완전 이식형 시각 보철 시스템을 위한 연구

학위논문(박사)--서울대학교 대학원 :공과대학 전기·정보공학부,2020. 2. 김성준.A visual prosthetic system typically consists of a neural stimulator, which is a surgically implantable device for electrical stimulation intended to restore the partial vision of blind patients, and peripheral external devices including an image sensor, a controller, and a processor. Although several visual prosthetic systems, such as retinal prostheses or retinal implants, have already been commercialized, there are still many issues on them (e.g., substrate materials for implantable units, electrode configurations, the use of external hardware, power supply and data transmission methods, design and fabrication approaches, etc.) to be dealt with for an improved visual prosthetic system. In this dissertation, a totally implantable visual prosthetic system is suggested with four motivations, which are thought to be important, as in the following: 1) simple fabrication of implantable parts, such as micro-sized electrodes and a case, for a neural stimulator based on polymer without semiconductor techniques, 2) multi-polar stimulation for virtual channel generation to overcome a limited number of physical electrodes in a confined space, 3) a new image acquisition strategy using an implantable camera, and 4) power supply as well as data transmission to a neural stimulator without hindering patients various activities. First, polymer materials have been widely used to develop various implantable devices for visual prosthetic systems because of their outstanding advantages including flexibility and applicability to microfabrication, compared with metal, silicon, or ceramic. Most polymer-based implantable devices have been fabricated by the semiconductor technology based on metal deposition and photolithography. This technology provides high accuracy and precision for metal patterning on a polymer substrate. However, the technology is also complicated and time-consuming as it requires masks for photolithography and vacuum for metal deposition as well as huge fabrication facilities. This is the reason why biocompatible cyclic olefin polymer (COP) with low water absorption (<0.01 %) and high light transmission (92 %) was chosen as a new substrate material of an implantable device in this study. Based on COP, simple fabrication process of an implantable device was developed without masks, vacuum, and huge fabrication facilities. COP is characterized by strong adhesion to gold and high ultraviolet (UV) transparency as well. Because of such adhesion and UV transparency, a gold thin film can be thermally laminated on a COP substrate with no adhesion layer and micromachined by a UV laser without damaging the substrate. Using the developed COP-based process, a depth-type microprobe was fabricated first, and its electrochemical and mechanical properties as well as functionality were evaluated by impedance measurements, buckling tests, and in vivo neural signal recording, respectively. Furthermore, the long-term reliability of COP encapsulation formed by the developed process was estimated through leakage current measurements during accelerated aging in saline solution, to show the feasibility of the encapsulation using COP as well. Second, even if stimulation electrodes become sufficiently small, it is demanding to arrange them for precise stimulation on individual neurons due to electrical crosstalk, which is the spatial superposition of electric fields generated by simultaneous stimuli. Hence, an adequate spacing between adjacent electrodes is required, and this causes a limited number of physical electrodes in a confined space such as in the brain or in the retina. To overcome this limitation, many researchers have proposed stimulation strategies using virtual channels, which are intermediate areas with large magnitudes of electric fields between physical electrodes. Such virtual channels can be created by multi-polar stimulation that can combine stimuli output from two or more electrodes at the same time. To produce more delicate stimulation patterns using virtual channels herein, penta-polar stimulation with a grid-shaped arrangement of electrodes was leveraged specially to generate them in two dimensions. This penta-polar stimulation was realized using a custom-designed integrated circuit with five different current sources and surface-type electrodes fabricated by the developed COP-based process. The effectiveness of the penta-polar stimulation was firstly evaluated by focusing electric fields in comparison to mono-polar stimulation. In addition, the distribution of electric fields changed by the penta-polar stimulation, which indicated virtual channel generation, was estimated in accordance with an amplitude ratio between stimuli of the two adjacent electrodes and a distance from them, through both finite element analysis and in vitro evaluation. Third, an implantable camera is herein proposed as a new image acquisition approach capturing real-time images while implanted in the eye, to construct a totally implantable visual prosthetic system. This implantable camera has distinct advantages in that it can provide blind patients with benefits to perform several ordinary activities, such as sleep, shower, or running, while focusing on objects in accordance with natural eye movements. These advantages are impossible to be achieved using a wearing unit such as a glasses-mounted camera used in a conventional partially implantable visual prosthetic system. Moreover, the implantable camera also has a merit of garnering a variety of image information using the complete structure of a camera, compared with a micro-photodiode array of a retinal implant. To fulfill these advantageous features, after having been coated with a biocompatible epoxy to prevent moisture penetration and sealed using a medical-grade silicone elastomer to gain biocompatibility as well as flexibility, the implantable camera was fabricated enough to be inserted into the eye. Its operation was assessed by wireless image acquisition that displayed a processed black and white image. In addition, to estimate reliable wireless communication ranges of the implantable camera in the body, signal-to-noise ratio measurements were conducted while it