A vestibular prosthesis with highly-isolated parallel multichannel stimulation.

This paper presents an implantable vestibular stimulation system capable of providing high flexibility independent parallel stimulation to the semicircular canals in the inner ear for restoring three-dimensional sensation of head movements. To minimize channel interaction during parallel stimulation, the system is implemented with a power isolation method for crosstalk reduction. Experimental results demonstrate that, with this method, electrodes for different stimulation channels located in close proximity ( mm) can deliver current pulses simultaneously with minimum inter-channel crosstalk. The design features a memory-based scheme that manages stimulation to the three canals in parallel. A vestibular evoked potential (VEP) recording unit is included for closed-loop adaptive stimulation control. The main components of the prototype vestibular prosthesis are three ASICs, all implemented in a 0.6- μm high-voltage CMOS technology. The measured performance was verified using vestibular electrodes in vitro

Advances in Microelectronics for Implantable Medical Devices

Implantable medical devices provide therapy to treat numerous health conditions as well as monitoring and diagnosis. Over the years, the development of these devices has seen remarkable progress thanks to tremendous advances in microelectronics, electrode technology, packaging and signal processing techniques. Many of today’s implantable devices use wireless technology to supply power and provide communication. There are many challenges when creating an implantable device. Issues such as reliable and fast bidirectional data communication, efficient power delivery to the implantable circuits, low noise and low power for the recording part of the system, and delivery of safe stimulation to avoid tissue and electrode damage are some of the challenges faced by the microelectronics circuit designer. This paper provides a review of advances in microelectronics over the last decade or so for implantable medical devices and systems. The focus is on neural recording and stimulation circuits suitable for fabrication in modern silicon process technologies and biotelemetry methods for power and data transfer, with particular emphasis on methods employing radio frequency inductive coupling. The paper concludes by highlighting some of the issues that will drive future research in the field

A Multichannel High-Frequency Power-Isolated Neural Stimulator With Crosstalk Reduction

In neuroprostheses applications requiring simultaneous stimulations on a multielectrode array, electric crosstalk, the spatial interaction between electric fields from various electrodes is a major limitation to the performance of multichannel stimulation. This paper presents a multichannel stimulator design that combines high-frequency current stimulation (using biphasic charge-balanced chopped pulse profile) with a switched-capacitor power isolation method. The approach minimizes crosstalk and is particularly suitable for fully integrated realization. A stimulator fabricated in a 0.6 & #x03BC;m CMOS high-voltage technology is presented. It is used to implement a multichannel, high-frequency, power-isolated stimulator. Crosstalk reduction is demonstrated with electrodes in physiological media while the efficacy of the high-frequency stimulator chip is proven in vivo. The stimulator provides fully independent operation on multiple channels and full flexibility in the design of neural modulation protocols

The Vestibular Implant: Quo Vadis?

Objective: To assess the progress of the development of the vestibular implant (VI) and its feasibility short-term. Data sources: A search was performed in Pubmed, Medline, and Embase. Key words used were “vestibular prosth*” and “VI.” The only search limit was language: English or Dutch. Additional sources were medical books, conference lectures and our personal experience with per-operative vestibular stimulation in patients selected for cochlear implantation. Study selection: All studies about the VI and related topics were included and evaluated by two reviewers. No study was excluded since every study investigated different aspects of the VI. Data extraction and synthesis: Data was extracted by the first author from selected reports, supplemented by additional information, medical books conference lectures. Since each study had its own point of interest with its own outcomes, it was not possible to compare data of different studies. Conclusion: To use a basic VI in humans seems feasible in the very near future. Investigations show that electric stimulation of the canal nerves induces a nystagmus which corresponds to the plane of the canal which is innervated by the stimulated nerve branch. The brain is able to adapt to a higher baseline stimulation, while still reacting on a dynamic component. The best response will be achieved by a combination of the optimal stimulus (stimulus profile, stimulus location, precompensation), complemented by central vestibular adaptation. The degree of response will probably vary between individuals, depending on pathology and their ability to adapt

A Versatile Hermetically Sealed Microelectronic Implant for Peripheral Nerve Stimulation Applications

This article presents a versatile neurostimulation platform featuring a fully implantable multi-channel neural stimulator for chronic experimental studies with freely moving large animal models involving peripheral nerves. The implant is hermetically sealed in a ceramic enclosure and encapsulated in medical grade silicone rubber, and then underwent active tests at accelerated aging conditions at 100°C for 15 consecutive days. The stimulator microelectronics are implemented in a 0.6-μm CMOS technology, with a crosstalk reduction scheme to minimize cross-channel interference, and high-speed power and data telemetry for battery-less operation. A wearable transmitter equipped with a Bluetooth Low Energy radio link, and a custom graphical user interface provide real-time, remotely controlled stimulation. Three parallel stimulators provide independent stimulation on three channels, where each stimulator supports six stimulating sites and two return sites through multiplexing, hence the implant can facilitate stimulation at up to 36 different electrode pairs. The design of the electronics, method of hermetic packaging and electrical performance as well as in vitro testing with electrodes in saline are presented

An Integrated Passive Phase-Shift Keying Modulator for Biomedical Implants With Power Telemetry Over a Single Inductive Link

