Abstract: Example devices and techniques for improving signal quality of a sensed evoked response signal include processing circuitry communicatively coupled to stimulation generation circuitry and sensing circuitry. The processing circuitry is configured to control the stimulation generation circuitry to generate a stimulation signal and receive from the sensing circuitry the sensed evoked response signal. The processing circuitry is configured to determine that a characteristic value of at least one of the artifact or the sensed evoked response signal meets a threshold and automatically change, based on the determination that the characteristic value of the at least one of an artifact in the sensed evoked response signal or the sensed evoked response signal meets the threshold, at least one sensing parameter.

Abstract: A system to provide flexible stimulation pattern definition, delivery, and control to dynamically adjust a therapy regimen for electrical stimulation therapy based on patient needs. Firmware in an electrical stimulation delivery device that executes the therapy regimen may be implemented as a “player” of a series of instructions for the received stimulation patterns. The system may include a wearable device or an implantable device. An external computing device configured to program the electrical stimulation delivery device may include a stimulation pattern construct collection from which a clinician can select, assemble, and modify waveforms, bursts, pattern, sensing or other event triggers etc. to create a therapy regimen. The external computing device may transmit software that defines the selected regimen to the electrical stimulation delivery device memory, where the device “plays” the instructions to deliver electrical stimulation according to the therapy regimen.

Abstract: Techniques are disclosed for defining a homeostatic window for controlling delivery of electrical stimulation therapy to a patient. In one example, a method includes generating and delivering electrical stimulation therapy to tissue of a patient via electrodes. Further, the method includes adjusting a level of a parameter of the electrical stimulation therapy such that a signal of the patient is not less than a lower bound and not greater than an upper bound. The lower bound is determined to be the magnitude of the signal while receiving electrical stimulation therapy sufficient to reduce one or more symptoms of a disease while the patient was receiving medication for reduction of the one or more symptoms. Further, the upper bound is determined to be the magnitude of the signal while receiving electrical stimulation therapy sufficient to reduce the one or more symptoms when the patient was not receiving the medication.

Abstract: Techniques are disclosed for defining a homeostatic window for controlling delivery of electrical stimulation therapy to a patient. In one example, a method includes generating and delivering electrical stimulation therapy to tissue of a patient via electrodes. Further, the method includes adjusting a level of a parameter of the electrical stimulation therapy such that a signal of the patient is not less than a lower bound and not greater than an upper bound. The lower bound is determined to be the magnitude of the signal while receiving electrical stimulation therapy sufficient to reduce one or more symptoms of a disease while the patient was receiving medication for reduction of the one or more symptoms. Further, the upper bound is determined to be the magnitude of the signal while receiving electrical stimulation therapy sufficient to reduce the one or more symptoms when the patient was not receiving the medication.

Abstract: An example system includes stimulation generation circuitry configured to deliver electrical stimulation to a patient; sensing circuitry configured to sense one or more biomarker signals; and processing circuitry configured to: cause delivery of electrical stimulation with the patient in a first patient state; receive a first instance of a biomarker signal in presence of the electrical stimulation with the patient in the first patient state; cause delivery of electrical stimulation with the patient in a second patient state; receive a second instance of the biomarker signal in presence of the electrical stimulation with the patient in the second patient state; determine whether a difference between the first instance of the biomarker signal and the second instance of the biomarker signal satisfies a threshold; select a therapy mode based on whether the difference satisfies the threshold; and cause delivery of electrical stimulation in accordance with the selected therapy mode.

Abstract: An example method includes determining, by an implantable medical device (IMD), an electrode of a plurality of electrodes of a lead to be used to deliver electrical stimulation to a patient at a particular time; selecting, by the IMD and based on the determined electrode, a set of electrodes of the plurality of electrodes; and sensing, by the IMD and via the selected set of electrodes, electrical signals of the patient at the particular time.

Abstract: A medical device for providing electrical stimulation to a brain of a patient includes one or more processors. The one or more processors are configured to determine a first set of parameters of a first electrical signal that is delivered via a first electrode configured to apply electrical stimulation to a first region of the brain and to determine a second set of parameters of a second electrical signal based on the first set of parameters. The second electrical signal is delivered via a second electrode configured to apply electrical stimulation to a second region of the brain. The one or more processors are further configured to deliver, with the first electrode, the first electrical signal having the first set of parameters and to deliver, with the second electrode, the second electrical signal having the second set of parameters.

Abstract: Devices, systems, and techniques are described for transitioning between different groups of electrical stimulation programs. For example, a system may control delivery of second electrical stimulation defined by one or more second programs of a second group of stimulation programs on a time-interleaved basis with first electrical stimulation defined by one or more first programs of the first group of stimulation programs. The system may change a first ratio of the one or more first programs used to define the first electrical stimulation to the one or more second programs used to define the second electrical stimulation delivered within a first period of time to a second ratio of the one or more first programs used to define the first electrical stimulation to the one or more second programs used to define the second electrical stimulation delivered within a second period of time.

Abstract: A medical device or system of medical devices can be configured to detect an indicator of a symptom in a patient; in response to detecting the indicator of the symptom in the patient, deliver to the patient a first stimulation therapy; and in response to determining that the indicator of the symptom has been present for more than a threshold amount of time after beginning to deliver the first stimulation therapy a second stimulation therapy different than the first stimulation therapy.