was covered by an 8-mm-thick biological medium that mimicked an in vivo environment. Lastly, external hardware attached on the body has been generally used in conventional visual prosthetic systems to stably deliver power and data to implanted units and to acquire image signals outside the body. However, there are common problems caused by this external hardware, including functional failure due to external damages, unavailability during sleep, in the shower, or while running or swimming, and cosmetic issues. Especially, an external coil for power and data transmission in a conventional visual prosthetic system is connected to a controller and processor through a wire, which makes the coil more vulnerable to the problems. To solve this issue, a totally implantable neural stimulation system controlled by a handheld remote controller is presented. This handheld remote controller can control a totally implantable stimulator powered by a rechargeable battery through low-power but relatively long-range ZigBee wireless communication. Moreover, two more functions can be performed by the handheld controller for expanded applications; one is percutaneous stimulation, and the other is inductive charging of the rechargeable battery. Additionally, simple switches on the handheld controller enable users to modulate parameters of stimuli like a gamepad. These handheld and user-friendly interfaces can make it easy to use the controller under various circumstances. The functionality of the controller was evaluated in vivo, through percutaneous stimulation and remote control especially for avian navigation, as well as in vitro. Results of both in vivo experiments were compared in order to verify the feasibility of remote control of neural stimulation using the controller. In conclusion, several discussions on results of this study, including the COP-based simple fabrication process, the penta-polar stimulation, the implantable camera, and the multi-functional handheld remote controller, are addressed. Based on these findings and discussions, how the researches in this thesis can be applied to the realization of a totally implantable visual prosthetic system is elucidated at the end of this dissertation.시각 보철 시스템은 일반적으로 실명 환자들의 부분 시력을 전기 자극으로 회복시키기 위하여 수술적으로 이식될 수 있는 장치인 신경 자극기와 이미지 센서 또는 컨트롤러, 프로세서를 포함하는 외부의 주변 장치들로 구성된다. 망막 보철 장치 또는 망막 임플란트와 같이 몇몇 시각 보철 시스템은 이미 상용화 되었지만, 여전히 더 나은 시각 보철 시스템을 위하여 다뤄져야 할 많은 이슈들 (예를 들어, 이식형 장치의 기판 물질, 전극의 배열, 외부 하드웨어의 사용, 전력 공급 및 데이터 전송 방법, 설계 및 제작 방식 등)이 있다. 본 학위논문은 완전 이식형 시각 보철 시스템을 제안하며, 이를 위하여 다음과 같이 중요하다고 생각되는 총 네 가지의 이슈들과 관련된 연구 내용을 다룬다. 1) 폴리머를 기반으로 한 신경 자극기의 미세 전극 및 패키지와 같은 이식 가능한 부분을 반도체 기술 없이 간단하게 제작하는 방법과 2) 제한된 공간에서 전극 개수의 물리적인 한계를 극복하기 위하여 가상 채널을 형성하는 다극성 자극 방식, 3) 이식형 카메라를 사용하는 새로운 이미지 획득 전략, 4) 환자의 다양한 활동을 방해하지 않으면서 신경 자극기에 전력을 공급하고 데이터를 전송하는 방법. 첫째로, 금속이나 실리콘, 세라믹에 비하여 폴리머는 유연성 및 미세 제작에의 적용 가능성을 포함하는 두드러진 이점들이 있기 때문에 시각 보철 시스템을 구성하는 다양한 이식 가능한 부분들에 널리 이용되었다. 대부분의 폴리머 기반 이식형 장치들은 금속 증착과 사진 식각을 기반으로 하는 반도체 공정으로 제작되었다. 이 공정은 폴리머 기판 위에 금속을 패터닝 하는 데에 있어서 높은 정확성과 정밀도를 제공한다. 하지만 그 공정은 또한, 사진 식각에 쓰이는 마스크와 금속 증착을 위한 진공뿐만 아니라 아주 큰 공정 설비를 요구하기 때문에 시간 소모가 심하고 복잡하다. 이는 본 연구에서 낮은 수분 흡수 (<0.01 %)와 높은 빛 투과 (92 %)를 특징으로 하는 생체적합한 고리형 올레핀 폴리머 (cyclic olefin polymer, COP)가 이식형 장치를 위한 새로운 기판 물질로써 선택된 이유이다. COP를 기반으로 하여, 마스크와 진공, 큰 공정 설비가 필요 없이 이식 가능한 장치를 간단하게 제작하는 공정이 개발되었다. COP는 금과의 강한 접합과 자외선에 대한 높은 투명성을 또 다른 특징으로 한다. 이와 같은 접합 특성과 자외선 투명성 덕분에, 금박은 COP 기판에 별도의 접합층 없이 열로 접합될 수 있을 뿐만 아니라 그 기판에 손상을 주지 않으면서 자외선 레이저를 통하여 미세하게 가공될 수 있다. 개발된 COP 기반의 공정을 처음으로 사용하여 침습형 미세 프로브가 제작되었고, 그 전기화학적, 기계적 특성과 기능성이 각각 임피던스 측정과 버클링 테스트, 생체 내 신경신호 기록으로 평가되었다. 그리고 COP를 사용한 밀봉의 가능성도 알아보기 위하여, 개발된 공정을 사용하여 형성된 COP 밀봉의 장기 안정성이 생리식염수에서의 가속 노화 중 누설 전류 측정을 통하여 추정되었다. 둘째로, 자극 전극의 크기가 충분히 작아진다고 하더라도, 동시에 출력되는 자극에 의해 형성되는 전기장의 중첩인 크로스 토크 때문에 개개의 신경세포를 정밀하게 자극하기 위하여 전극을 배열하는 것은 아주 어렵다. 따라서 인접한 전극 사이에 적당한 간격이 필요하게 되고, 이는 특히 뇌 또는 망막과 같은 제한된 공간에서 전극 개수의 물리적인 한계를 야기한다. 이 한계를 극복하기 위하여, 많은 연구자들은 실제 전극 사이에서 큰 전기장 세기를 갖는 중간 영역을 나타내는 가상 채널을 이용한 자극 전략을 제안하였다. 이러한 가상 채널은 둘 이상의 전극에서 동시에 출력되는 자극 파형을 합칠 수 있는 다극성 자극에 의하여 형성이 가능하다. 본 연구에서는 가상 채널을 이용하여 더 정교한 자극 패턴을 만들기 위하여, 특히 2차원에서의 가상 채널을 생성하고자 격자형 배열의 전극과 함께 5극성 자극이 사용되었다. 이 5극성 자극은 다섯 개의 서로 다른 전류원을 갖도록 맞춤 설계된 집적회로와 개발된 COP 기반 공정으로 제작된 평면형 전극을 사용하여 구현되었다. 먼저, 5극성 자극의 효과를 확인하고자 이 자극으로 전기장을 한 곳에 더 집중된 형태로 만들 수 있음이 단극성 자극과의 비교를 통하여 검증되었다. 그리고 유한 요소 분석과 생체 외 평가 둘 모두를 통하여, 5극성 자극으로 인한 가상 채널 형성을 뜻하는 전기장 분포가 인접한 두 전극에서 나오는 자극의 진폭비와 그 전극으로부터 떨어진 거리에 따라 변화됨이 추정되었다. 셋째로, 본 연구에서는 눈에 이식된 채로 실시간 이미지를 얻음으로써 완전 이식형 시각 보철 시스템을 구성하는 이식형 카메라를 새로운 이미지 획득 방식으로써 제안한다. 이 이식형 카메라는 실명 환자들이 자연스러운 눈의 움직임을 따라서 물체를 볼 수 있으며 잠이나 샤워, 달리기와 같은 일상적인 활동들을 방해 받지 않고 수행할 수 있도록 돕는다는 점에서 독특한 장점을 갖는다. 기존의 부분 이식형 시각 보철 시스템에서 쓰이는 안경 부착형 카메라와 같은 착용 장비로는 이러한 장점들을 얻을 수 없다. 게다가, 이식형 카메라는 망막 임플란트의 미세 포토다이오드 어레이와 달리 완전한 카메라 구조를 이용하여 다양한 이미지 정보를 획득할 수 있다는 장점을 갖는다. 이러한 이점들을 달성하기 위하여, 그 이식형 카메라는 수분 침투를 막고자 생체적합한 에폭시로 코팅되었고 생체적합성과 유연성을 얻기 위하여 의료용 실리콘 엘라스토머로 밀봉된 후에 눈에 충분히 삽입될 수 있는 형태 및 크기로 제작되었다. 이 장치의 동작은 흑백으로 처리된 이미지를 표시하는 무선 이미지 획득으로 시험되었다. 그리고 몸 안에서 이식형 카메라 갖는 안정적인 통신 거리를 측정하기 위하여, 장치가 생체 내 환경을 모사하기 위한 8 mm 두께의 생체 물질로 덮인 상태에서 그 장치의 신호 대 잡음비가 측정되었다. 마지막으로, 기존의 시각 보철 시스템에서 몸에 부착된 형태의 외부 하드웨어는 이식된 장치에 전력과 데이터를 안정적으로 전달하고 이미지 신호를 수집하기 위하여 일반적으로 사용되었다. 그럼에도 불구하고, 이러한 하드웨어는 외부로부터의 손상으로 인한 기능적인 결함과 수면 및 샤워, 달리기, 수영 활동 중 이용 불가능성, 외형적인 이슈 등을 포함하는 공통적인 문제들을 야기한다. 전력 및 데이터 전송을 위한 외부 코일은 시각 보철 시스템에서 컨트롤러와 프로세서에 유선으로 연결되고, 이러한 연결은 그 코일이 앞서 언급된 문제들에 특히 취약하게 만든다. 이러한 이슈를 해결하고자, 휴대용 무선 컨트롤러로 제어되는 완전 이식형 신경 자극 시스템이 제안된다. 이 휴대용 무선 컨트롤러는 저전력이지만 비교적 장거리 통신이 가능한 직비 (ZigBee) 무선 통신을 통하여 재충전 가능한 배터리로 동작하는 완전 이식형 자극기를 제어할 수 있다. 이 외에도, 이 휴대용 컨트롤러를 사용하면 폭넓은 응용을 위한 두 가지 기능을 추가로 수행할 수 있다. 하나는 유선 경피 자극이며, 다른 하나는 재충전 가능한 배터리의 유도 충전 기능이다. 또한, 이 휴대용 컨트롤러의 간단한 스위치를 사용하면 사용자는 게임패드와 같이 자극 파라미터를 쉽게 조절할 수 있다. 이러한 휴대 가능하고 사용자 친화적인 인터페이스를 통해 다양한 상황에서 그 컨트롤러를 쉽게 사용할 수 있다. 그 컨트롤러의 기능은 생체 외 평가뿐만 아니라 조류의 움직임 제어를 위한 유선 경피 자극 및 원격 제어를 통해 생체 내에서도 평가되었다. 또한, 그 컨트롤러를 사용한 원격 신경 자극 제어의 수행 가능성을 검증하기 위하여 두 생체 내 실험의 결과가 서로 비교되었다. 결론적으로, COP 기반의 간단한 제작 공정과 5극성 자극, 이식형 카메라, 휴대용 다기능 무선 컨트롤러를 포함하는 연구 결과에 대한 여러 논의가 이루어진다. 