Abstract: An example of a neurostimulation system may include a storage device for storing data representing physiological signals and a user interface including a user input, a display screen, and a presentation control circuit. The user input may be configured to receive a selection of signal(s) from the physiological signals and a selection of viewing mode from viewing modes including a metric mode and/or a presence mode. The metric mode allows for visualization of a signal property indicated by a parameter measured from the selected signal(s). The presence mode allows for viewing presence of a feature in the selected signal(s). The presentation control circuit may be configured to allow for the selection of the signal(s) and the viewing mode, to determine a segment of each of the selected signal(s) for presentation according to the selected viewing mode, and to present the determined segment on the display screen.

Abstract: An implantable device includes one or more electrodes to sense an electrical signal from a brain and a waveform analyzer to identify a half wave in the electrical signal; determine an amplitude and a duration of the half wave; determine if the amplitude satisfies a half wave amplitude criterion defined by a set of amplitude parameters comprising a minimum half wave amplitude and a maximum half wave amplitude; determine if the duration satisfies a half wave duration criterion defined by a set of duration parameters comprising a minimum half wave duration and a maximum half wave duration; and identify the half wave as a qualified half wave when the half wave amplitude criterion and the half wave duration criterion is satisfied. A neurological event may be detected based on one or more qualified half waves and electrical stimulation therapy may be delivered to the brain in response to the detection.

Abstract: An examples of a system for delivering neurostimulation to a patient may include a stimulation output circuit configured to deliver the neurostimulation, a sensing circuit configured to sense a neural signal indicative of neural responses to the neurostimulation, and stimulation control circuit. The stimulation control circuit may be configured to control the delivery of the neurostimulation using a plurality of stimulation parameters and may be configured to detect morphological features of the neural responses, to produce a neural response parameter using the detected morphological features, to detect a change in the sensed neural signal, to analyze the produced neural response parameter for attributing the detected change to one of a neural activation change in the patient or a body movement of the patient, and to control a dynamically controlled stimulation parameter of the plurality of stimulation parameters using the sensed neural signal and an outcome of the analysis.

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: Methods and systems for providing neuromodulation therapy are disclosed. The systems include an Implantable Pulse Generator (IPG) or External Trial Stimulator (ETS) that is capable of sensing an Evoked Compound Action Potential (ECAP), and (perhaps in conjunction with an external device) is capable of adjusting a stimulation program while based on the sensed ECAP. The stimulation program may include a pre-pulse component that may be adjusted based on the sensed ECAP. Moreover, stimulation may be applied to neural elements timed to coincide with the arrival of ECAPs at those neural elements. The stimulation may enhance or suppress activation of those neural elements.

Abstract: An initial set of parameters for operating one or more detection tools is automatically derived and subsequently adjusted so that each detection tool is more or less sensitive to signal characteristics in a region of interest. Detection tool(s) may be applied to physiological signals sensed from a patient (such as EEG signals) and may be configured to run in an implanted medical device that is programmable with the parameters to look for rhythmic activity, spiking, and power changes in the sensed signals, etc. A detection tool may be selected and parameter values derived in a logical sequence and/or in pairs based on a graphical representation of an activity type which may be selected by a user, for example, by clicking and dragging on the graphic via a GUI. Displayed simulations allow a user to assess what will be detected with a derived parameter set and then to adjust the sensitivity of the set or start over as desired.

Abstract: Methods and systems are described for detecting if a stimulation lead implanted in a patient's brain has moved. Lead movement occurring between a first time and a second time may be determined by comparing features extracted from evoked potentials recorded at the two times. The disclosed methods and systems are particularly useful for determining if a stimulation lead has moved between the time it was implanted in the patient's brain and the time that stimulation parameters are being optimized. Lead movement during implantation, during parameter optimization, and during or between other lead optimization processes may be determined as well.

Abstract: Methods and systems for spinal cord stimulation (SCS) are disclosed. The methods and systems involve using electrode leads implanted within the patient's spinal column to record neural responses evoked by the stimulation. The disclosed neural responses are different in several respects from electrical responses that have previously been measured in the context of SCS, such as stimulation artifacts and evoked compound action potentials (ECAPs). The disclosed neural responses typically occur later in time following the evoking stimulation pulse. Another distinguishing feature is that disclosed neural responses are generally most prominently observed with consistent, relatively unchanging amplitudes when the evoking stimulation frequency is ultra-low, for example, about 10 Hz or less.

Abstract: This document discusses, among other things, systems and methods for managing pain of a subject. A system includes one or more physiological sensors configured to sense a physiological signal indicative of patient brain activity. The physiological signals may include an electroencephalography signal, a magnetoencephalography signal, or a brain-evoked potential. The system may extract from the brain activity signal one or more signal metrics indicative of strength or pattern of brain electromagnetic activity associated with pain, and generate a pain score using the one or more signal metrics. The pain score can be output to a patient or a process. The system may select an electrode configuration for pain-relief electrostimulation based on the pain score, and deliver a closed-loop pain therapy according to the selected electrode configuration.

Abstract: Methods and systems for providing closed loop control of stimulation provided by an implantable stimulator device are disclosed herein. The disclosed methods and systems use a neural feature prediction model to predict a neural feature, which is used as a feedback control variable for adjusting stimulation. The predicted neural feature is determined based on one or more signals from an accelerometer configured in contact with the patient. The disclosed methods and systems can be used to provide closed loop feedback in situations, such as sub-perception therapy, when neural features cannot be readily directly measured.

