METHODS OF MAKING

CROSS-REFERENCE TO RELATED APPLICATIONS This application claims the benefit under 35 U.S.C. § 119(e) of U.S. Provisional Patent Application Serial No. 62/768,610, filed November 16, 2018, which is

incorporated herein by reference.

FIELD

The present disclosure is directed to the area of implantable electrical/optical stimulation systems and methods of making and using the systems. The present disclosure is also directed to implantable electrical stimulation systems that include an arrangement for also providing optical stimulation using a connector or adapter that produces light.

BACKGROUND

Implantable electrical stimulation systems have proven therapeutic in a variety of diseases and disorders. For example, spinal cord stimulation systems have been used as a therapeutic modality for the treatment of chronic pain syndromes. Peripheral nerve stimulation has been used to treat chronic pain syndrome and incontinence, with a number of other applications under investigation. Functional electrical stimulation systems have been applied to restore some functionality to paralyzed extremities in spinal cord injury patients. Stimulation of the brain, such as deep brain stimulation, can be used to treat a variety of diseases or disorders.

Stimulators have been developed to provide therapy for a variety of treatments. A stimulator can include a control module (with a pulse generator), one or more leads, and an array of stimulator electrodes on each lead. The stimulator electrodes are in contact with or near the nerves, muscles, or other tissue to be stimulated. The pulse generator in the control module generates electrical pulses that are delivered by the electrodes to body tissue.

Optical stimulation can also provide therapeutic benefits in a variety of diseases and disorders by itself or in combination with electrical stimulation. An optical stimulation system may include a stimulator with one or more light sources and, often, one or more optical fibers to carry the light to the desired stimulation site.

BRIEF SUMMARY

In one aspect, an adapter for a stimulation system includes an adapter body having a distal end and a proximal end and a connector disposed on the distal end of the adapter body. The connector includes a connector body defining a port and a connector lumen extending from the port for receiving a proximal end of a stimulation lead; connector contacts disposed in the connector body and arranged along the connector lumen; and a light source disposed in the connector body. The adapter also includes terminals disposed along the proximal end of the adapter body and conductors extending along the adapter body and electrically coupling the connector contacts and the light source to the terminals.

In at least some aspects, the light source is disposed at a proximal end of the connector lumen. In at least some aspects, the adapter further includes a fiber optic extending from the light source to or through the connector lumen. In at least some aspects, the connector body defines a fiber optic port through which the fiber optic extends. In at least some aspects, the fiber optic is configured to be slidably movable through the fiber optic port. In at least some aspects, the fiber optic extends through the connector lumen and is configured for a portion of the fiber optic to be received within a stimulation lead.

In at least some embodiments, the fiber optic comprises a core and a cladding disposed around the core. In at least some embodiments, the cladding comprises at least one emission region, wherein an index of refraction of the emission region is greater than an index of refraction of the core. In at least some embodiments, the at least one emission region comprises at least one directional emission region, wherein the directional emission region extends around no more than 75% of a circumference of the fiber optic.

In another aspect, a kit for providing optical stimulation includes any of the adapters described above and an optical stylet configured to receive and transmit light from the light source when a portion of the optical stylet is inserted into the connector of the adapter. In at least some aspects, the optical stylet includes a core and a cladding disposed around the core. In at least some aspects, the cladding includes at least one emission region, where an index of refraction of the emission region is greater than an index of refraction of the core. In at least some aspects, the at least one emission region includes at least one directional emission region, where the directional emission region extends around no more than 75% of a circumference of the optical stylet.

In at least some aspects, the kit further includes an electrical stimulation lead having a lead body having a distal end portion and a proximal end portion and defining a lumen configured for receiving the optical stylet, wherein the proximal end portion is configured for insertion through the port of the connector and into the connector lumen of the connector; electrodes disposed along the distal end portion of the lead body; terminals disposed along the proximal end portion of the lead body; and conductors extending along the lead body and electrically coupling the electrodes to the terminals. In at least some aspects, the optical stylet is removably insertable into the lumen of the electrical stimulation lead. In at least some aspects, the optical stylet is permanently disposed in the lumen of the electrical stimulation lead.

Yet another aspect is a system for electrical/optical stimulation that includes any of the kits described above, as was as an electrical stimulation lead having a lead body having a distal end portion and a proximal end portion and defining a lumen configured for receiving the optical stylet, where the proximal end portion is configured for insertion through the port of the connector and into the connector lumen of the connector;

electrodes disposed along the distal end portion of the lead body; terminals disposed along the proximal end portion of the lead body; and conductors extending along the lead body and electrically coupling the electrodes to the terminals. The system also includes a control module having a control module connector defining a port and a connector lumen extending from the port for receiving a proximal end of the adapter, the control module connector including connector contacts disposed in the connector body and arranged along the connector lumen; a housing coupled to the control module connector; and an electronic subassembly disposed in the housing and electrically coupled to the connector contacts of the control module connector. In a further aspect, a kit for providing optical stimulation includes any of the adapters described above that includes a fiber optic, as well as an electrical stimulation lead having a lead body having a distal end portion and a proximal end portion and defining a lumen configured for receiving the fiber optic of the adapter, where the proximal end portion is configured for insertion through the port of the connector and into the connector lumen of the connector; electrodes disposed along the distal end portion of the lead body; terminals disposed along the proximal end portion of the lead body; and conductors extending along the lead body and electrically coupling the electrodes to the terminals.