그리고 이러한 결과와 고찰에 기초하여, 본 학위논문의 연구가 완전 이식형 시각 보철 시스템의 구현에 어떻게 적용될 수 있는 지가 이 논문의 끝에서 상세히 설명된다.Abstract ------------------------------------------------------------------ i Contents ---------------------------------------------------------------- vi List of Figures ---------------------------------------------------------- xi List of Tables ----------------------------------------------------------- xx List of Abbreviations ------------------------------------------------ xxii Chapter 1. Introduction --------------------------------------------- 1 1.1. Visual Prosthetic System --------------------------------------- 2 1.1.1. Current Issues ------------------------------------------------- 2 1.1.1.1. Substrate Materials ---------------------------------------- 3 1.1.1.2. Electrode Configurations --------------------------------- 5 1.1.1.3. External Hardware ----------------------------------------- 6 1.1.1.4. Other Issues ------------------------------------------------- 7 1.2. Suggested Visual Prosthetic System ------------------------ 8 1.3. Four Motivations ---------------------------------------------- 10 1.4. Proposed Approaches ---------------------------------------- 11 1.4.1. Cyclic Olefin Polymer (COP) ------------------------------ 11 1.4.2. Penta-Polar Stimulation ----------------------------------- 13 1.4.3. Implantable Camera --------------------------------------- 16 1.4.4. Handheld Remote Controller ---------------------------- 18 1.5. Objectives of this Dissertation ------------------------------ 20 Chapter 2. Materials and Methods ----------------------------- 23 2.1. COP-Based Fabrication and Encapsulation -------------- 24 2.1.1. Overview ----------------------------------------------------- 24 2.1.2. Simple Fabrication Process ------------------------------- 24 2.1.3. Depth-Type Microprobe ---------------------------------- 26 2.1.3.1. Design ----------------------------------------------------- 26 2.1.3.2. Characterization ----------------------------------------- 27 2.1.3.3. In Vivo Neural Signal Recording ---------------------- 30 2.1.4. COP Encapsulation ---------------------------------------- 31 2.1.4.1. In Vitro Reliability Test ---------------------------------- 33 2.2. Penta-Polar Stimulation ------------------------------------- 34 2.2.1. Overview ---------------------------------------------------- 34 2.2.2. Design and Fabrication ----------------------------------- 35 2.2.2.1. Integrated Circuit (IC) Design ------------------------- 35 2.2.2.2. Surface-Type Electrode Fabrication ------------------ 38 2.2.3. Evaluations -------------------------------------------------- 39 2.2.3.1. Focused Electric Field Measurement ---------------- 42 2.2.3.2. Steered Electric Field Measurement ----------------- 42 2.3. Implantable Camera ----------------------------------------- 43 2.3.1. Overview ---------------------------------------------------- 43 2.3.2. Design and Fabrication ----------------------------------- 43 2.3.2.1. Circuit Design -------------------------------------------- 43 2.3.2.2. Wireless Communication Program ------------------ 46 2.3.2.3. Epoxy Coating and Elastomer Sealing -------------- 47 2.3.3. Evaluations ------------------------------------------------- 50 2.3.3.1. Wireless Image Acquisition --------------------------- 50 2.3.3.2. Signal-to-Noise Ratio (SNR) Measurement -------- 52 2.4. Multi-Functional Handheld Remote Controller --------- 53 2.4.1. Overview ---------------------------------------------------- 53 2.4.2. Design and Fabrication ----------------------------------- 53 2.4.2.1. Hardware Description ---------------------------------- 53 2.4.2.2. Software Description ----------------------------------- 57 2.4.3. Evaluations -------------------------------------------------- 57 2.4.3.1. In Vitro Evaluation -------------------------------------- 57 2.4.3.2. In Vivo Evaluation --------------------------------------- 59 Chapter 3. Results ------------------------------------------------- 61 3.1. COP-Based Fabrication and Encapsulation ------------- 62 3.1.1. Fabricated Depth-Type Microprobe ------------------- 62 3.1.1.1. Electrochemical Impedance -------------------------- 63 3.1.1.2. Mechanical Characteristics --------------------------- 64 3.1.1.3. In Vivo Neural Signal Recording --------------------- 66 3.1.2. COP Encapsulation --------------------------------------- 68 3.1.2.1. In Vitro Reliability Test --------------------------------- 68 3.2. Penta-Polar Stimulation ------------------------------------ 70 3.2.1. Fabricated IC and Surface-Type Electrodes ---------- 70 3.2.2. Evaluations ------------------------------------------------- 73 3.2.2.1. Focused Electric Field Measurement --------------- 73 3.2.2.2. Steered Electric Field Measurement ---------------- 75 3.3. Implantable Camera ---------------------------------------- 76 3.3.1. Fabricated Implantable Camera ----------------------- 76 3.3.2. Evaluations ------------------------------------------------ 77 3.3.2.1. Wireless Image Acquisition -------------------------- 77 3.3.2.2. SNR Measurement ------------------------------------ 78 3.4. Multi-Functional Handheld Remote Controller ------- 80 3.4.1. Fabricated Remote Controller ------------------------- 80 3.4.2. Evaluations ------------------------------------------------ 81 3.4.2.1. In Vitro Evaluation ------------------------------------ 81 3.4.2.2. In Vivo Evaluation ------------------------------------- 83 Chapter 4. Discussions ------------------------------------------ 86 4.1. COP-Based Fabrication and Encapsulation ------------ 87 4.1.1. Fabrication Process and Fabricated Devices -------- 87 4.1.2. Encapsulation and Optical Transparency ------------ 89 4.2. Penta-Polar Stimulation------------------------------------ 99 4.2.1. Designed IC and Electrode Configurations --------- 99 4.2.2. Virtual Channels in Two Dimensions ---------------- 101 4.3. Implantable Camera -------------------------------------- 102 4.3.1. Enhanced Reliability by Epoxy Coating ------------- 106 4.4. Multi-Functional Handheld Remote Controller ------ 107 4.4.1. Brief Discussions of the Two Extra Functions ------ 108 4.5. Totally Implantable Visual Prosthetic System --------- 113 Chapter 5. Conclusion ------------------------------------------ 117 References -------------------------------------------------------- 121 Supplements ------------------------------------------------------ 133 국문 초록 ----------------------------------------------------------- 143Docto

