Patent Application: US-66988208-A

Abstract:
hypertension may be caused by central nervous system - mediated effort to maintain a certain level of blood flow within the brain . a method is described for using neuromodulation techniques to lower central drive for hypertension .

Description:
in general , methods of lower systemic blood pressure in accordance with the present invention include 1 ) an “ indirect ” method in which overall cerebral blood flow is induced to rise using transcranial magnetic stimulation or other transcranial approach to the frontal , temporal , parietal , or occipital cortex , or to the cerebellum , thereby secondarily triggering to lowering of blood pressure regions , and 2 ) a “ direct ” method in which the solitary nucleus and tract of the brainstem or related circuitry is directly stimulated using transcranial magnetic stimulation or other transcranial approach . fig1 a , 1 b , and 1 c outline the basic steps of some of the methods described herein . in fig1 a , a method is described in which increasing cerebral perfusion in general is used to effect an antihypertensive treatment . in step 105 a region of a hypertensive patient is studied , and a region of that patient &# 39 ; s brain in selected to be the primary target for stimulation . this region could be the entire brain , for example using a large coil or a coil array that encircles the head , or could be a specific region , for example the brainstem . in step 110 that region is stimulated in a manner that is anticipated to increase blood flow in the brain or brainstem . stimulation means may include repetitive transcranial magnetic stimulation ( rtms ), stereotactic transcranial magnetic stimulation ( stms ) as described in u . s . ser . no . 10 / 821 , 807 , u . s . ser . no . 11 / 429 , 504 . stimulation means may also include the implanted electrodes of deep brain stimulation ( dbs ) as is known in the art , superficial cortical stimulation grids , and transcranial direct current stimulation ( tdcs ) ( lang , et al 2005 ). steps 115 through 130 describe the physiological responses that are evoked in response to targeted stimulations cited stimuli act upon those physiological circuits as described above . in step 115 , the body is stimulated to increase the metabolism of the stimulated brain region . for example , in step 120 , the body is stimulated to increase blood flow to the stimulated area . in step 125 , stimulation proceeds until the brain detects this increased flow with its intrinsic pressure receptor and flow sensors . areas in which these sensors are located are probably many , and include the solitary tract and nucleus ( nucleus tractus solitarii ) ( paton et al 2007 , waki et al 2007 , vayssettes - courchay et al 1993 ). in step 130 , the stimulation leads to detection of increased blood flow , triggering lower blood pressure through its intrinsic mechanisms , including downregulation of vascular tone , cardiac output , and blood volume . fig1 b outlines a method by which hypertension is treated by direct stimulation of the solitary nucleus and tract . in step 140 , the solitary nucleus and tract are stimulated , for example magnetically using a transcranial magnetic stimulation as shown in the subsequent figures and description , for example at a pulse rate of 5 hz , 3500 pulses delivered per day for 20 consecutive weekdays . in step 145 , the nucleus interprets this stimulation as signals of hypertension , in much the same manner that it normally interprets such activity as input from the baroreceptors in the carotid bodies and aortic bodies , and acts to lower blood pressure by its endogenous abilities based on the stimulation . fig2 illustrates examples of two anatomic locations for interventions in accordance with the steps outlined in fig1 a . tms coil 220 and tms coil 230 may be 70 mm air - cooled double coil attached to a rapid2 stimulator machine ( magstim ltd ., wales , uk ), and are shown in perspective to represent placement at an angle to the viewing plane . tms coil 220 is centered over brain area target 235 . tms coil 230 is shown placed in a posterior parietal location , as an example of an alternate placement . fig3 a and 3b shows the use of multiple - coil arrays , like those described in “ robotic device for stereotactic transcranial magnetic stimulation .” schneider mb and mishelevich dj u . s . ser . no . 10 / 821 , 807 , and in “ trajectory - based transcranial magnetic stimulation ” mishelevich dj and schneider mb , pending u . s . patent application ser . no . 11 / 429 , 504 . in fig3 a , coils 305 , 310 , and 315 surround the posterior aspect of the head , and may be moveable or stationary . in fig3 a the central coil 325 ( equivalent to coil 305 in fig3 a ) is shown in transparency . solitary nucleus and tract 350 is shown in the lower pons and the medulla , roughly beneath the center of coil 325 . coil 320 and 330 are equivalent to coil 210 and 315 , respectively . ohnishi t , matsuda h , imabayashi e , okabe s , takano h , arai n , ugawa y . rcbf changes elicited by rtms over dlpfc in humans . suppl clin neurophysiol . 2004 ; 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