In at least some aspects, the kit further includes an optical stylet configured to receive and transmit light from the light source when a portion of the optical stylet is inserted into the connector of the adapter.

Another aspect is a system for electrical/optical stimulation that includes any of the kits described above that have an electrical stimulation lead and an adapter with an fiber optic. The system also includes a control module having a control module connector defining a port and a connector lumen extending from the port for receiving a proximal end of the adapter, the control module connector including connector contacts disposed in the connector body and arranged along the connector lumen; a housing coupled to the control module connector; and an electronic subassembly disposed in the housing and electrically coupled to the connector contacts of the control module connector.

A further aspect is a method of assembling an optical stimulation system. The method includes providing any of the adapters or kits described above; electrically coupling the adapter to a control module; and inserting a fiber optic or an optical stylet optically coupled to the fiber optic into a lead.

Another aspect is a method of optically stimulating patient tissue. The method includes providing any of the adapters or kits described above; electrically coupling the adapter to a control module; inserting the fiber optic or an optical stylet optically coupled to the fiber optic into a lead; implanting the lead into the patient tissue; generating optical stimulation from the light source using the control module; and delivering the optical stimulation along i) the fiber optic or ii) the fiber optic and optical stylet to the patient tissue.

BRIEF DESCRIPTION OF THE DRAWINGS

Non-limiting and non-exhaustive embodiments of the present invention are described with reference to the following drawings. In the drawings, like reference numerals refer to like parts throughout the various figures unless otherwise specified.

For a better understanding of the present invention, reference will be made to the following Detailed Description, which is to be read in association with the accompanying drawings, wherein:

FIG. 1A is a schematic side view of one embodiment of an arrangement including a control module, an adapter, and a portion of an electrical stimulation lead;

FIG. IB is a schematic side view of one embodiment of a control module configured to electrically couple to a lead or lead extension;

FIG. 1C is a schematic side view of one embodiment of an electrical stimulation lead;

FIG. 2 is a schematic side view, with a cut-away region, of a portion of the adapter of FIG. 1A;

FIG. 3A is a schematic side view, with a cut-away region, of a portion of the electrical stimulation lead of FIG. 1C; FIG. 3B is a schematic perspective view of a portion of one embodiment of an optical stylet;

FIG. 4A is a schematic side view, with cut-away regions, of portion of one embodiment of an adapter, optical stylet, and lead coupled together;

FIG. 4B is a schematic magnified view of the cut-away regions of FIG. 4A; FIG. 5A is a schematic cross-sectional view of portions of one embodiment of a lead and optical stylet; FIG. 5B presents side views of portions of embodiments of optical stylets with different arrangements of emission regions;

FIG. 5C is a schematic perspective view of a portion of one embodiment of an optical stylet with directional emission regions; FIG. 6A is a schematic cross-sectional view of portions of one embodiment of a lead and optical stylet;

FIG. 6B is a schematic cross-sectional view of portions of the lead and optical stylet of FIG. 6A with the position of the optical stylet altered relative to the lead;

FIG. 7 is a schematic side view of another embodiment of an arrangement including a control module, an adapter, and a portion of an electrical stimulation lead:¾nd

FIG. 8 is a block diagram of one embodiment of a system for electrical/optical stimulation.

DETAILED DESCRIPTION

The present disclosure is directed to the area of implantable electrical/optical stimulation systems and methods of making and using the systems. The present disclosure is also directed to implantable electrical stimulation systems that include an arrangement for also providing optical stimulation using a connector or adapter that produces light.

The stimulation systems described herein can produce both optical and electrical stimulation. In at least some of these embodiments, the optical stimulation can be provided through a modification of an electrical stimulation system. Optical stimulation may include, but is not necessarily limited to, stimulation resulting from response to particular wavelengths or wavelength ranges of light or from thermal effects generated using light or any combination thereof. Figure 1 A is a schematic side view of a portion of an embodiment of an electrical/optical stimulation system 100. The optical stimulation system 100 includes an adapter 160 (which optionally may also function as a lead extension, as illustrated in Figure 1 A) that is configured to couple one or more proximal ends 142 of a lead to the control module 146. In Figure 1A, the adapter 160 is shown coupled to a single port 150 defined in the control module connector 144. Additionally, the adapter 160 is shown configured to couple to a single proximal end 142 of a lead (for example, the lead 180 of Figure 1C).