An update on retinal prostheses

Retinal prostheses are designed to restore a basic sense of sight to people with profound vision loss. They require a relatively intact posterior visual pathway (optic nerve, lateral geniculate nucleus and visual cortex). Retinal implants are options for people with severe stages of retinal degenerative disease such as retinitis pigmentosa and age-related macular degeneration. There have now been three regulatory-approved retinal prostheses. Over five hundred patients have been implanted globally over the past 15 years. Devices generally provide an improved ability to localize high-contrast objects, navigate, and perform basic orientation tasks. Adverse events have included conjunctival erosion, retinal detachment, loss of light perception, and the need for revision surgery, but are rare. There are also specific device risks, including overstimulation (which could cause damage to the retina) or delamination of implanted components, but these are very unlikely. Current challenges include how to improve visual acuity, enlarge the field-of-view, and reduce a complex visual scene to its most salient components through image processing. This review encompasses the work of over 40 individual research groups who have built devices, developed stimulation strategies, or investigated the basic physiology underpinning retinal prostheses. Current technologies are summarized, along with future challenges that face the field

Wireless Power Transfer Techniques for Implantable Medical Devices:A Review

Wireless power transfer (WPT) systems have become increasingly suitable solutions for the electrical powering of advanced multifunctional micro-electronic devices such as those found in current biomedical implants. The design and implementation of high power transfer efficiency WPT systems are, however, challenging. The size of the WPT system, the separation distance between the outside environment and location of the implanted medical device inside the body, the operating frequency and tissue safety due to power dissipation are key parameters to consider in the design of WPT systems. This article provides a systematic review of the wide range of WPT systems that have been investigated over the last two decades to improve overall system performance. The various strategies implemented to transfer wireless power in implantable medical devices (IMDs) were reviewed, which includes capacitive coupling, inductive coupling, magnetic resonance coupling and, more recently, acoustic and optical powering methods. The strengths and limitations of all these techniques are benchmarked against each other and particular emphasis is placed on comparing the implanted receiver size, the WPT distance, power transfer efficiency and tissue safety presented by the resulting systems. Necessary improvements and trends of each WPT techniques are also indicated per specific IMD