Abstract: Medical device systems and methods for providing spinal cord stimulation (SCS) are disclosed. The SCS systems and methods provide therapy below the perception threshold of the patient. The methods and systems are configured to measure neurological responses to stimulation and use the neurological responses as biomarkers to maintain and adjust therapy. An example of neurological responses includes an evoked compound action potential (ECAP).

Abstract: A system and method for extracting a cardiac signal from a spinal signal include measuring a spinal signal at one or more electrodes that are connected to a neurostimulator and implanted within a patient's spinal canal and processing the spinal signal to extract the cardiac signal, which includes features that are representative of the patient's cardiac activity. Processing the spinal signal to extract the cardiac signal can include filtering the spinal signal, or use of model reduction schemes such as independent component analysis. The extracted cardiac signal can include a number of features that correspond to an electrocardiogram and can be used to determine the patient's heart rate and/or to detect a cardiac anomaly. Cardiac features that are determined from the cardiac signal can additionally be used to adjust parameters of the stimulation that is provided by the neurostimulator.

Abstract: Methods and systems are described for detecting if a stimulation lead implanted in a patient's brain has moved. Lead movement occurring between a first time and a second time may be determined by comparing features extracted from evoked potentials recorded at the two times. The disclosed methods and systems are particularly useful for determining if a stimulation lead has moved between the time it was implanted in the patient's brain and the time that stimulation parameters are being optimized. Lead movement during implantation, during parameter optimization, and during or between other lead optimization processes may be determined as well.

Abstract: An initial set of parameters for operating one or more detection tools is automatically derived and subsequently adjusted so that each detection tool is more or less sensitive to signal characteristics in a region of interest. Detection tool(s) may be applied to physiological signals sensed from a patient (such as EEG signals) and may be configured to run in an implanted medical device that is programmable with the parameters to look for rhythmic activity, spiking, and power changes in the sensed signals, etc. A detection tool may be selected and parameter values derived in a logical sequence and/or in pairs based on a graphical representation of an activity type which may be selected by a user, for example, by clicking and dragging on the graphic via a GUI. Displayed simulations allow a user to assess what will be detected with a derived parameter set and then to adjust the sensitivity of the set or start over as desired.

Abstract: Methods and systems for providing closed loop control of stimulation provided by an implantable stimulator device are disclosed herein. The disclosed methods and systems use a neural feature prediction model to predict a neural feature, which is used as a feedback control variable for adjusting stimulation. The predicted neural feature is determined based on one or more signals from an accelerometer configured in contact with the patient. The disclosed methods and systems can be used to provide closed loop feedback in situations, such as sub-perception therapy, when neural features cannot be readily directly measured.

Abstract: Medical device systems and methods for providing spinal cord stimulation (SCS) are disclosed. The SCS systems and methods provide therapy below the perception threshold of the patient. The methods and systems are configured to measure neurological responses to stimulation and use the neurological responses as biomarkers to maintain and adjust therapy. An example of neurological responses includes an evoked compound action potential (ECAP).

Abstract: An example of a system for managing pain may include a pain monitoring circuit, a pain relief device, and a control circuit. The pain monitoring circuit may include a parameter analyzer and a pain score generator. The parameter analyzer may be configured to receive and analyze at least two parameters selected from a physiological parameter indicative of a physiological function or state of a patient, a functional parameter indicative of a physical activity or state of the patient, or a patient parameter including subjective information provided by the patient. The pain score generator may be configured to compute a composite pain score using an outcome of the analysis. The composite pain score may indicate a degree of the pain. The pain relief device may be configured to deliver a pain-relief therapy. The control circuit may be configured to control the delivery of the pain-relief therapy using the composite pain score.

Abstract: An example of an apparatus for percutaneously delivering neurostimulation energy to a patient and sensing from the patient using a test device placed externally to the patient is provided. The apparatus may include a stimulation lead, a sensing reference electrode, a sensing wire, and a connection system. The stimulation lead may be configured to be percutaneously introduced into the patient to place the one or more electrodes in the patient. The sensing reference electrode may be configured to be placed in the patient. The sensing wire may be connected to the sensing reference electrode and configured to be percutaneously introduced into the patient to place the sensing reference electrode in the patient. The connection system may be configured to mate the lead connector and the wire connector and to provide electrical connections between the lead connector and the test device and between the wire connector and the test device.

Abstract: This document discusses a computer-implemented method of calibration of an implantable neurostimulation device. The method includes sensing one or more symptoms of a neurological condition of a subject using a sensor external to the neurostimulation device; delivering neurostimulation to the subject using the neurostimulation device and adjusting neurostimulation parameters based on the sensed symptom; sensing one or more neural response signals resulting from the neurostimulation using a sensor of the neurostimulation device; correlating the sensed symptom with the one or more sensed neural response signals; determining a target neural response using the correlating; and recurrently adjusting the neurostimulation parameters according to a comparison of subsequently sensed neural response signals to the target neural response signal.

Abstract: An example of a system for delivering neurostimulation and sensing one or more signals may include a programming control circuit and a parameter control circuit. The programming control circuit may be configured to control the delivery of the neurostimulation according to stimulation parameters and the sensing of a target neural signal including target neural responses according to sensing parameters. The parameter control circuit may be configured to determine the stimulation parameters and the sensing parameters and may include a recording analyzer. The recording analyzer may be configured to evaluate a sequence of test recording configurations each including a set of recording configuration parameters selected from the stimulation parameters and the sensing parameters and to determine one or more recording configurations suitable for detection of the target neural responses using an outcome of the evaluation.