Abstract: Methods for determining stimulation for a patient having a stimulator device are disclosed. A model is received at an external system indicative of a range or volume of preferred stimulation parameters, which model is preferably specific to and determined for the patient. The external system receives a plurality of pieces of fitting information for the patient, including information indicative of a symptom of the patient, information indicative of stimulation provided by the stimulator device during a fitting procedure, and/or phenotype information for the patient. The external system determines one or more sets of stimulation parameters for the patient using the pieces of fitting information. In one example, training data is applied to the pieces of fitting information to select the one or more sets of stimulation parameters from the range or volume of preferred stimulation parameters in the model.

Abstract: Methods and systems for testing and treating spinal cord stimulation (SCS) patients are disclosed. Patients are eventually treated with sub-perception (paresthesia free) therapy. However, supra-perception stimulation is used during “sweet spot searching” during which active electrodes are selected for the patient. This allows sweet spot searching to occur much more quickly and without the need to wash in the various electrode combinations that are tried. After selecting electrodes using supra-perception therapy, therapy is titrated to sub-perception levels using the selected electrodes. Such sub-perception therapy has been investigated using pulses at or below 10 kHz, and it has been determined that a statistically significant correlation exists between pulse width (PW) and frequency (F) in this frequency range at which SCS patients experience significant reduction in symptoms such as back pain.

Abstract: New waveforms for use in an implantable pulse generator or external trial stimulator are disclosed which mimic actively-driven biphasic pulses, and which are particularly useful for issuing low frequencies pulses. The waveforms comprise at each electrode interleaved first and second pulses. Each first pulse comprises a first monophasic pulse and a first passive charge recovery period. Each second pulse comprises a second monophasic pulse with a polarity opposite the first monophasic pulse and a second passive charge recovery period. Preferably, the amplitudes and pulse widths of the first and second monophasic pulses are equal, or at least charge balanced at each electrode. The first and second monophasic pulses mimic the functionality of a symmetric biphasic pulse, with the first monophasic pulse mimicking the functionality of the biphasic pulse's first phase, and the with the second monophasic pulse mimicking the functionality of the biphasic pulse's second phase.

Abstract: Methods and systems for providing stimulation therapy are disclosed. Embodiments of the system include an implantable stimulator and an external controller configured to control the implantable stimulator. A clinician can prescribe a set amount of stimulation therapy to a patient. The external controller is programmed with the prescription. As the patient uses the external controller and the stimulator device the external controller tracks the amount of stimulation the patient uses. Once the patient has used all of the prescribed therapy the patient may return to the clinician for a follow-up appointment.

Abstract: New waveforms for use in an implantable pulse generator or external trial stimulator are disclosed which mimic actively-driven biphasic pulses, and which are particularly useful for issuing low frequencies pulses. The waveforms comprise at each electrode interleaved first and second pulses. Each first pulse comprises a first monophasic pulse and a first passive charge recovery period. Each second pulse comprises a second monophasic pulse with a polarity opposite the first monophasic pulse and a second passive charge recovery period. Preferably, the amplitudes and pulse widths of the first and second monophasic pulses are equal, or at least charge balanced at each electrode. The first and second monophasic pulses mimic the functionality of a symmetric biphasic pulse, with the first monophasic pulse mimicking the functionality of the biphasic pulse's first phase, and the with the second monophasic pulse mimicking the functionality of the biphasic pulse's second phase.

Abstract: Systems and methods for controlling autonomic symptoms or side effects via spinal cord stimulation are discussed. An exemplary neuromodulation system comprises an electrostimulator to provide spinal cord stimulation (SCS) to a neural target, a user interface device to receive a user input including an autonomic symptom and affected anatomy, and a controller circuit to determine or adjust a stimulation parameter based at least on the autonomic symptoms and the affected anatomy. Spinal cord stimulation can be delivered in accordance with the determined or adjusted stimulation parameter to alleviate the autonomic symptom, or to treat or alleviate autonomic disorders.