소형동물의 뇌신경 자극을 위한 완전 이식형 신경자극기

학위논문(박사)--서울대학교 대학원 :공과대학 전기·정보공학부,2020. 2. 김성준.In this study, a fully implantable neural stimulator that is designed to stimulate the brain in the small animal is described. Electrical stimulation of the small animal is applicable to pre-clinical study, and behavior study for neuroscience research, etc. Especially, behavior study of the freely moving animal is useful to observe the modulation of sensory and motor functions by the stimulation. It involves conditioning animal's movement response through directional neural stimulation on the region of interest. The main technique that enables such applications is the development of an implantable neural stimulator. Implantable neural stimulator is used to modulate the behavior of the animal, while it ensures the free movement of the animals. Therefore, stable operation in vivo and device size are important issues in the design of implantable neural stimulators. Conventional neural stimulators for brain stimulation of small animal are comprised of electrodes implanted in the brain and a pulse generation circuit mounted on the back of the animal. The electrical stimulation generated from the circuit is conveyed to the target region by the electrodes wire-connected with the circuit. The devices are powered by a large battery, and controlled by a microcontroller unit. While it represents a simple approach, it is subject to various potential risks including short operation time, infection at the wound, mechanical failure of the device, and animals being hindered to move naturally, etc. A neural stimulator that is miniaturized, fully implantable, low-powered, and capable of wireless communication is required. In this dissertation, a fully implantable stimulator with remote controllability, compact size, and minimal power consumption is suggested for freely moving animal application. The stimulator consists of modular units of surface-type and depth-type arrays for accessing target brain area, package for accommodating the stimulating electronics all of which are assembled after independent fabrication and implantation using customized flat cables and connectors. The electronics in the package contains ZigBee telemetry for low-power wireless communication, inductive link for recharging lithium battery, and an ASIC that generates biphasic pulse for neural stimulation. A dual-mode power-saving scheme with a duty cycling was applied to minimize the power consumption. All modules were packaged using liquid crystal polymer (LCP) to avoid any chemical reaction after implantation. To evaluate the fabricated stimulator, wireless operation test was conducted. Signal-to-Noise Ratio (SNR) of the ZigBee telemetry were measured, and its communication range and data streaming capacity were tested. The amount of power delivered during the charging session depending on the coil distance was measured. After the evaluation of the device functionality, the stimulator was implanted into rats to train the animals to turn to the left (or right) following a directional cue applied to the barrel cortex. Functionality of the device was also demonstrated in a three-dimensional maze structure, by guiding the rats to navigate better in the maze. Finally, several aspects of the fabricated device were discussed further.본 연구에서는 소형 동물의 두뇌를 자극하기 위한 완전 이식형 신경자극기가 개발되었다. 소형 동물의 전기자극은 전임상 연구, 신경과학 연구를 위한 행동연구 등에 활용된다. 특히, 자유롭게 움직이는 동물을 대상으로 한 행동 연구는 자극에 의한 감각 및 운동 기능의 조절을 관찰하는 데 유용하게 활용된다. 행동 연구는 두뇌의 특정 관심 영역을 직접적으로 자극하여 동물의 행동반응을 조건화하는 방식으로 수행된다. 이러한 적용을 가능케 하는 핵심기술은 이식형 신경자극기의 개발이다. 이식형 신경자극기는 동물의 움직임을 방해하지 않으면서도 그 행동을 조절하기 위해 사용된다. 따라서 동물 내에서의 안정적인 동작과 장치의 크기가 이식형 신경자극기를 설계함에 있어 중요한 문제이다. 기존의 신경자극기는 두뇌에 이식되는 전극 부분과, 동물의 등 부분에 위치한 회로부분으로 구성된다. 회로에서 생산된 전기자극은 회로와 전선으로 연결된 전극을 통해 목표 지점으로 전달된다. 장치는 배터리에 의해 구동되며, 내장된 마이크로 컨트롤러에 의해 제어된다. 이는 쉽고 간단한 접근방식이지만, 짧은 동작시간, 이식부위의 감염이나 장치의 기계적 결함, 그리고 동물의 자연스러운 움직임 방해 등 여러 문제점을 야기할 수 있다. 이러한 문제의 개선을 위해 무선통신이 가능하고, 저전력, 소형화된 완전 이식형 신경자극기의 설계가 필요하다. 본 연구에서는 자유롭게 움직이는 동물에 적용하기 위하여 원격 제어가 가능하며, 크기가 작고, 소모전력이 최소화된 완전이식형 자극기를 제시한다. 설계된 신경자극기는 목표로 하는 두뇌 영역에 접근할 수 있는 표면형 전극과 탐침형 전극, 그리고 자극 펄스 생성 회로를 포함하는 패키지 등의 모듈들로 구성되며, 각각의 모듈은 독립적으로 제작되어 동물에 이식된 뒤 케이블과 커넥터로 연결된다. 패키지 내부의 회로는 저전력 무선통신을 위한 지그비 트랜시버, 리튬 배터리의 재충전을 위한 인덕티브 링크, 그리고 신경자극을 위한 이상성 자극파형을 생성하는 ASIC으로 구성된다. 전력 절감을 위해 두 개의 모드를 통해 사용률을 조절하는 방식이 장치에 적용된다. 모든 모듈들은 이식 후의 생물학적, 화학적 안정성을 위해 액정 폴리머로 패키징되었다. 제작된 신경자극기를 평가하기 위해 무선 동작 테스트가 수행되었다. 지그비 통신의 신호 대 잡음비가 측정되었으며, 해당 통신의 동작거리 및 데이터 스트리밍 성능이 검사되었고, 장치의 충전이 수행될 때 코일간의 거리에 따라 전송되는 전력의 크기가 측정되었다. 장치의 평가 이후, 신경자극기는 쥐에 이식되었으며, 해당 동물은 이식된 장치를 이용해 방향 신호에 따라 좌우로 이동하도록 훈련되었다. 또한, 3차원 미로 구조에서 쥐의 이동방향을 유도하는 실험을 통하여 장치의 기능성을 추가적으로 검증하였다. 마지막으로, 제작된 장치의 특징이 여러 측면에서 심층적으로 논의되었다.Chapter 1 : Introduction 1 1.1. Neural Interface 2 1.1.1. Concept 2 1.1.2. Major Approaches 3 1.2. Neural Stimulator for Animal Brain Stimulation 5 1.2.1. Concept 5 1.2.2. Neural Stimulator for Freely Moving Small Animal 7 1.3. Suggested Approaches 8 1.3.1. Wireless Communication 8 1.3.2. Power Management 9 1.3.2.1. Wireless Power Transmission 10 1.3.2.2. Energy Harvesting 11 1.3.3. Full implantation 14 1.3.3.1. Polymer Packaging 14 1.3.3.2. Modular Configuration 16 1.4. Objectives of This Dissertation 16 Chapter 2 : Methods 18 2.1. Overview 19 2.1.1. Circuit Description 20 2.1.1.1. Pulse Generator ASIC 21 2.1.1.2. ZigBee Transceiver 23 2.1.1.3. Inductive Link 24 2.1.1.4. Energy Harvester 25 2.1.1.5. Surrounding Circuitries 26 2.1.2. Software Description 27 2.2. Antenna Design 29 2.2.1. RF Antenna 30 2.2.1.1. Design of Monopole Antenna 31 2.2.1.2. FEM Simulation 31 2.2.2. Inductive Link 36 2.2.2.1. Design of Coil Antenna 36 2.2.2.2. FEM Simulation 38 2.3. Device Fabrication 41 2.3.1. Circuit Assembly 41 2.3.2. Packaging 42 2.3.3. Electrode, Feedthrough, Cable, and Connector 43 2.4. Evaluations 45 2.4.1. Wireless Operation Test 46 2.4.1.1. Signal-to-Noise Ratio (SNR) Measurement 46 2.4.1.2. Communication Range Test 47 2.4.1.3. Device Operation Monitoring Test 48 2.4.2. Wireless Power Transmission 49 2.4.3. Electrochemical Measurements In Vitro 50 2.4.4. Animal Testing In Vivo 52 Chapter 3 : Results 57 3.1. Fabricated System 58 3.2. Wireless Operation Test 59 3.2.1. Signal-to-Noise Ratio Measurement 59 3.2.2. Communication Range Test 61 3.2.3. Device Operation Monitoring Test 62 3.3. Wireless Power Transmission 64 3.4. Electrochemical Measurements In Vitro 65 3.5. Animal Testing In Vivo 67 Chapter 4 : Discussion 73 4.1. Comparison with Conventional Devices 74 4.2. Safety of Device Operation 76 4.2.1. Safe Electrical Stimulation 76 4.2.2. Safe Wireless Power Transmission 80 4.3. Potential Applications 84 4.4. Opportunities for Further Improvements 86 4.4.1. Weight and Size 86 4.4.2. Long-Term Reliability 93 Chapter 5 : Conclusion 96 Reference 98 Appendix - Liquid Crystal Polymer (LCP) -Based Spinal Cord Stimulator 107 국문 초록 138 감사의 글 140Docto