The adapter 160 includes a connector 162 and at least one adapter body 159 extending from the connector. In Figure 1A, the adapter connector 162 is shown disposed at a distal end 164 of the adapter 160. The adapter connector 162 includes a connector housing 166. The connector housing 166 defines at least one port 168 into which terminals 148 of the proximal end 142 of the lead can be inserted, as shown by directional arrow 170. The connector housing 166 also includes a plurality of connector contacts, such as connector contact 172. When the proximal end 142 is inserted into the port 168, the connector contacts 172 disposed in the connector housing 166 can be aligned with the terminals 148 for electrical coupling. In addition, as illustrated in Figure 2, the connector 162 may also include a light source 178.

In at least some embodiments, the adapter connector 162 further includes a retention block 167 to fasten the corresponding lead body (or a retention ring on the lead body) of the lead or lead extension to the connector 162 when the lead body is inserted into the connector assembly and prevent undesired detachment of the lead body from the connector assembly or misalignment of the terminals on the lead body with the connector contacts. For example, the retention block 167 may include an aperture through which a fastener 169 (e.g., a set screw, pin, or the like) may be inserted and secured against an inserted lead body. Other types of retention blocks or retention assemblies can be used including, but not limited to, those described in U.S. Patent No. 9,440,066; U.S. Patent Applications Serial Nos. 15/627,016 and 15/641,688; and U.S. Provisional Patent Application Serial No. 62/464,710, all of which are incorporated herein by reference.

In at least some embodiments, the proximal end 174 of the adapter 160 is similarly configured as a proximal end 142 of a lead with terminals (such as terminals 148 in Figure IB) disposed along the proximal end of the adapter body 159. The adapter 160 includes conductors (not shown), such as electrically conductive wires or cables, that electrically couple the connector contacts 172 to the terminals (not shown) on the proximal end 174 of the adapter 160. In at least some embodiments (as shown in Figure 1A), the proximal end 174 of the adapter 160 is configured for insertion into a port 150 of a control module connector 144 or other connector. In other embodiments, the proximal end may be permanently attached to the control module 146.

Figure IB is a schematic side view of one embodiment of proximal ends 142 of one or more adapters or leads (for example, adapter 160 of Figure 1A or lead 180 of Figure 1C) coupling to a control module 146 (or other device) through one or more control module connectors 144. The one or more proximal ends 142 include terminals 148 (such as the terminals of adapter 160).

The control module connector 144 defines at least one port 150a, 150b into which a proximal end 142 can be inserted, as shown by directional arrows 152a and 152b. The control module 146 (or other device) can define any suitable number of ports including, for example, one, two, three, four, five, six, seven, eight, or more ports.

The control module connector 144 also includes a plurality of connector contacts, such as connector contact 154, disposed within each port 150a and 150b. When the proximal end 142 is inserted into the ports 150a and 150b, the connector contacts 154 can be aligned with a plurality of terminals 148 disposed along the proximal end(s) 142. Examples of connectors in control modules are found in, for example, U.S. Patent No. 7,244,150 and 8,224,450, which are incorporated by reference, as well as other references listed herein.

In at least some embodiments, the control module 146 includes a connector housing 145 and a sealed electronics housing 147. In at least some embodiments, an electronic subassembly 110 and an optional power source 112 are disposed in the electronics housing 147. Other embodiments of a control module 146 may have more or fewer components.

Figure 1C illustrates schematically one embodiment of an electrical stimulation lead 180 coupleable to the control module 146 or the adapter 160. The lead 180 includes one or more lead bodies 182, an array 183 of electrodes 126, and an array 185 of terminals 148 disposed along the one or more lead bodies 182. In at least some embodiments, the lead is isodiametric along a longitudinal length of the lead body 182. Conductors (not shown), such as electrically conductive wires, cables, or the like, extend from the terminals 148 to the electrodes 126. Typically, one or more electrodes 126 are electrically coupled to each terminal 148. In at least some embodiments, each terminal 148 is only connected to one electrode 126.

The lead 180 can be coupled to the control module 146 in any suitable manner. In at least some embodiments, the lead 180 couples directly to the control module 146. In at least some other embodiments, the lead 180 couples to the control module 146 via one or more intermediate devices, such as the adapter 160. For example, in at least some embodiments one or more adapters 160 or lead extensions can be disposed between the lead 180 and the control module 146 to extend the distance between the lead 180 and the control module 146. Other intermediate devices may be used in addition to, or in lieu of, one or more lead extensions including, for example, a splitter or the like or any combination thereof. It will be understood that, in the case where the electrical stimulation system 100 includes multiple elongated devices disposed between the lead 180 and the control module 146, the intermediate devices may be configured into any suitable arrangement.

The electrical stimulation system or components of the electrical stimulation system, including one or more of the leads 180 and the control module 146, are typically implanted into the body of a patient. The electrical stimulation system can be used for a variety of applications including, but not limited to, brain stimulation, neural stimulation, spinal cord stimulation, muscle stimulation, and the like.

