Abstract: An implantable medical device (IMD) with a housing and electrodes on at least two surfaces of the housing is described. The surfaces may be, for example, opposed, substantially parallel surfaces, e.g., top and bottom surfaces. Location of electrodes on multiple surfaces of the housing may allow the IMD to deliver stimulation to a variety of tissues and with a variety of current field configurations. For example, the IMD may deliver peripheral nerve field stimulation (PNFS) to one or more tissue areas via electrodes selected from one or both of the surfaces to, for example, reduce the sensation of pain in a tissue area proximate to an implantation site of the IMD without targeting a specific nerve. The IMD may be implanted between or within intra-dermal, deep dermal, or subcutaneous layers of the tissue of the patient to deliver PNFS to any one or more of these layers.

Abstract: Delivery of peripheral nerve field stimulation (PNFS) in combination with one or more other therapies is described. The other therapy delivered in combination with PNFS may be, for example, a different type of neurostimulation, such as spinal cord stimulation (SCS), or a drug. PNFS and the other therapy may be delivered simultaneously, in an alternating fashion, according to a schedule, and/or selectively, e.g., in response to a request received from a patient or clinician. A combination therapy that includes PNFS may be able to more completely address complex or multifocal pain than would be possible through delivery of either PNFS or other therapies alone. Further, the combination of PNFS with one or more other therapies may reduce the likelihood that neural accommodation will impair the perceived effectiveness PNFS or the other therapies.

Abstract: Enhanced therapies for treating pain are described. The therapies include subcutaneous stimulation of tissue in proximity to a source of pain at low frequencies (less than about 20 Hz) and high frequencies (greater than about 50 Hz). The subcutaneous stimulation may be applied in proximity to a structure in the back, such as discs, facet joints, nerve roots or ganglions, sympathetic chain, ligaments, muscles, and the like. Subcutaneous stimulation at high and low frequencies applied in combination with epidural stimulation is also described.

Abstract: The invention is directed to a technique for rating neuromodulation efficacy based on evaluation of the response of the patient to sensory stimuli with and without delivery of neuromodulation therapy. In addition, the invention may provide a system capable of delivering sensory stimuli on a quantitative basis in a coordinated manner with delivery of neuromodulation therapy. A device programmer may provide a platform for controlling delivery of the sensory stimuli, delivery of neuromodulation therapy, and generation of rating information for neuromodulation efficacy based on patient sensory response to the stimuli. In operation, the programmer controls application of selected sensory stimuli to the patient's body and records the patient's verbal or physiological responses to the stimuli. This invention can be used to be a diagnostic or prognostic test that a given neuromodulation therapy, such as neurostimulation or drug delivery, is and will be successful.

Abstract: The disclosure is directed to techniques for shifting between two electrode combinations. An amplitude of a first electrode combination is incrementally decreased while an amplitude of a second, or subsequent, electrode combination is concurrently incrementally increased. Alternatively, an amplitude of the first electrode combination is maintained at a target amplitude level while the amplitude of the second electrode combination is incrementally increased. The stimulation pulses of the electrode combinations are delivered to the patient interleaved in time. In this manner, the invention provides for a smooth, gradual shift from a first electrode combination to a second electrode combination, allowing the patient to maintain a continual perception of stimulation. The shifting techniques described herein may be used during programming to shift between different electrode combinations to find an efficacious electrode combination.

Abstract: Techniques for adjusting stimulation are disclosed. A medical device measures an impedance associated with one or more electrodes, e.g., the impedance presented to the medical device by a total electrical circuit that includes the one or more electrodes, the conductors associated with the electrodes, and tissue proximate to the electrodes. The medical device stores at least one patient-specific relationship between impedance and a stimulation parameter, and adjusts the value of the stimulation parameter based on the measured impedance according to the relationship. The medical device may store multiple relationships, and select one the relationships based on, for example, an activity level of the patient, posture of the patient, or a current stimulation program or electrode combination used to deliver stimulation. By adjusting a stimulation parameter, such as amplitude, according to such a relationship, the stimulation intensity as perceived by the patient may be kept substantially constant.

Abstract: An implantable neurostimulation lead, method and system adapted for tripolar electric simulation and/or field steering. The neurostimulation lead is are adapted to provide an electrode array defining, for example, a plurality of electrode sets that may be used to provide tripolar stimulation and/or electric field steering.

Abstract: Techniques for adjusting stimulation are disclosed. A medical device measures an impedance associated with one or more electrodes, e.g., the impedance presented to the medical device by a total electrical circuit that includes the one or more electrodes, the conductors associated with the electrodes, and tissue proximate to the electrodes. The medical device stores at least one patient-specific relationship between impedance and a stimulation parameter, and adjusts the value of the stimulation parameter based on the measured impedance according to the relationship. The medical device may store multiple relationships, and select one the relationships based on, for example, an activity level of the patient, posture of the patient, or a current stimulation program or electrode combination used to deliver stimulation. By adjusting a stimulation parameter, such as amplitude, according to such a relationship, the stimulation intensity as perceived by the patient may be kept substantially constant.