An Optoelectronic Stimulator for Retinal Prosthesis

Retinal prostheses require the presence of viable population of cells in the inner retina. Evaluations of retina with Age-Related Macular Degeneration (AMD) and Retinitis Pigmentosa (RP) have shown a large number of cells remain in the inner retina compared with the outer retina. Therefore, vision loss caused by AMD and RP is potentially treatable with retinal prostheses. Photostimulation based retinal prostheses have shown many advantages compared with retinal implants. In contrary to electrode based stimulation, light does not require mechanical contact. Therefore, the system can be completely external and not does have the power and degradation problems of implanted devices. In addition, the stimulating point is flexible and does not require a prior decision on the stimulation location. Furthermore, a beam of light can be projected on tissue with both temporal and spatial precision. This thesis aims at fi nding a feasible solution to such a system. Firstly, a prototype of an optoelectronic stimulator was proposed and implemented by using the Xilinx Virtex-4 FPGA evaluation board. The platform was used to demonstrate the possibility of photostimulation of the photosensitized neurons. Meanwhile, with the aim of developing a portable retinal prosthesis, a system on chip (SoC) architecture was proposed and a wide tuning range sinusoidal voltage-controlled oscillator (VCO) which is the pivotal component of the system was designed. The VCO is based on a new designed Complementary Metal Oxide Semiconductor (CMOS) Operational Transconductance Ampli er (OTA) which achieves a good linearity over a wide tuning range. Both the OTA and the VCO were fabricated in the AMS 0.35 µm CMOS process. Finally a 9X9 CMOS image sensor with spiking pixels was designed. Each pixel acts as an independent oscillator whose frequency is controlled by the incident light intensity. The sensor was fabricated in the AMS 0.35 µm CMOS Opto Process. Experimental validation and measured results are provided

Argus® II Retinal Prosthesis System: Clinical & Functional Outcomes

Developing artificial visual systems to restore sight in blind patients has long been the dream of scientists, clinicians and the public at large. After decades of research, the greatest success in the field has been achieved with electronic retinal prostheses. To date, 3 retinal prosthetic systems have made the transition from laboratory / clinical research to entering the commercial market for clinical use, namely the Argus® II Retinal Prosthesis System (Second Sight), the alpha-IMS system (Retinal Implant AG), and the IRIS® II (Pixium Vision). The following body of work describes the Argus® II Retinal Prosthesis system, which obtained regulatory approval in the European Economic Area in 2011 (CE marking) and later on in the USA (FDA approval in February 2013), based on the results of an international multi-centre clinical feasibility trial (Clinical Trial identifier: NCT 00407602). This thesis aims to examine the long-term clinical and functional outcomes in an early cohort of subjects chronically implanted with the Argus® II system, from the original feasibility study. A further aim is to elucidate the characteristics of the artificial vision that is perceived and its long-term repeatability and reproducibility in individual subjects. These two broad aims will assist in understanding the nature of the visual performance provided by this device, as well as to add to the current data that is defining the feasibility of constructing predictable pixelated patterns to achieve useful artificial vision in the future. Finally, we explored the feasibility of real-time imaging of visual cortex activation in response to electrical retinal stimulation with the Argus® II system, using functional near infra-red spectroscopy (fNIRS). Development of this real-time imaging tool will enable future investigations into the differences in the cortical activities in response to different stimulations and in different subjects. This may in turn help us understand the variability in their visual performance, as well as to further explore the extent and effect of cross-modal plasticity at the cortical level, in this cohort of patients who have been deprived of visual inputs for decades. Visual function was assessed in terms of: a) form recognition and b) spatial localisation under both 2-dimensional (2D) screen-based laboratory settings and 3-dimensional (3D) paradigms simulating real-life settings. A prospective study of 11 Argus® II subjects showed that the subjects could identify distinct geometric shapes presented in high contrast better with the prosthetic system switched on (median % of correct identification = 20.0%, IQR = 18.8), versus off (median = 12.5%, IQR = 5.0). The accuracy of shapes identification could be further improved by enhancing the outlines of the geometric shape (median = 33.1%, IQR = 21.6). A further prospective study from a subset of 7 subjects showed that this 2D shape identification could be translated into improved identification of 3D objects. These subjects could identify 8 common daily-life objects presented in high contrast with the prosthetic system switched on (median = 31.3%, IQR = 20.3) versus off (median = 12.5%, IQR = 12.5). Scrambling of the transmission signals within the prosthetic system in order to separate light information from form information (i.e. “scrambled mode”) hindered the identification in some but not all subjects (median = 25.0%, IQR = 12.5). The accuracy of object identification could also be improved by enhancing the edges of objects (median = 43.8%, IQR = 15.6). Previously published data showed that Argus® II subjects were able to locate and point to white squares presented on touch screens against a black background more accurately with the prosthetic system switched on versus off. We demonstrated with a prospective study of 5 subjects that they could localise an object on the table, reach out and grasp the object (prehension) with great accuracy (66.7 – 100%) when the prosthetic system was switched on, versus no object prehension (0%) with the system switched off. A prospective study of 6 Argus® II subjects illustrated that while there was a wide variation in the shape and size of the phosphenes perceived by individual subjects, the elicited phosphenes were consistently reproducible in each subject using fixed stimulating parameters, with inter-stimuli intervals ranging from 20 minutes apart, down to 1 second. The perceived location of the phosphenes grossly matched retinotopic agreement, with 4 subjects drawing phosphenes in the same visual field quadrant as predicted by the relative stimulus-fovea position, and 2 subjects depicting phosphenes in the same hemi-field as the expected locations. A retrospective study of 3 Argus® II subjects who underwent MRI brain scan (for unrelated medical reasons) showed that MRI brain scans of up to 1.5 Tesla field strength appeared to have no detrimental effect on the subjects and their implant function. The Argus® II implant produced an artefact of around 50mm x 50mm in size which would prevent visualisation of structures within the orbit, but visualisation of surrounding tissues outside this areas are unaffected. The use of functional MRI as a tool of exploring visual cortex activation in Argus® II subjects was discounted, due to concerns of signal interference from the radiofrequency telemetry of Argus® II system with that of MRI. Subsequently, we have demonstrated in a prospective study that an alternative neuro-imaging technique, functional near infra-red spectroscopy (fNIRS), was capable of capturing real-time cortical activation in 5 out of 6 Argus® II subjects, and maybe a feasible tool for future investigation into cortical function and interactions. The work in this thesis has shown that the Argus® II retinal prosthesis system could improve visual function both in terms of form recognition, as well as object localisation in 3D in situations simulating real-life settings, in a cohort of patients with end-stage retinitis pigmentosa or other outer retinal diseases such as choroideremia. The wide variation in the visual performance level observed could in part be attributable to the diversity in the phosphene features perceived by these subjects. Nevertheless, the consistency and reproducibility with which these phosphenes could be elicited, with fixed stimulating parameters within each subject, provides an encouraging basis for the construction of more complicated pixelated images. Future work to determine the underlying factors influencing the perceived phosphene characteristics, may allow for better prediction of functional outcome, which could in turn be useful for patient selection and tailored preoperative counselling. For those subjects already implanted with the Argus® II system, future work into determining the suitable stimulating parameters for each electrode / quad stimulation may be required for individual subjects, to achieve the construction of optimised and useful, pixelated prosthetic vision