The electrodes 126, terminals 148, and conductive contacts 154, 172 can be formed using any conductive, biocompatible material. Examples of suitable materials include metals, alloys, conductive polymers, conductive carbon, and the like, as well as combinations thereof. In at least some embodiments, one or more of the electrodes 126 or terminals 148 are formed from one or more of: platinum, platinum iridium, palladium, palladium rhodium, or titanium. The number of electrodes 126 in each array 183, the number of terminals 148 in each array 185, and the number of conductor contacts 154,

172 in a connector 144,162 may vary. For example, there can be two, four, six, eight, ten, twelve, fourteen, sixteen, or more electrodes 126, terminals 148, or conductor contacts 144, 162. As will be recognized, other numbers of electrodes 126, terminals 148, or conductor contacts 154,172 may also be used. The lead body 182 and adapter body 159 can be made of any suitable materials. For example, the lead body 182 and adapter body 159 can be made of non-conductive materials, such as silicone or polyurethane, forming a jacket or other conductor guide structures through which the conductors extend.

Examples of electrical stimulation systems with leads are found in, for example,

U.S. Patents Nos. 6,181,969; 6,295,944; 6,391,985; 6,516,227; 6,609,029; 6,609,032;

6,741,892; 7,244,150; 7,450,997; 7,672,734;7,761,165; 7,783,359; 7,792,590; 7,809,446;

7,949,395; 7,974,706; 8,831,742; 8,688,235; 8,175,710; 8,224,450; 8,271,094; 8,295,944;

8,364,278; and 8,391,985; U.S. Patent Applications Publication Nos. 2007/0150036; 2009/0187222; 2009/0276021; 2010/0076535; 2010/0268298; 2011/0004267;

2011/0078900; 2011/0130817; 2011/0130818; 2011/0238129; 2011/0313500;

2012/0016378; 2012/0046710; 2012/0071949; 2012/0165911; 2012/0197375;

2012/0203316; 2012/0203320; 2012/0203321; 2012/0316615; 2013/0105071;

2011/0005069; 2010/0268298; 2011/0130817; 2011/0130818; 2011/0078900;

2011/0238129; 2011/0313500; 2012/0016378; 2012/0046710; 2012/0165911;

2012/0197375; 2012/0203316; 2012/0203320; and 2012/0203321, all of which are incorporated by reference in their entireties.

Figure 2 illustrates a portion of one embodiment of the adapter connector 162 partially cut-away to illustrate components within the adapter connector. In this embodiment, the adapter connector 162 includes a connector housing 166, a connector lumen 171 (which extends from the connector port 168 - Figure 1 A), connector contacts 172 arranged along the connector lumen, contact housings 173 to hold the connector contacts, spacers 176 disposed between the connector contacts, and a light source 178 disposed at the proximal end of the connector lumen.

The connector housing 166 can be made of any suitable material or materials including, but not limited to, silicone, polyurethane, other plastic, metal, or ceramic or any combination thereof. The connector contacts 172 may take the form of conductive spring contacts or any other suitable contact arrangement. Examples of connector contacts include, but are not limited to, canted coil contacts available from Bal Seal Engineering, Inc. (Foothill Ranch, CA) and contacts described in U.S. Patents Nos.

7,803,021; 8,682,439; 8,897,876; 9,409,032; 9,604,068; 9,656,093; and 9,770,598; U.S. Patent Application Publications Nos. 2011/0022100; 2016/0228692; and 2016/0296745; U.S. Patent Applications Serial Nos. 15/627,016 and 15/656,612; and U.S. Provisional Patent Application Serial No. 62/483,141, all of which are incorporated herein by reference. The contact housing 173 (which may be absent in some embodiments) provide a seat for the contact 172 and may be formed of conductive or non-conductive material or any combination thereof. As indicated above, conductors are coupled to the contacts 172 and extend through the adapter 160 to terminals on the adapter. The conductors may be attached directly to the contacts 172 or may be attached to conductive contact housings 173 which are, in turn, electrically coupled to the contacts 172 or may be coupled to the contacts using any other suitable coupling arrangement.

The spacers 176 can be made of any suitable non-conductive material including, but not limited to, silicone, polyurethane, or the like. The spacers 176 electrically isolate the contacts 172 from each other. In at least some embodiments, the spacers 176 may be flexible and may provide at least a partial seal to reduce, or even eliminate, seepage of fluid into the connector from the environment external to the connector.

The light source 178 can be, for example, a laser diode, a light emitting diode (LED), an organic light emitting diode (OLED), a lamp, or any other suitable light source. In at least some embodiments, the light source 178 may act as an end stop to insertion of the lead into the adapter connector 162. In other embodiments, there may be another component that acts as an end stop to halt insertion of the lead into the adapter connector 162 prior to engagement of the lead with the light source 178.