Abstract: Techniques are disclosed for defining a homeostatic window for controlling delivery of electrical stimulation therapy to a patient. In one example, a method includes generating and delivering electrical stimulation therapy to tissue of a patient via electrodes. Further, the method includes adjusting a level of a parameter of the electrical stimulation therapy such that a signal of the patient is not less than a lower bound and not greater than an upper bound. The lower bound is determined to be the magnitude of the signal while receiving electrical stimulation therapy sufficient to reduce one or more symptoms of a disease while the patient was receiving medication for reduction of the one or more symptoms. Further, the upper bound is determined to be the magnitude of the signal while receiving electrical stimulation therapy sufficient to reduce the one or more symptoms when the patient was not receiving the medication.

Abstract: Techniques are disclosed for defining a homeostatic window for controlling delivery of electrical stimulation therapy to a patient. In one example, a method includes generating and delivering electrical stimulation therapy to tissue of a patient via electrodes. Further, the method includes adjusting a level of a parameter of the electrical stimulation therapy such that a signal of the patient is not less than a lower bound and not greater than an upper bound. The lower bound is determined to be the magnitude of the signal while receiving electrical stimulation therapy sufficient to reduce one or more symptoms of a disease while the patient was receiving medication for reduction of the one or more symptoms. Further, the upper bound is determined to be the magnitude of the signal while receiving electrical stimulation therapy sufficient to reduce the one or more symptoms when the patient was not receiving the medication.

Abstract: Devices, systems, and techniques are described for transitioning between different groups of electrical stimulation programs. For example, a system may control delivery of second electrical stimulation defined by one or more second programs of a second group of stimulation programs on a time-interleaved basis with first electrical stimulation defined by one or more first programs of the first group of stimulation programs. The system may change a first ratio of the one or more first programs used to define the first electrical stimulation to the one or more second programs used to define the second electrical stimulation delivered within a first period of time to a second ratio of the one or more first programs used to define the first electrical stimulation to the one or more second programs used to define the second electrical stimulation delivered within a second period of time.

Abstract: Systems and method may be used for interfacing with a patient. Systems may include a plurality of electrodes in electrical communication with a processor. The processor may determine a relative impedance difference between a first electrode and a second electrode, and apply a sub-therapeutic stimulation pulse to one of the first and second electrodes to adjust the relative impedance difference therebetween. Systems may include a processor capable of one or both of providing therapeutic stimulation to a patient via at least one electrode, and receiving electrical signals indicative of the patient's physiological activity. In some examples, the processor may simultaneously provide therapeutic stimulation to a patient and receive electrical signals from the patient indicative of the patient's physiological activity.

Abstract: Techniques are disclosed for defining a homeostatic window for controlling delivery of electrical stimulation therapy to a patient. In one example, a method includes generating and delivering electrical stimulation therapy to tissue of a patient via electrodes. Further, the method includes adjusting a level of a parameter of the electrical stimulation therapy such that a signal of the patient is not less than a lower bound and not greater than an upper bound. The lower bound is determined to be the magnitude of the signal while receiving electrical stimulation therapy sufficient to reduce one or more symptoms of a disease while the patient was receiving medication for reduction of the one or more symptoms. Further, the upper bound is determined to be the magnitude of the signal while receiving electrical stimulation therapy sufficient to reduce the one or more symptoms when the patient was not receiving the medication.

Abstract: Systems and method may be used for interfacing with a patient. Systems may include a plurality of electrodes in electrical communication with a processor. The processor may determine a relative impedance difference between a first electrode and a second electrode, and apply a sub-therapeutic stimulation pulse to one of the first and second electrodes to adjust the relative impedance difference therebetween. Systems may include a processor capable of one or both of providing therapeutic stimulation to a patient via at least one electrode, and receiving electrical signals indicative of the patient's physiological activity. In some examples, the processor may simultaneously provide therapeutic stimulation to a patient and receive electrical signals from the patient indicative of the patient's physiological activity.

Abstract: This disclosure describes a state machine framework for programming closed-loop algorithms that control the delivery of therapy to a patient by an implantable medical device (IMD). The state machine framework may use one or more programmable state parameters to define at least part of a structure of a state machine that generates one or more therapy decisions based on one or more sensed states of the patient. The state machine framework may include a state machine runtime environment that executes on an IMD and that is configurable to implement a variety of different state machines depending on programmable state parameters that are received from an external device. The techniques of this disclosure may, in some cases, allow IMD developers and/or users to program, change, and/or download new closed-loop control policy algorithms during the lifespan of the IMD without requiring new firmware code to be downloaded onto the IMD.

Abstract: This disclosure describes a state machine framework for programming closed-loop algorithms that control the delivery of therapy to a patient by an implantable medical device (IMD). The state machine framework may use one or more programmable state parameters to define at least part of a structure of a state machine that generates one or more therapy decisions based on one or more sensed states of the patient. The state machine framework may include a state machine runtime environment that executes on an IMD and that is configurable to implement a variety of different state machines depending on programmable state parameters that are received from an external device. The techniques of this disclosure may, in some cases, allow IMD developers and/or users to program, change, and/or download new closed-loop control policy algorithms during the lifespan of the IMD without requiring new firmware code to be downloaded onto the IMD.