Abstract: Systems and methods for controlling an implantable stimulator device such as a spinal cord stimulation are disclosed. Optimal stimulation parameters for the patient, which may be personalized for the patient based on test stimulation and organized as a neural dose, are subject to duty cycling in which stimulation is applied during an on duration and is turned off during an off duration. The duty cycling applied is automatically determined by and dependent on the stimulation parameters chosen, and in particular the frequency of those parameters. Further, a user interface element is provided to allow a user to automatically step thought suitable duty cycle values determined to be appropriate for the stimulation parameters. As such, the user does need not need to engage in guess work to specify individual on and off times when duty cycling is desired.

Abstract: An example of a system for delivering neurostimulation from a stimulation device to a patient may include a programming control circuit, a sensory profiling circuit, and a stimulation control circuit. The programming control circuit may be configured to program the stimulation device for controlling delivery of the neurostimulation according to one or more stimulation waveforms and one or more stimulation fields. The sensory profiling circuit may be configured to receive information regarding painful symptoms of the patient and to determine a pain sensory profile for the patient using the received information. The stimulation control circuit may be configured to determine a recommendation for one or more spinal cord stimulation (SCS) therapies using the determined pain sensory profile and to determine the one or more stimulation waveforms and the one or more stimulation fields using the recommended one or more SCS therapies.

Abstract: Techniques are disclosed for adjusting sub-perception stimulation applied to a patient by an Implantable Pulse Generator (IPG). Adjustment can occur through use of one or more modulation functions associated with a stimulation modulation algorithm that adjusts the total charge provided by the stimulation to the patient as a function of time. The modulation function and algorithm can adjust the charge either by duty cycling the stimulation, or by adjusting the sub-perception stimulation parameters, and such adjustment can occur in the IPG or an external device. The stimulation modulation algorithm may use one or more models when adjusting the stimulation parameters to keep them at optimal values for sub-perception stimulation while simultaneous adjusting the charge stimulation provided as prescribed by the modulation function.

Abstract: A system may be used with a medical imaging system and a programming system. The medical imaging system may be configured to display a medical image and the programming system may be configured to implement a program used in programming a neuromodulation device. The system may comprise a mobile device having at least one processor, a camera and a user interface including a display. The mobile device may be configured to acquire a displayed medical image from the medical imaging system, determine based on the acquired medical image location data indicative of the position of at least one of the electrodes relative to at least one of the anatomy or at least another one of the electrodes, and provide the location data for use by the program implemented by the programming system.

Abstract: Graphical User Interface (GUI) control of a stimulator device is disclosed. The GUI receives modeling information indicating optimal stimulation parameters for a patient based on patient testing, and may also receive an indication of a particular stimulation mode to be used for the patient which comprises a subset of those parameters. The GUI provides simple options to allow a user to navigate the optimal parameters or subsets to constrain selection to only those stimulation parameters set within the optimal parameters or subsets.

Abstract: A system may be used with a medical imaging system and a programming system. The medical imaging system may be configured to display a medical image and the programming system may be configured to implement a program used in programming a neuromodulation device. The system may comprise a mobile device having at least one processor, a camera and a user interface including a display. The mobile device may be configured to acquire a displayed medical image from the medical imaging system, determine based on the acquired medical image location data indicative of the position of at least one of the electrodes relative to at least one of the anatomy or at least another one of the electrodes, and provide the location data for use by the program implemented by the programming system.

Abstract: Systems and methods are disclosed to permit a patient to use his external controller to move the location of stimulation in an implantable stimulator system. The external controller can be programmed with a steering algorithm, which prompts the patient to enter certain data regarding their symptoms (e.g., pain), such as pain scores and stimulation coverage. Such data is preferably entered for a plurality of different regions of the patient's body. The algorithm can compute for each body regions a targeting precision value (TP), and from these values determine a steering vector D that suggests a direction and/or a magnitude that stimulation can be moved in the electrode array to more precisely target the patient's pain. The patient may then move the location of the stimulation in accordance with the steering vector using their external controller. The algorithm can be repeated if necessary to again move the stimulation.

Abstract: Systems and methods are disclosed in which a time series analysis algorithm is used to analyze inputs such as adjustments a patient has made to the amplitude of stimulation in an implantable stimulator system. The algorithm uses these inputs to predict how the patient would likely adjust the amplitude in the future, i.e. to predict future amplitudes for the patient as a function of time. Preferably, the algorithm determines one or more of an amplitude level, at least one seasonal variation, or at least one trend when predicting the amplitude. This predicted amplitude can then be used to automatically adjust the amplitude of the stimulation provided by the patient's stimulator. The algorithm may only use previous amplitude adjustments to predict the amplitude, other time-varying inputs, or combinations of both.

