Abstract: Systems of techniques for controlling charge flow during the electrical stimulation of tissue. In one aspect, a method includes receiving a charge setting describing an amount of charge that is to flow during a stimulation pulse that electrically stimulates a tissue, and generating and delivering the stimulation pulse in a manner such that an amount of charge delivered to the tissue during the stimulation pulse accords with the charge setting.

Abstract: Architectures for implantable stimulators having N electrodes are disclosed. The architectures contains X current sources, or DACs. In a single anode/multiple cathode design, one of the electrodes is designated as the anode, and up to X of the electrodes can be designated as cathodes and independently controlled by one of the X DACs, allowing complex patient therapy and current steering between electrodes. The design uses at least X decoupling capacitors: X capacitors in the X cathode paths, or one in the anode path and X?1 in the X cathode paths. In a multiple anode/multiple cathode design having X DACs, a total of X?1 decoupling capacitors are needed. Because the number of DACs X can typically be much less than the total number of electrodes (N), these architectures minimize the number of decoupling capacitors which saves space, and ensures no DC current injection even during current steering.

Abstract: The disclosed techniques allow for externalizing errors from an implantable medical device using the device's charging coil, for receipt at an external charger or other external device. Transmission of errors in this manner is particularly useful when telemetry of error codes through a traditional telemetry coil in the implant is not possible, for example, because the error experienced is so fundamental as to preclude use of such traditional means. By externalizing the error via the charging coil, and though the use of robust error modulation circuitry in the implant designed to be generally insensitive to fundamental errors, the external charger can be consulted to understand the failure mode involved, and to take appropriate action.

Abstract: An example of a system may include electrodes on at least one lead configured to be operationally positioned for use in modulating neural tissue. The neural tissue may include at least one of dorsal horn tissue, dorsal root tissue or dorsal column tissue. The system may include an implantable device including a neural modulation device and a controller. The neural modulation device may be configured to use at least some of the electrodes to generate a modulation field to deliver sub-perception modulation to the neural tissue. The sub-perception modulation may have an intensity below a patient-perception threshold. The patient-perception threshold may be a boundary below which a patient does not sense generation of the modulation field. The controller may be configured to control the neural modulation device to generate the modulation field, and automatically adjust the modulation field in response to a patient input.

Abstract: Architectures for implantable stimulators having N electrodes are disclosed. The architectures contains X current sources, or DACs. In a single anode/multiple cathode design, one of the electrodes is designated as the anode, and up to X of the electrodes can be designated as cathodes and independently controlled by one of the X DACs, allowing complex patient therapy and current steering between electrodes. The design uses at least X decoupling capacitors: X capacitors in the X cathode paths, or one in the anode path and X?1 in the X cathode paths. In a multiple anode/multiple cathode design having X DACs, a total of X?1 decoupling capacitors are needed. Because the number of DACs X can typically be much less than the total number of electrodes (N), these architectures minimize the number of decoupling capacitors which saves space, and ensures no DC current injection even during current steering.

Abstract: Systems of techniques for controlling charge flow during the electrical stimulation of tissue. In one aspect, a method includes receiving a charge setting describing an amount of charge that is to flow during a stimulation pulse that electrically stimulates a tissue, and generating and delivering the stimulation pulse in a manner such that an amount of charge delivered to the tissue during the stimulation pulse accords with the charge setting.

Abstract: A miniaturized controller includes communication and control circuitry for monitoring and controlling an implantable medical device (IMD). The miniaturized controller includes a display that allows it to essentially mimic the IMD control functionality of a traditional IMD controller. The size of the miniaturized controller, which may be approximately 1.1 cubic inches, enables it to be carried discreetly by a patient during the patient's daily activities. While the miniaturized controller functions as a standalone IMD controller in a first mode of operation, it is also wearable by the patient to function as a smartwatch, for example, in a second mode of operation. In the second mode of operation, the miniaturized controller, which may include sensors for measuring physiological parameters of the patient as well as patient motion when worn by the patient, is capable of providing closed-loop control of the IMD.