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

Current Stimulator IC for Retinal Prosthesis Using Nanowire FET Switch Array and in vitro Experiment with rd1 Mouse

학위논문 (석사)-- 서울대학교 대학원 : 전기·컴퓨터공학부, 2015. 2. 조동일.망막 색소 변성 (Retinitis pigmentosa) 및 노인성 황반 변성 (Age-related macular degeneration) 은 난치성 망막 변성 질환으로서 발병 후 수 년 내에 시력을 완전히 상실하게 한다. 이러한 망막 변성 질환을 치료하기 위해 전기 자극으로 시각 신경 신호를 발생시키는 인공망막 장치가 개발되어 왔다. 최근에는 세계 각지의 연구 그룹에서 자극 해상도를 1,000 픽셀 이상으로 높여 보다 뚜렷한 시각 정보를 전달하려는 시도를 하고 있다. 그러나 기존의 one-to-one interconnection 방식으로 전극과 자극기 회로를 연결할 경우, 배선이 복잡해져 유연한 인공망막 장치를 개발하기 어렵다. 이에 따라 본 연구진에서는 32 × 32 픽셀의 나노와이어 field-effect transistor (FET) 스위치 array 를 이용하여 배선의 복잡성을 줄인 고해상도 인공망막 장치를 개발하고 있다. 본 논문에서는 나노와이어 FET 스위치 기반의 인공망막 자극기 구동을 위한 자극기 회로에 대해 다루고 있다. 본 자극기 회로는 12 V 의 자극 전압을 사용하여, 0 ~ 100 μA 의 자극 전류를 주입할 수 있도록 설계하였다. 또한 나노와이어 FET 스위치 기반의 인공망막 자극 시스템 구동을 위한 디지털 인터페이스 회로를 포함하고 있다. 본 자극기 회로는 12 V 의 고전압 자극을 인가하기 위해 0.35 μm bipolar-CMOS (Complementary Metal-Oxide-Semiconductor)-DMOS (Double Diffused Metal-Oxide-Semiconductor) 공정을 이용하여 제작하였다. 자극기 회로의 기능 검증을 위해 전류 주입 실험 및 in vitro 실험을 진행하였다. 전류 주입 실험 결과 입력 신호에 따라 자극 전류의 세기가 적절히 변화하였으며, 시뮬레이션과 5% 내외의 오차를 보였다. 또한 in vitro 실험을 통해 전류 자극 세기에 따라 신경 반응이 조절되는 유효한 신경 자극을 인가할 수 있음을 확인하였다.Retina pigmentosa (RP) and Age-related macular degeneration (ARMD) are incurable retinal degenerative diseases that cause vision loss in several years after disease onset. Retinal prosthetic devices using electrical stimulations have been developed to restore vision of people blinded from the RP and ARMD. Recently, many research efforts have been tried to achieve a high-spatial resolution with more than 1,000 pixels. However, it is difficult to achieve the high-spatial resolution with the conventional one-to-one interconnection method that requires excessive wiring complexities. In our research group, a high-resolution retinal prosthetic system using a nanowire field-effect transistor (FET) switch integrated 32 × 32 microelectrode array (MEA) has been developed to resolve the wiring problem. In this paper, a current stimulator integrated circuit (IC) to operate the nanowire FET switch integrated MEA is presented. The stimulator circuit generates a biphasic stimulation current in a range of 0 to 100 μA using a high stimulation voltage of 12 V. The digital interface circuits are also integrated in the stimulator IC to operate the MEA. For the high voltage stimulation of 12 V, the stimulator IC is fabricated using a 0.35 μm bipolar-CMOS (Complementary Metal-Oxid-Semiconductor)-DMOS (Double Diffused Metal-Oxide-Semiconductor) process. Experimental results show that the amplitude of the stimulation current is properly modulated according to the level of the input signal. Errors between the measured current amplitudes and the simulated levels are approximately 5%. An in vitro experiment is also conducted to evaluate the neural stimulating function of the fabricated stimulator IC. In the in vitro experiment, the neural responses are successfully evoked by the current stimulation from the stimulator IC.제 1 장 서 론 1 제 1 절 연구의 배경 1 제 1 항 망막 변성 질환 1 제 2 항 시각 보철의 종류 5 제 3 항 인공망막 장치의 분류 7 제 4 항 인공망막 장치 연구 동향 12 제 5 항 고해상도 인공망막 자극기 개발의 필요성 15 제 6 항 고해상도 자극을 위한 나노와이어 FET 스위치 array 기반 인공망막 자극 시스템 17 제 2 장 본 론 19 제 1 절 설계 개념 19 제 1 항 나노와이어 FET 스위치 array 기반 인공망막 자극 시스템의 동작 개념 19 제 2 항 나노와이어 FET 스위치 array 기반 인공망막 자극기 회로의 동작 조건 21 제 2 절 설계 및 시뮬레이션 25 제 1 항 자극기 회로 전체 구성 25 제 2 항 Analog block 설계 27 제 3 항 Digital block 설계 36 제 4 항 Layout 43 제 3 절 시스템 구현 45 제 1 항 자극 시스템 구현을 위한 PCB 제작 45 제 4 절 실험 및 검증 48 제 1 항 전기적 특성 평가 48 제 2 항 in vitro 동물 실험 56 제 3 장 결 론 65 제 1 절 자극기 회로의 기능성 평가 65 제 2 절 향후 계획 67 참고문헌 68 ABSTRACT 74Maste

Design of Wireless Power Transfer and Data Telemetry System for Biomedical Applications

With the advancement of biomedical instrumentation technologies sensor based remote healthcare monitoring system is gaining more attention day by day. In this system wearable and implantable sensors are placed outside or inside of the human body. Certain sensors are needed to be placed inside the human body to acquire the information on the vital physiological phenomena such as glucose, lactate, pH, oxygen, etc. These implantable sensors have associated circuits for sensor signal processing and data transmission. Powering the circuit is always a crucial design issue. Batteries cannot be used in implantable sensors which can come in contact with the blood resulting in serious health risks. An alternate approach is to supply power wirelessly for tether-less and battery- less operation of the circuits.Inductive power transfer is the most common method of wireless power transfer to the implantable sensors. For good inductive coupling, the inductors should have high inductance and high quality factor. But the physical dimensions of the implanted inductors cannot be large due to a number of biomedical constraints. Therefore, there is a need for small sized and high inductance, high quality factor inductors for implantable sensor applications. In this work, design of a multi-spiral solenoidal printed circuit board (PCB) inductor for biomedical application is presented. The targeted frequency for power transfer is 13.56 MHz which is within the license-free industrial, scientific and medical (ISM) band. A figure of merit based optimization technique has been utilized to optimize the PCB inductors. Similar principal is applied to design on-chip inductor which could be a potential solution for further miniaturization of the implantable system. For layered human tissue the optimum frequency of power transfer is 1 GHz for smaller coil size. For this reason, design and optimization of multi-spiral solenoidal integrated inductors for 1 GHz frequency is proposed. Finally, it is demonstrated that the proposed inductors exhibit a better overall performance in comparison with the conventional inductors for biomedical applications