The light source 178 is positioned to produce light that can then be transmitted along the lead, as described below. The light source 178 is electrically coupled to the terminals of the adapter 160 by conductors 179. In at least some embodiments, conductors 179 are coupled to the light source 178 to provide power to the light source. These conductors 179 are attached to terminals of the adapter 160 (for example, terminals 148 of Figure IB) that are inserted into the control module 146 to receive power from the control module for operating the light source 178. Alternatively, the connector 162 or other portion of the adapter may include a power source for the light source 178. In some embodiments, although the light source 178 is electrically coupled to the terminals of the adapter 160 by the conductors 179, there may also be one or more additional components, such as an electrical-to-optical signal converter, between the light source 178 and the terminals.

Figure 3 A illustrates a distal portion of one embodiment of a lead 380 partially cut-away to illustrate components within the lead. The lead includes a lead body 382, electrodes 326, and an optional light emission tip 386 which may be a lens, a diffuser, a transparent or translucent tip, or any combination thereof or any other suitable arrangement for emission of light. Figure 3A includes a cut-away section to illustrate one of the conductors 325 and a central lumen 330.

Figure 3B illustrates a portion of one embodiment of an optical stylet 332 that can be, for example, an optical fiber (or multiple optical fibers) with a core 334 and a cladding 336. The optical stylet 332 is configured for insertion in the central lumen 330 of the lead 380 and for carrying light from the light source 178 in the connector 162 along the lead 380 to the light emission tip 386 (or one or more other light emission regions along the lead, as described below) when the proximal end of the lead is inserted into the connector.

The terms“optical fiber” and“fiber optic” are used interchangeably herein and include light guides. The core of an optical fiber can be made of, for example, glass, polymer (such as silicone), or any other suitable material. The cladding can also be made of any suitable material including, but not limited to, polymers such as fluoropolymers.

In at least some embodiments, the optical stylet 332 can be used as both a steering or implantation stylet and as a conduit for light to provide optical stimulation of tissue. Thus, in at least some embodiments, the optical stylet 332 has multiple uses and purposes. Alternatively, in at least some embodiments, a separate steering or implantation stylet may be used for implantation of the lead and then replaced after implantation with the optical stylet 332.

Figures 4A and 4B illustrate the lead 380 with inserted optical stylet 332 coupled to the connector 162 of the adapter 160. Figure 4B includes cutaway portions of the lead 380 and adapter 160 in order to view components within the lead and adapter. As illustrated, the proximal end of the optical stylet 332 is positioned to receive light from the light source 178 in the connector 162. In at least some embodiments, the optical stylet 332 is removable from the lead 380. In other embodiments, the optical stylet 332 is permanently disposed in the lead. For example, instead of a removable optical stylet, a permanently emplaced optical fiber traverses the longitudinal length of the lead. It will be recognized that, although the optical stylet 332 is disposed in the central lumen 330 of the lead 380 in the illustrated embodiment, in other embodiments, the optical stylet 332 (or an optical fiber or multiple optical fibers or stylets) can be disposed in a non-central lumen or other portion of the lead.

Figures 5A to 5C illustrate alternative optical stylets that are arranged to emit light at positions other than the distal end of the optical stylet. For example, these stylets may provide light emission out of the side of the lead, instead of, or in addition to, the end of the lead.

Figure 5 A illustrates a portion of a lead 580 with electrodes 526 and a lead body 582 (which may include, but is not limited to, a spacer between electrodes or a jacket for the lead). Within the lead 580 is an optical stylet 532 (or an optical fiber) that includes a core 534, a cladding 536, and light emission regions 558 formed in the cladding. In general, the cladding 536, except at the light emission regions 558, has an index of refraction, n, (for at least one or more wavelengths of light that are to be transmitted along the optical stylet 332) that is less than the index of refraction, n _¥ re, of the core 534 (n<n _¥ re). Light 591 transmitted along the core 534 will be reflected at the barrier between the core and cladding 536 if the angle of incidence, Q, is less than a critical angle defined as sin ' (n/ncoic) where n is the index of refraction of the cladding and n _¥ re is the index of refraction of the core. Typically, light that is present at this portion of the optical stylet 532, which is relatively distant from the light source 178 (Figure 2) and near the electrodes 526, has an angle of incidence less than or equal to the critical angle because light that did not meet this criterion will typically have already exited the optical stylet nearer the light source.

In Figures 5A to 5C, the cladding 536 of the optical stylet 532 (or optical fiber) is modified, removed, or replaced at one or more emission regions 558 along the optical stylet (or optical fiber). As illustrated in Figure 5B, an optical stylet may have one, two , three, four, six, eight, ten, twelve, or more emission regions. In at least some embodiments, the optical stylet 532 and lead 580 may be arranged so that the emission regions 558 on the optical stylet 532 are aligned with spaces between the electrodes 526 when the optical stylet is disposed in the lead.