Abstract: In general, the invention is directed to techniques for shifting between two electrode combinations. An amplitude of a first electrode combination is incrementally decreased while an amplitude of a second, or subsequent, electrode combination is concurrently incrementally increased. The stimulation pulses of the first and second electrode combinations are delivered to the patient interleaved in time. In this manner, the invention provides for a smooth, gradual shift from a first electrode combination to a second electrode combination, thereby allowing the patient to maintain a continual perception of stimulation. The shifting techniques described herein may be used during programming to shift between different electrode combinations to find the most efficacious electrode combination. Additionally, the techniques may be used for shifting between different electrode combinations associated with different stimulation programs or program sets.

Abstract: A method of stimulating two sites of neurological tissue. A lead is implanted in or near the spinal column. The lead has a first set of at least two electrodes and a second set of at least first, second and third electrodes. The first and second electrodes are positioned on opposite sides of an imaginary longitudinal axis that passes through the center of the third electrode. The placement of the first set of electrodes is at a higher vertebral level than the placement of the second set of electrodes.

Abstract: A lead system for stimulating two sites of neurological tissue. The lead system includes at least a paddle lead and another lead. The paddle lead includes an anchor channel configured for anchoring the two leads together. A method for implanting a lead system for stimulating two sites is also provided.

Abstract: An implantable medical device for stimulating electrically excitable tissue within a patient, and more particularly relates to such a system having a pulse generator and a lead. The lead includes a first set of electrodes including at least three electrodes. The lead also includes a second set of electrodes including at least first, second and third electrodes. The first and second electrodes are positioned on opposite sides of an imaginary longitudinal axis that passes through the center of the third electrode. The second set of electrodes is located at or nearer to the proximal portion of the lead relative to the location of the first set of electrodes.

Abstract: An implantable neurostimulation lead kit adapted for tripolar electric simulation and/or field steering using percutaneously implantable electric stimulation leads. The kit includes three electric stimulation leads that are adapted to provide an electrode array defining, for example, a plurality of electrode sets that may be used to provide tripolar stimulation and/or electric field steering. A method of electrically stimulating the spinal cord is also described.

Abstract: According to the present invention at least a pair of neurological stimulation electrodes are disposed in, on, about, adjacent and/or within excitable neural tissue of a subject. Cardiac activity of a patient is detected using one or more electrodes adapted for delivery of a neurological stimulation therapy (NST). Following detection of certain types of cardiac activity one or more of the plurality of stimulation electrodes deliver or withhold NST, if desired in synchrony with the cardiac activity or in response to the detected cardiac activity. The NST delivered includes without limitation subcutaneous stimulation, peripheral, TENS and/or vagal nerve stimulation therapy or the like.

Abstract: The locus of electrically excitable tissue where action potentials are induced can be controlled using the physiological principle of electrotonus. In one embodiment, first and second pulses are applied to first and second electrodes, respectively, to generate first and second subthreshold potential areas, respectively, within the tissue. The locus within the tissue where action potentials are induced is determined by a superposition of the first and second subthreshold areas according to the physiological principle of electrotonus. In another embodiment, a two-dimensional array of electrodes are formed. The cathode may be positioned near the center of the two-dimensional array or may be left out. The first and second subthreshold areas may thereby be steered. An array of anodal rings may be used to contain the field of excitation.

Abstract: The configuration of the logical processors of a logical partition is managed dynamically. A logical partition is initially configured with one or more logical processors. Thereafter, the configuration can be dynamically adjusted. This dynamic adjustment may be in response to workload of the logical partition.

Abstract: A desired effect is produced by therapeutically activating tissue at a first site within a patient's body and a corresponding undesired side effect is reduced by blocking activation of tissue or conduction of action potentials at a second site within the patient's body by applying high frequency stimulation and/or direct current pulses at or near the second site. Time-varying DC pulses may be used before or after a high frequency blocking signal. The high frequency stimulation may begin before and continue during the therapeutic activation. The high frequency stimulation may begin with a relatively low amplitude, and the amplitude may be gradually increased. The desired effect may be promotion of micturition or defecation and the undesired side effect may be sphincter contraction. The desired effect may be defibrillation of the patient's atria or defibrillation of the patient's ventricles, and the undesired side effect may be pain.

Abstract: The invention is directed to a technique for rating neuromodulation efficacy based on evaluation of the response of the patient to sensory stimuli with and without delivery of neuromodulation therapy. In addition, the invention may provide a system capable of delivering sensory stimuli on a quantitative basis in a coordinated manner with delivery of neuromodulation therapy. A device programmer may provide a platform for controlling delivery of the sensory stimuli, delivery of neuromodulation therapy, and generation of rating information for neuromodulation efficacy based on patient sensory response to the stimuli. In operation, the programmer controls application of selected sensory stimuli to the patient's body and records the patient's verbal or physiological responses to the stimuli. This invention can be used to be a diagnostic or prognostic test that a given neuromodulation therapy, such as neurostimulation or drug delivery, is and will be successful.

Abstract: An implantable medical device includes a controlling device for transmitting a first series of command signals, the controlling device comprising a connector block, a first lead body including at least one electrical lead, and a hermetic encasement. The hermetic encasement includes a housing defining an interior space, an electronic network housed within the interior space and configured to receive the first set of command signals from the controlling device and output a second series of command signals based on the first set of command signals, a first set of one or more feedthrough terminals extending through the housing and directly coupling the electronic network to the connector block, and a second set of one or more feedthrough terminals extending through the housing and directly coupling the electronic network to the first lead body.