Neurostimulateur hautement intégré et nouvelle stratégie de stimulation pour améliorer la miction chez les paraplégiques

RÉSUMÉ Une lésion de la moelle épinière est un problème dévastateur médicalement et socialement. Pour la population des États-Unis seulement, il y a près de 10 000 nouveaux cas chaque année. A cause des nombreux types de lésions possibles, divers degrés de dysfonctionnement du bas appareil urinaire peuvent en découler. Une lésion est dite complète lors d’une perte totale des fonctions sensorielles et motrices volontaires en dessous du niveau de la lésion. Une lésion incomplète implique que certaines activités sensorielles et/ou motrices soient encore présentes. Si la lésion se produit au dessus du cône médullaire, la vessie développera une hyperréflexie qui se manifeste par des contractions réflexes non-inhibées. Ces contractions peuvent être accompagnées d’une augmentation de l’activité du sphincter externe. Par conséquent, cela mène à un état d’obstruction fonctionnelle de la vessie, qui induit une forte pression intravésicale à chacune des contractions réflexes et qui peut potentiellement endommager le haut appareil urinaire. Dans ce contexte, la neurostimulation est l'une des techniques les plus prometteuses pour la réhabilitation de la vessie chez les patients ayant subi une lésion de la moelle épinière. Le seul neurostimulateur implantable commercialisé, ciblant l'amélioration de la miction et ayant obtenu des résultats satisfaisants, nécessite une rhizotomie (section de certains nerfs) afin de réduire la dyssynergie entre la vessie et le sphincter. Cependant, la rhizotomie est irréversible et peut abolir les réflexes sexuels, de défécation ainsi que les sensations sacrales si encore présents dans le cas de lésions incomplètes. Afin d'éviter la rhizotomie, nous proposons une nouvelle stratégie de stimulation multi-site appliquée aux racines sacrées, et basée sur le blocage de la conduction des nerfs à l'aide d'une stimulation à haute fréquence comme alternative à la rhizotomie. Cette approche permettrait une meilleure miction en augmentant sélectivement la contraction de la vessie et en diminuant la dyssynergie. Huit expériences en phase aigüe ont étés menées sur des chiens pour vérifier la réponse de la vessie et du sphincter urétral externe à la stratégie de stimulation proposée. Le blocage à haute-fréquence (1 kHz) combiné à la stimulation basse-fréquence (30 Hz), a augmenté la différence de pression intra-vésicale/intra-urétrale moyenne jusqu'à 53 cmH2O et a réduit la pression intra-urétrale moyenne jusqu'à hauteur de 86 % relativement au niveau de référence. Dans l’objectif de tester la stratégie de neurostimulation proposée avec des expériences animales en phase chronique, un dispositif de neurostimulation implantable est requis. Un prototype discret implémentant cette stratégie de stimulation a été réalisé en utilisant uniquement des composants discrets disponibles commercialement. Ce prototype est capable de générer des impulsions à une fréquence aussi basse que 18 Hz tout en générant simultanément une forme d’onde alternative à une fréquence aussi haute que 8.6 kHz, et ce sur de multiples canaux. Lorsque tous les étages de stimulation et leurs différentes sorties sont activés avec des fréquences d’impulsions (2 mA, 217 μs) et de sinusoïdes de 30 Hz et 1 kHz respectivement, la consommation de puissance totale est autour de 4.5 mA (rms). Avec 50 mW de puissance inductive disponible par exemple et 4.5 mA de consommation de courant, le régulateur haute-tension peut être réglé à 10 V permettant ainsi une stimulation de 2 mA avec une impédance nerf-électrode de 4.4 kΩ. Le nombre effectif de sorties activées et le maximum réalisable des paramètres de stimulation sont limités par l’énergie disponible fournie par le lien inductif et l’impédance des interfaces nerf-électrode. Cependant, une plus grande intégration du neurostimulateur devient de plus en plus nécessaire à des fins de miniaturisation, de réduction de consommation de puissance, et d’augmentation du nombre de canaux de stimulation. Comme première étape vers une intégration totale, nous présentons la conception d’un neurostimulateur hautement intégré et qui peut être assemblé sur un circuit imprimé de 21 mm de diamètre. Le prototype est basé sur trois circuits intégrés, dédiés et fabriqués en technologie CMOS haute-tension, ainsi qu’un FPGA miniature à faible puissance et disponible commercialement. En utilisant une approche basée sur un abaisseur de tension, où la tension induite est laissée libre jusqu’à 20 V, l’étage d’entrée de récupération de puissance inductive et de données est totalement intégré.----------ABSTRACT Spinal cord injury (SCI) is a devastating condition medically and socially. For the population of USA only, the incidence is around 10 000 new cases per year. SCI leads to different degrees of dysfunction of the lower urinary tract due to a large variety of possible lesions. With a complete lesion, there is a complete loss of sensory and motor control below the level of lesion. An incomplete lesion implies that some sensory and/or motor activity is still present. Most patients with suprasacral SCI suffer from detrusor over-activity (DO) and detrusor sphincter dyssynergia (DSD). DSD leads to high intravesical pressure, high residual urine, urinary tract infection, and deterioration of the upper urinary tract. In this context, neurostimulation is one of the most promising techniques for bladder rehabilitation in SCI patients. The only commercialized implantable neurostimulator aiming for improved micturition and having obtained satisfactory results requires rhizotomy to reduce DSD. However, rhizotomy is irreversible and may abolish sexual and defecation reflexes as well as sacral sensations, if still present in case of incomplete SCI. In order to avoid rhizotomy, we propose a new multisite stimulation strategy applied to sacral roots, and based on nerve conduction blockade using high-frequency stimulation as an alternative to rhizotomy. This approach would allow a better micturition by increasing bladder contraction selectively and decreasing dyssynergia. Eight acute dog experiments were carried out to verify the bladder and the external urethral sphincter responses to the proposed stimulation strategy. High-frequency blockade (1 kHz) combined with low-frequency stimulation (30 Hz) increased the average intravesical-intraurethral pressure difference up to 53 cmH2O and reduced the average intraurethral pressure with respect to baseline by up to 86 %. To test the proposed neurostimulation strategy during chronic animal experiments, an implantable neurostimulateur is required. A discrete prototype implementing the proposed stimulation strategy has been designed using commercially available discrete components. This prototype is capable of generating a low frequency pulse waveform as low as 18 Hz with a simultaneous high frequency alternating waveform as high as 8.6 kHz, and that over different and multiple channels