In at least some embodiments, the material of the emission regions 558 adjacent the core 534 is selected to have an index of refraction, n’, that is greater than or equal to the index of refraction, n _¥ re, of the core 534 (n’>n¥re). This arrangement will typically result in most or all of the incident light 593 being transmitted through the emission region 558. Light incident on the emission regions 558 will leave the core 534 and be transmitted through the emission region 558 and out of the lead 380 (unless reflected by the electrodes 526 or lead body/tissue interface). In at least some embodiments, to limit the amount of light that is transmitted, the material of the emission regions 558 adjacent the core 534 is selected to have an index of refraction, n’, that is greater than the index of refraction, n, of the cladding 532, but less than the index of refraction of the core 534, ncore ( n P . n o ic )

Preferably, the lead body 582, at least in the portions of the lead where it may be desirable to transmit light out of the optical stylet 532, is made of material that is transparent or translucent to the light emitted from the optical stylet 532. In some embodiments, the lead body 582 may include a lens, diffuser, or other optical element at positions from which light can be emitted from the optical stylet 532. In some embodiments, the emission regions 558 may include a lens, diffuser, or other optical element.

Figure 5B illustrates various arrangements of emission regions 558 on portions of different optical stylets 532a, 532b, 532c, 532d. The emission regions 558 can be spaced apart at regular intervals (optical stylets 532a, 532b, 532c) or different intervals (optical stylet 532d) or even at random or irregular intervals. Any suitable arrangement of emission regions can be used. The emission regions 558 in Figure 5B are optionally cylindrical and wrap around the entire outer circumference of the optical stylet. An optical stylet may have any number of emission regions including, but not limited to, one, two , three, four, six, eight, ten, twelve, or more emission regions.

Figure 5C illustrates a portion of one embodiment of an optical stylet 532e with one or more directional emission regions 558a where the directional emission region wraps around only a portion of the outer circumference of the optical stylet. For example, a directional emission region may wrap around only 10, 20, 30, 40, 50, 60, 70, 75, 80, or 90% of the outer circumference of the optical stylet 532. Light within the optical stylet 532e and incident on the directional emission regions 558a will be emitted, but light incident on the cladding adjacent the directional emission regions will remain in the optical stylet. The directional emission regions 558a can be used to limit the emission light to only a portion of the circumference of the optical stylet 532e (and also the lead), thereby providing a directionality to the light emission as opposed to a cylindrical emission region 558 where light is emitted around the entire circumference of the optical stylet. An optical stylet may have any number of directional emission regions including, but not limited to, one, two, three, four six, eight, ten, twelve, or more directional emission regions. In some embodiments, an optical stylet may have any combination of circumferential emission regions and directional emission regions.

Figures 6A and 6B illustrate another feature of at least some embodiments of the optical stylet 632. In Figure 6A, the optical stylet 632 is positioned in lead 680 so that the optical stylet extends to the distal end of the lead. In at least some embodiments, a proximal portion of the optical stylet can be removed or cut to adjust the position of the light emission regions 658 of the optical stylet. In Figure 6B, a portion of the optical stylet 632 has been removed, as compared to Figure 6A, so that the two light emission regions 658 are shifted proximally.

Figure 7 illustrates another embodiment of an adapter 760 that includes a connector 762 is disposed on the distal end 764 of the adapter 760. The adapter 760 can have the same components, features, and options as the adapter 160 except as noted below. The adapter connector 762 includes a connector housing 766, at least one port 768 into which the proximal end of a lead 180 can be inserted, a connector lumen (similar to connector lumen 171 of Figure 2) that extends from the connector port, and connector contacts 772 disposed along that connector lumen. When the proximal end of the lead 180 is inserted into the port 768, the connector contacts 772 disposed in the connector housing 766 can be aligned with the terminals of the lead for electrical coupling.

The connector 762 also includes a light source 778; however, unlike the light source 178 of Figure 2, the light source 778 is not disposed along the connector lumen, but is offset from the connector lumen and connector contacts 772 and disposed in a different portion of the connector housing 766. The connector 762 includes a fiber optic 733 (or optical fiber) that receives light from the light source 778. In at least some embodiments, the fiber optic 733 is directly attached or coupled to the light source 778 to facilitate transfer of light from the light source to the fiber optic. In at least some embodiments, the fiber optic 733 then extends out of the connector housing 766, as illustrated in Figure 7, and reenters the connector housing 766 through a port 775. The fiber optic 733 then extends along the connector lumen so that the fiber optic can be inserted into the proximal end of the lead 780 and can extend along the lead, as illustrated in Figure 7, like the optical stylet 332, 532, 532’. Alternatively, instead of exiting the connector housing 766, the fiber optic 733 may extend within the connector housing 766 from the light source 778 into the connector lumen. The fiber optic 733 can include any of the features and options described above for the optical stylet 332, 532, 532’ including, but not limited to, light emission regions 558 and directional light emission regions 558’.