This paper presents a passive phase-shift keying (PPSK) modulator for uplink data transmission for biomedical implants with simultaneous power and data transmission over a single 13.56 MHz inductive link. The PPSK modulator provides a data rate up to 1.35 Mbps with a modulation index between 3% and 38% for a variation of the coupling coefficient between 0.05 and 0.26. This modulation scheme is particularly suited for biomedical implants that have high power demand and low coupling coefficients. The PPSK modulator operates in conjunction with on-off-keying downlink communication. The same inductive link is used to provide up to 100 mW of power to a multi-channel stimulator. The majority of the system on the implant side was implemented as an application specific integrated circuit (ASIC), fabricated in 0.6-[Formula: see text] high voltage CMOS technology. The theory of PPSK modulation, simulated and measured performance evaluation, and comparison with other state-of-the-art impedance modulation techniques is presented. The measured bit error rate around critical coupling at 1.35 Mbps is below 6 ×10(-8)

An Implantable Wireless Multi-Channel Neural Prosthesis for Epidural Stimulation

This paper presents a fully implantable multi-channel neural prosthesis for epidural stimulation. The prosthesis features three telemetry-operated independent stimulators providing in total eighteen stimulation channels. The stimulator circuits were implemented in a 0.6-μm CMOS technology. The prosthesis is protected in a hermetically sealed ceramic enclosure and encapsulated in medical grade silicone rubber. In-vitro measured results with electrodes in saline are presented

Continuous Restoration of the Human Vestibulo-Ocular Reflex Using a Multichannel Vestibular Implant

Bilateral loss of vestibular sensation causes blurry vision during head movement, postural instability, chronic unsteadiness, and an increased fall risk. Individuals who fail to compensate despite rehabilitation therapy and cessation of exacerbating medications have no adequate treatment options. Inspired by the success of cochlear implants in restoring hearing, prosthetic stimulation of vestibular afferent neurons to encode head motion has been investigated as a potential treatment. Until now, no human had been continuously stimulated for more than a day, and human responses had not been assessed using 3-dimensional (3D) binocular oculography, without which one cannot determine whether an implant independently stimulates each of the implanted ear’s three semicircular canals. We report 3D binocular vestibulo-ocular reflex (VOR) responses in four human subjects with bilateral vestibular loss who were each implanted with a system designed to provide long-term motion-modulated prosthetic stimulation via electrodes in the semicircular canals of one ear. Initiation of prosthetic stimulation evoked nystagmus that decayed within 30 minutes. Stimulation targeting one canal produced 3D VOR responses aligned with that canal’s anatomic axis, while targeting canal pairs reliably yielded responses aligned with a vector sum of individual responses. Over 8 weeks of continuous use, modulated electrical stimulation produced robust and stable VOR responses that grew predictably with stimulus intensity and aligned approximately with any specified 3D head rotation axis. Combining mechanical and electrical stimulation enhanced low frequency responses. These results demonstrate that a vestibular implant can partially restore 3D inner ear sensation to individuals disabled by vestibular loss. Lastly, we show that temporal discretization inherent to cochlear implant signal processing has minimal effects on evoked responses, motivating a future combined device

Restoring Sensation of Gravitoinertial Acceleration through Prosthetic Stimulation of the Utricle and Saccule

Individuals with bilateral vestibular hypofunction suffer reduced quality of life due to loss of postural and ocular reflexes essential to maintaining balance and visual acuity during head movements. Vestibular stimulation has demonstrated success in restoring sensation of angular head rotations using electrical stimulation of the semi-circular canals (SCCs). Efforts toward utricle and saccule stimulation to restore sensation of gravitoinertial acceleration have been limited due to the complexity of the otolith end organs and otolith-ocular reflexes (OORs). Four key pieces of technology were developed to extend prosthetic stimulation to the utricle and saccule: a low-noise scleral coil system to record binocular 3D eye movements; a motion platform control system for automated presentation of rotational and translational stimuli; custom electrode arrays with fifty contacts targeting the SCCs, utricle and saccule; and a general-purpose neuroelectronic stimulator for vestibular and other neuromodulation applications. Using these new technologies, OORs were first characterized in six chinchillas to establish OOR norms during translations and static tilts. Results led to creation of a model that infers the axis of head tilt from measured binocular eye movements and thereby provides a context and means to assess the selectivity of prosthetic utricle and saccule stimulation. The model confirms the expectation that excitation of the left utricle and saccule primarily encodes tilts that bring the left ear down. Three of the chinchillas were implanted with electrode arrays in the left ear. Step changes in pulse rate were delivered to utricle and saccule electrodes near the maculae while measuring 3D binocular eye movements with the animal stationary in darkness. These stimuli elicited sustained ocular counter-roll responses that increased in magnitude as pulse rate or amplitude increased. Bipolar stimulation via neighboring electrodes elicited slow-rising or delayed onset of ocular counter-rolls (consistent with normal translational OOR low-pass filter behavior). Two chinchillas showed different direction of electrically-evoked ocular counter-roll between utricle versus saccule stimulation. Only near-neighbor bipolar electrode combinations elicited eye responses compensatory for tilts other than the ‘usual’ left ear down, suggesting the need for distributing multiple bipolar electrode pairs across the maculae to achieve selective stimulation and restore 3D sensation of gravitoinertial acceleration

A Multi-Channel Stimulator With High-Resolution Time-to-Current Conversion for Vagal-Cardiac Neuromodulation

This paper presents an integrated stimulator for a cardiac neuroprosthesis aiming to restore the parasympathetic control after heart transplantation. The stimulator is based on time-to-current conversion. Instead of the conventional current mode digital-to-analog converter (DAC) that uses ten of microamp for biasing, the proposed design uses a novel capacitor time-based DAC offering close to 10 bit of current amplitude resolution while using only a bias current 250 nA. The stimulator chip was design in a 0.18 m CMOS high-voltage (HV) technology. It consists of 16 independent channels, each capable of delivering 550 A stimulus current under a HV output stage that can be operated up to 30 V. Featuring both power efficiency and high-resolution current amplitude stimulation, the design is suitable for multi-channel neural simulation applications