Abstract: A neuromodulation system and method of providing therapy to a patient. Electrical energy is delivered to the patient in accordance with a modulation parameter, thereby providing therapy to the patient, and the modulation parameter of the delivered electrical energy is varied over a period of time, such that the delivered electrical energy is continually maintained at a sub-threshold level throughout the period of time. The sub-threshold level may be referred to as a patient-perception threshold, which may be referred to as a boundary below which a patient does not sense delivery of the electrical energy. For example, in a spinal cord modulation system, the patient-perception threshold may be a boundary below which a patient does not experience paresthesia.

Abstract: A current generation architecture for an implantable stimulator device such as an Implantable Pulse Generator (IPG) is disclosed. Current source and sink circuitry are both divided into coarse and fine portions, which respectively can provide coarse and fine current resolutions to a specified electrode on the IPG. The coarse portion is distributed across all of the electrodes and so can source or sink current to any of the electrodes. The coarse portion is divided into a plurality of stages, each of which is capable via an associated switch bank of sourcing or sinking a coarse amount of current to or from any one of the electrodes on the device. The fine portion of the current generation circuit preferably includes source and sink circuitry dedicated to each of the electrode on the device, which can comprise digital-to-analog current converters (DACs).

Abstract: Charging circuitry is disclosed for receiving a magnetic charging field and using the received field to charge a battery in an Implantable Medical Device (IMD) without passive trickle charging, and even if the battery voltage (Vbat) is severely depleted. The charging circuitry includes a source capable of producing a constant charging current via a current mirror that receives a reference current for setting the charging current. Two reference current generators are provided: a first enabled when Vbat is severely depleted to produce a small non-adjustable reference current; and a second enabled once Vbat is recovered to produce a reference current that can be controlled to adjust the charging current. Because Vbat may be too low, the first generator is powered by a DC voltage produced from the magnetic charging field. A passively-generated undervoltage control signal is used to transition between use of the first and second generators.

Abstract: Timing channel circuitry for controlling stimulation circuitry in an implantable stimulator is disclosed. The timing channel circuitry comprises a addressable memory. Data for the various phases of a desired pulse are stored in the memory using different numbers of words, including a command indicative of the number of words in the phase, a next address for the next phase stored in the memory, and a pulse width or duration of the current phase, control data for the stimulation circuitry, pulse amplitude, and electrode data. The command data is used to address through the words in the current phase via the address bus, which words are sent to a control register for the stimulation circuitry. After the duration of the pulse width for the current phase has passed, the stored next address is used to access the data for the next phase stored in the memory.

Abstract: An example of a system may include electrodes on at least one lead configured to be operationally positioned for use in modulating neural tissue. The neural tissue may include at least one of dorsal horn tissue, dorsal root tissue or dorsal column tissue. The system may include an implantable device including a neural modulation device and a controller. The neural modulation device may be configured to use at least some of the electrodes to generate a modulation field to deliver sub-perception modulation to the neural tissue. The sub-perception modulation may have an intensity below a patient-perception threshold. The patient-perception threshold may be a boundary below which a patient does not sense generation of the modulation field. The controller may be configured to control the neural modulation device to generate the modulation field, and automatically adjust the modulation field in response to a patient input.

Abstract: An algorithm programmed into the control circuitry of a rechargeable-battery Implantable Medical Device (IMD) is disclosed that can quantitatively forecast and determine the timing of an early replacement indicator (tEOLi) and an IMD End of Life (tEOL). These forecasts and determinations of tEOLi and tEOL occur in accordance with one or more parameters having an effect on rechargeable battery capacity, such as number of charging cycles, charging current, discharge depth, load current, and battery calendar age. The algorithm consults such parameters as stored over the history of the operation of the IMD in a parameter log, and in conjunction with a battery capacity database reflective of the effect of these parameters on battery capacity, determines and forecasts tEOLi and tEOL. Such forecasted or determined values may also be used by a shutdown algorithm to suspend therapeutic operation of the IMD.

Abstract: The problem of a potentially high amount of supra-threshold charge passing through the patient's tissue at the end of an Implantable Pulse Generator (IPG) program is addressed by circuitry that periodically dissipates only small amount of the charge stored on capacitances (e.g., DC-blocking capacitors) during a pulsed post-program recovery period. This occurs by periodically activating control signals to turn on passive recovery switches to form a series of discharge pulses each dissipating a sub-threshold amount of charge. Such periodic pulsed dissipation may extend the duration of post-program recovery, but is not likely to be noticeable by the patient when the programming in the IPG changes from a first to a second program. Periodic pulsed dissipation of charge may also be used during a program, such as between stimulation pulses.