Abstract: A method is disclosed for programming a patient's stimulator device using an external device. The method provides a Graphical User Interface (GUI) on the external device that allows the patient to select from a plurality of displayed stimulation modes to program stimulation provided by one or more electrodes of the stimulator device. The external device stores a model derived for the patient, which model comprises information indicative of a plurality of frequency/pulse width/amplitude coordinates predicted to provide optimal stimulation for the patient. Each stimulation mode corresponds with a subset of coordinates defined in accordance with the plurality of coordinates in the model. Selection of one of the stimulation modes limits programming the stimulator device with coordinates that are within the corresponding subset of coordinates.

Abstract: Methods and systems for determining sub-perception stimulation for a patient having a spinal cord stimulator device are disclosed. In one example, an external device includes an algorithm configured to determine a stimulation program for the stimulator device. The algorithm includes a model that comprises pre-determined energy values that cause sub-perception stimulation. The algorithm is configured to determine stimulation parameters for the stimulation program that yield an energy value within the first model. The energy values in the model may be expressed as a function of frequency. The model in particular provides optimal sub-perception stimulation at low frequencies, such as at 1 kHz and below, or even at 400 Hz and below.

Abstract: Methods and systems for testing and treating spinal cord stimulation (SCS) patients are disclosed. Patients are eventually treated with sub-perception (paresthesia free) therapy. However, supra-perception stimulation is used during “sweet spot searching” during which active electrodes are selected for the patient. This allows sweet spot searching to occur much more quickly and without the need to wash in the various electrode combinations that are tried. After selecting electrodes using supra-perception therapy, therapy is titrated to sub-perception levels using the selected electrodes. Such sub-perception therapy has been investigated using pulses at or below 10 kHz, and it has been determined that a statistically significant correlation exists between pulse width (PW) and frequency (F) in this frequency range at which SCS patients experience significant reduction in symptoms such as back pain.

Abstract: A method is disclosed for programming a patient's stimulator device using an external device. The method provides a Graphical User Interface (GUI) on the external device that allows the patient to select from a plurality of displayed stimulation modes to program stimulation provided by one or more electrodes of the stimulator device. The external device stores a model derived for the patient, which model comprises information indicative of a plurality of frequency/pulse width/amplitude coordinates predicted to provide optimal stimulation for the patient. Each stimulation mode corresponds with a subset of coordinates defined in accordance with the plurality of coordinates in the model. Selection of one of the stimulation modes limits programming the stimulator device with coordinates that are within the corresponding subset of coordinates.

Abstract: A system may include at least one sensor configured to bilaterally sense neurophysiological signals from the patient to provide bilateral sensing data, and at least one processor configured to calibrate at least a first electrode contact and a second electrode contact on the least one neuromodulation lead, including: instruct the neuromodulation device to deliver neuromodulation energy using at least the first electrode contact to cause a first neurophysiological response and at least the second electrode contact to cause a second neurophysiological response; receive from the at least one sensor first bilateral sensed data corresponding to the first neurophysiological response and second bilateral sensed data corresponding to the second neurophysiological response; and determine based on the first and second neurophysiological responses at least one of: physiological midline information or electrode-tissue coupling information.

Abstract: Methods and systems for testing and treating spinal cord stimulation (SCS) patients are disclosed. Patients are eventually treated with sub-perception (paresthesia free) therapy. However, supra-perception stimulation is used during “sweet spot searching” during which active electrodes are selected for the patient. This allows sweet spot searching to occur much more quickly and without the need to wash in the various electrode combinations that are tried. After selecting electrodes using supra-perception therapy, therapy is titrated to sub-perception levels using the selected electrodes. Such sub-perception therapy has been investigated using pulses at or below 10 kHz, and it has been determined that a statistically significant correlation exists between pulse width (PW) and frequency (F) in this frequency range at which SCS patients experience significant reduction in symptoms such as back pain.