In at least some embodiments, conductors (not shown) extending from terminals (not shown) of the adapter 760 can be coupled to the light source 778 to power the light source 778. In at least some embodiments, the fiber optic 733 is slidably movable relative to the port 775 so that the length of the fiber optic 733 disposed within the lead 180 can be adjusted in a manner similar to that illustrated in Figures 6A and 6B. This can be used to adjust the position of emission regions or directional emission regions on the fiber optic 773 relative to the lead. In at least some embodiments, the adapter 760 may include a retention block and fastener (similar to that illustrated in Figure 1 A) on the proximal portion of the connector 762 to fasten against the fiber optic 733 and hold the fiber optic 733 in place and prevent or reduce sliding of the fiber optic relative to the lead 180 after the desired fiber optic position has been selected. In at least some

embodiments, an anchor or anchoring sleeve or suture or other arrangement may be positioned around the portion of the fiber optic 733 outside the connector housing 766 and attached to patient tissue to prevent or reduce movement of the fiber optic. In other embodiments, the fiber optic 733 may not be slidably movable through the port 775, but instead may be fixed in relation to the port 775 and connector housing 766. As an alternative, the fiber optic 733 can terminate in the connector lumen (for example, at the proximal end of the connector lumen at the position corresponding to light source 178 in Figure 2). The terminal end of the fiber optic 733 can act as a light source (for example, as light source 178 in Figure 2) for an optical stylet 332, 532, 532a- 532e disposed in the lead 180, as described above.

In at least some embodiments, instead of being inserted into the lead 780, the fiber optic 733 may remain outside the lead and implanted next to the lead or elsewhere in the tissue to provide optical stimulation at a desired location in the tissue. Some

embodiments may include more than one fiber optic, such as, but not limited to, one, two, three, four, six, eight, or more fiber optics which may be positioned within the lead or outside the lead or any combination thereof.

In at least some embodiments, the optical stylet 332, 532, 532a-532e or fiber optic 733 has at least one radiopaque marker disposed thereon to aid in fluoroscopic visualization of the position of the optical stylet or fiber optic. In at least some embodiments, the optical stylet 332, 532, 532a-532e or fiber optic 733 may include one or more lenses, diffusers, or other optical components to aid or alter the light emission. In at least some embodiments, multiple adapters 160, 760 may be used in series to provide multiple light sources which may be the same or different.

In at least some embodiments, the light source 178, 778 may utilize conductors from two of the terminals of the adapter 160, 760 which may result in two fewer active electrodes on the lead 180. For example, an adapter 160, 760 with eight terminals may only be capable of powering six independent lead electrodes as the other two terminals are used to power the light source 178, 778. In at least some embodiments, the adapters 160, 760 (with an optical stylet 332, 532, 532a-532e or fiber optic 733 or any

combination thereof) can be used with existing control modules and leads of an electrical stimulation system to add optical stimulation capability without altering the existing control module or lead (other than to optionally reduce the number of active electrodes in order to power the light source in the adapter). In at least some embodiments, a lead 180 may be open at the distal end to permit a distal portion of the optical stylet 332, 532, 532a-532e or fiber optic 733 to extend out of the lead.

In at least some embodiments, when implanting the control module 146, the adapter connector 162, 762 may be implanted at a same anatomical space as the control module or a different anatomical space. In at least some embodiments, the adapter 160, 760 can be implanted using the same surgical tools as implantation of the control module 146 and lead 180.

Although the leads described above can provide both electrical stimulation and optical stimulation, it will be understood that the leads, systems, arrangements, and methods can be modified to provide an optical stimulation lead without electrical stimulation by, for example, omitting, removing, or not employing the components, such as electrodes or elements that provide current to the electrodes, for electrical stimulation.

Figure 8 is a schematic overview of one embodiment of components of an electrical/optical stimulation system 800 including an electronic subassembly 810 disposed within a control module (for example, an implantable or external pulse generator). It will be understood that the electrical/optical stimulation system can include more, fewer, or different components and can have a variety of different configurations including those configurations disclosed in the stimulator references cited herein.

In at least some embodiments, selected components (for example, a power source 812, an antenna 818, a receiver 802, a processor 804, and a memory 805) of the electrical/optical stimulation system can be positioned on one or more circuit boards or similar carriers within a sealed housing of a control module. Any suitable processor 804 can be used and can be as simple as an electronic device that, for example, produces signals to direct or generate electrical/optical stimulation at a regular interval or the processor can be capable of receiving and interpreting instructions from an external programming unit 808 that, for example, allows modification of stimulation parameters or characteristics.

The processor 804 is generally included to control the timing and other characteristics of the electrical/optical stimulation system. For example, the processor 804 can, if desired, control one or more of the timing, pulse frequency, amplitude, and duration of the electrical/optical stimulation. In addition, the processor 804 can select one or more of the electrodes 826 to provide electrical stimulation, if desired. In some embodiments, the processor 804 selects which of the electrode(s) are cathodes and which electrode(s) are anodes.

