can further be provided with a load bearing reinforcing structure <NUM>, internally disposed, and configured to provide structural rigidity to the central body portion. The reinforcing structure can be resilient and allow for a degree of flexibility to the central body portion when force is applied thereto in the direction of arrow E, allowing at least a portion of the central body portion to flex e.g. as seen in <FIG>. the reinforcing structure in the illustrated example is provided through the central body and provides for a walled structured <NUM> to surround the electronics <NUM> and also longitudinal ribs <NUM> as seen e.g. in <FIG>. It will be appreciated the reinforcing structure may have a different structure, e.g. crossed ribs to form a net like structure, a spiral, e.g. interconnected stips, etc. to provide for the same function of reinforcement and substantial exposure of the antenna a and the electronic parts.

The implant may further comprise a surgical mesh, e.g. polymeric mesh, provided at least over a portion thereof. In another example, the surgical mesh may be of any suitable material. In another aspect of the disclosed subject matter there is disclosed an implant unit activation device illustrated in <FIG> and generally designated <NUM>. The device, comprises a main body <NUM> comprising an implant activator and an axially displaceable retractor <NUM> configured to displace relative the main body.

The implant activator comprises an antenna, a power source and associated circuitry (not shown) and being configured to wirelessly transfer energy from the power source to an implant unit (e.g. surgical implant <NUM>) during implantation of the implant unit into the body of a subject to cause stimulation of at least one nerve in the body of the subject during the implantation procedure. The axial displacement of the retractor <NUM> allows adjusting of the degree of energy received by the implant unit. The activation device is configured to deliver energy to the implant unit with the retractor allowing to displace or more particularly retract the activation unit in the direction of arrow P (seen in <FIG>) from the implant so as to control the amount of energy received by the implant unit as a function of distance at which it is delivered thereto. As an alternative example, the axis of
displacement may comprise e.g. displacement along axis Q and\or R (e.g. as shown in <FIG> and <FIG>).

The retractor <NUM> is in this example a sleeve like member configured to controllably slide over the main shaft S of the activation device main body. The sleeve like member defines a hollowed and axially extending interior which securably mounts over the shaft of the main body. To facilitate the retraction, the sleeve like member is provided with a release lever <NUM> and engagement mechanism <NUM>, such that the engagement mechanism is configured to selectively engage the corresponding engaging members <NUM> on the shaft of the main body. In the present example the shaft is provided with toothed surface <NUM> and the inner side of the sleeve is provided with the engagement mechanism <NUM> constituted by a protrusion configured to engage the toothed surface to lock thereagainst. The main body shaft may be provided with indicia <NUM> allowing the user to determine the location at which it is desired to lock the sleeve against the shaft. As seen in <FIG>, the shaft is provided with a protrusion <NUM> which when aligned with the sleeve extends slidable in a slit <NUM> in the sleeve which in the example extends at two opposite sides of the sleeve as seen in <FIG>. It will be appreciated that other configurations are envisioned that will allow the main body of the activation device to be distanced from the implant unit keeping the device at the predetermined position with respect to the implant unit. The sleeve can further be provided with a support and gripping element <NUM> to allow the user to grip the sleeve, while activating the lever <NUM> to release the engagement of the mechanism <NUM> and retracting the shaft body through the sleeve to distance its end portion <NUM> from the opening <NUM> in the sleeve.

As seen in the illustrated example, the edge of the device <NUM> is angled to enable line of sight during use and for ergonomic considerations. It will be appreciated, that while in the illustrated example the amount of energy or power level is determined by the axial movement of the retractor, other examples include a screw on sleeve, partial elements extending from the shaft and configured to distance the edge of the shaft from the point of contact with the implant device. In an alternative example, the amount and level of energy may be controlled directly through the device, without adjusting the distance between the shaft edge relative the implant device.

An exemplary method of positioning and activating a neurostimulation implant device (e.g. surgical implant <NUM>) in accordance with the disclosed subject matter is provided. The method in accordance with the disclosed subject matter, comprises:
providing the implant and positioning it over the tissue of the subject, e.g. the genioglossus muscle.

Providing an implant unit activation device as disclosed, the device comprising: a main body comprising an implant activator having a power source, a second antenna configured to provide a signal to the first antenna and an axially displaceable adaptor\retractor associated with the implant activator, the implant activator configured to wirelessly transfer energy from a power source to the implant during implantation to cause modulation of at least one nerve in the body of the subject; and
wherein the axial displacement (e.g. retraction) of the adaptor from at least a first position to at least a second position allows adjusting of the degree of energy received by the implant unit.

To determine the correct location for positioning the implant and in particular the electrodes to stimulate the nerve, next step comprises identifying the stimulation threshold by determining a degree of nerve modulation response for each of the at least first pair of electrodes and a second pair of electrodes by positioning said first pair of electrodes at an estimated implant location proximal to the nerve and selectively displacing the second antenna to deliver a first amount of power and a second amount of power required to obtain a stimulation threshold in at least the first pair of electrodes based on one or more patient signals;.

In one embodiment the implant may be configured for treatment of obstructive sleep apnea and the location of implantation may be in the vicinity of the hypoglossal
nerve. In accordance with this embodiment the neurostimulation device may be configured to modulate at least one branch of the hypoglossal nerves.

The second amount may be greater or equal to the first amount of power. The second amount may be equal to or less relative the first amount of power.

Claim 1:
A surgical implant (<NUM>) for delivering neuromodulation/neurostimulation comprising:
a. a substantially planar central body portion (<NUM>) having a top side (<NUM>) and a bottom side (<NUM>);
b. at least two adjustable wing portions (132A, 132B), each of said wing portions (132A, 132B) including a plurality of electrodes (e) configured to generate an electric field within the body of a patient;
c. at least two connecting members (134A, 134B), each one of the at least two connecting members (134A, 134B) extending from opposite sides of the central body portion (<NUM>), the each one of the at least two connecting members (134A, 134B) being configured for flexibly connecting each one of the at least two wing portions (132A, 132B) at opposite sides to said central body portion (<NUM>),
wherein at least the central body portion (<NUM>) is further provided with an internally disposed load bearing reinforcing structure (<NUM>), configured to provide structural rigidity to the central body portion (<NUM>).