Abstract: Electrode voltage monitoring circuitry for an implantable neurostimulator system having a plurality of electrode-driver integrated circuits (ICs) in provided. Electrodes from either or both ICs can be chosen to provide stimulation, and one of the IC acts as the master while the other acts as the slave. Electrodes voltages on the slave IC are routed to the master IC, and thus the master IC can monitor both electrode voltages on the slave as well as electrode voltages on the master. Such voltages can be monitored for a variety of purposes, and in particular use of such voltage is disclosed for determining the resistance between electrodes and to set a compliance voltage for stimulation.

Abstract: A current generation architecture for an implantable stimulator device such as an Implantable Pulse Generator (IPG) is disclosed. Current source and sink circuitry are both divided into coarse and fine portions, which respectively can provide coarse and fine current resolutions to a specified electrode on the IPG. The coarse portion is distributed across all of the electrodes and so can source or sink current to any of the electrodes. The coarse portion is divided into a plurality of stages, each of which is capable via an associated switch bank of sourcing or sinking a coarse amount of current to or from any one of the electrodes on the device. The fine portion of the current generation circuit preferably includes source and sink circuitry dedicated to each of the electrode on the device, which can comprise digital-to-analog current converters (DACs).

Abstract: Multi-phasic fields are produced at a neuromodulation site using electrodes. A first phase is directed at a target region such that a first-polarity electrical charge is injected to the target region, and a second phase is directed at portions of the neuromodulation site other than the target region, such that a second-polarity electrical charge opposite the first-polarity electrical charge is injected to those portions of the neuromodulation site to essentially neutralize the first-polarity charge injected at the neuromodulation site while maintaining at least a portion of the first-polarity charge at the target region. In some embodiments, each anode used to produce the first phase is used as a cathode to produce the second phase, and each cathode used to produce the first phase is used as an anode to produce the second phase, and the quantity of charge injected by each electrode in both phases is essentially zero.

Abstract: Battery management circuitry for an implantable medical device such as an implantable neurostimulator is described. The circuitry has a T-shape with respect to the battery terminal, with charging circuitry coupled between rectifier circuitry and the battery terminal on one side of the T, and load isolation circuitry coupled between the load and the battery terminal on the other side. The load isolation circuitry can comprise two switches wired in parallel. An undervoltage fault condition opens both switches to isolate the battery terminal from the load to prevent further dissipation of the battery. Other fault conditions will open only one the switches leaving the other closed to allow for reduced power to the load to continue implant operations albeit at safer low-power levels. The battery management circuitry can be fixed in a particular location on an integrated circuit which also includes for example the stimulation circuitry for the electrodes.

Abstract: A neuromodulation system configured for providing sub-threshold neuromodulation therapy to a patient. The neuromodulation system comprises a neuromodulation lead having at least one electrode configured for being implanted along a spinal cord of a patient, a plurality of electrical terminals configured for being respectively coupled to the at least one electrode, modulation output circuitry configured for delivering sub-threshold modulation energy to active ones of the at least one electrode, and control/processing circuitry configured for selecting a percentage from a plurality of percentages based on a known longitudinal location of the neuromodulation lead relative to the spinal cord, computing an amplitude value as a function of the selected percentage, and controlling the modulation output circuitry to deliver sub-threshold modulation energy to the patient at the computed amplitude value.

Abstract: Compliance voltage generation circuitry for a medical device is disclosed. The circuitry in one embodiment comprises a boost converter and a charge pump, either of which is capable of generating an appropriate compliance voltage from the voltage of the battery in the device. A boost signal from compliance voltage monitor-and-adjust logic circuitry is processed with a telemetry enable signal to selectively enable either the charge pump or the boost converter: if the telemetry enable signal is not active, the boost converter is used to generate the compliance voltage; if the telemetry enable signal is active, the charge pump is used. Because the charge pump circuitry does not produce a magnetic field, the charge pump will not interfere with magnetically-coupled telemetry between the implant and an external controller. By contrast, the boost converter is allowed to operate during periods of no telemetry, when magnetic interference is not a concern.