Any suitable memory 805 can be used. The memory 805 illustrates a type of computer-readable media, namely computer-readable storage media. Computer-readable storage media may include, but is not limited to, nonvolatile, non-transitory, removable, and non-removable media implemented in any method or technology for storage of information, such as computer readable instructions, data structures, program modules, or other data. Examples of computer-readable storage media include RAM, ROM,

EEPROM, flash memory, or other memory technology, magnetic storage devices, or any other medium which can be used to store the desired information and which can be accessed by a processor.

The processor 804 is coupled to a light source 878, such as a light source 178, 778 in an adapter 160, 760 as described above. Any suitable light source can be used including, but not limited to, light emitting diodes (LEDs), organic light emitting diodes (OLEDs), laser diodes, lamps, light bulbs, or the like or any combination thereof. In at least some embodiments, the electrical/optical stimulation system may include multiple light sources. In at least some embodiments, each of the multiple light sources may emit light having a different wavelength or different wavelength range. Any suitable wavelength or wavelength range can be used including, but not limited to, visible, near infrared, and ultraviolet wavelengths or wavelength ranges. In at least some

embodiments, the optical stimulation system includes a light source that emits in the orange, red, or infrared wavelength ranges (for example, in the range of 600 to 1200 nm or in the range of 600 to 700 nm or in the range of 610 to 650 nm or 620 nm or the like.) In at least some embodiments, the optical stimulation system includes a light source that emits in the green or blue wavelength ranges (for example, in the range of 450 to 550 nm or in the range of 495 to 545 nm or the like.) A wavelength or wavelength range of a light source may be selected to obtain a specific therapeutic, chemical, or biological effect. Any power source 812 can be used including, for example, a battery such as a primary battery or a rechargeable battery. Examples of other power sources include super capacitors, nuclear or atomic batteries, fuel cells, mechanical resonators, infrared collectors, flexural powered energy sources, thermally-powered energy sources, bioenergy power sources, bioelectric cells, osmotic pressure pumps, and the like. As another alternative, power can be supplied by an external power source through inductive coupling via an antenna 818 or a secondary antenna. The external power source can be in a device that is mounted on the skin of the user or in a unit that is provided near the user on a permanent or periodic basis. In at least some embodiments, if the power source 812 is a rechargeable battery, the battery may be recharged using the antenna 818 and a recharging unit 816. In some embodiments, power can be provided to the battery for recharging by inductively coupling the battery to the external recharging unit 816.

In at least some embodiments, the processor 804 is coupled to a receiver 802 which, in turn, is coupled to an antenna 818. This allows the processor 804 to receive instructions from an external source, such as programming unit 808, to, for example, direct the stimulation parameters and characteristics. The signals sent to the processor 804 via the antenna 818 and the receiver 802 can be used to modify or otherwise direct the operation of the electrical/optical stimulation system. For example, the signals may be used to modify the stimulation characteristics of the electrical/optical stimulation system such as modifying one or more of stimulation duration and stimulation amplitude. The signals may also direct the electrical/optical stimulation system 800 to cease operation, to start operation, to start charging the battery, or to stop charging the battery.

In other embodiments, the stimulation system does not include the antenna 818 or receiver 802 and the processor 804 operates as initially programmed.

In at least some embodiments, the antenna 818 is capable of receiving signals (e.g., RF signals) from an external programming unit 808 (such as a clinician programmer or patient remote control or any other device) which can be programmed by a user, a clinician, or other individual. The programming unit 808 can be any unit that can provide information or instructions to the electrical/optical stimulation system 800. In at least some embodiments, the programming unit 808 can provide signals or information to the processor 804 via a wireless or wired connection. One example of a suitable programming unit is a clinician programmer or other computer operated by a clinician or other user to select, set, or program operational parameters for the stimulation. Another example of the programming unit 808 is a remote control such as, for example, a device that is worn on the skin of the user or can be carried by the user and can have a form similar to a pager, cellular phone, or remote control, if desired. In at least some embodiments, a remote control used by a patient may have fewer options or capabilities for altering stimulation parameters than a clinician programmer.

Optionally, the electrical/optical stimulation system 800 may include a transmitter (not shown) coupled to the processor 804 and the antenna 818 for transmitting signals back to the programming unit 808 or another unit capable of receiving the signals. For example, the electrical/optical stimulation system 800 may transmit signals indicating whether the electrical/optical stimulation system 800 is operating properly or not or indicating when the battery needs to be charged or the level of charge remaining in the battery. The processor 804 may also be capable of transmitting information about the stimulation characteristics so that a user or clinician can determine or verify the characteristics.

Although the stimulation systems described above can provide both electrical stimulation and optical stimulation, it will be understood that the systems, arrangements, and methods described above can be modified to provide optical stimulation without electrical stimulation by, for example, may omitting, removing, or not employing the components, such as electrodes or elements that provide current to the electrodes, for electrical stimulation.

The above specification provides a description of the manufacture and use of the invention. Since many embodiments of the invention can be made without departing from the spirit and scope of the invention, the invention also resides in the claims hereinafter appended.