Abstract: A neuromodulation targeting system includes a GUI that facilitates selection of one or more neuromodulation target regions. The GUI provides an interactive display representing anatomy of a patient with user-selectable portions corresponding to a plurality of predefined anatomical regions associated with distinct localized clinical effects of neuromodulation. The system further includes a targeting selector engine that is responsive to user selection of a first portion of the interactive display by configuring delivery of neuromodulation therapy to a first target region to produce a first localized clinical effect in the patient at a location corresponding to the first portion of the display, upon administration of the neuromodulation therapy to the patient.

Abstract: A system for delivering neurostimulation to a patient may include a pattern optimization circuit and a programming control circuit. The pattern optimization circuit may receive an objective function, a model, and one or more patterns of neurostimulation each including multiple stimulation parameters and may include optimization processing circuitry configured to determine an optimal pattern of neurostimulation using a simulation with the objective function, the model, and the one or more patterns of neurostimulation. The optimal pattern of neurostimulation including first stimulation parameter(s) each identified by the simulation to have a fixed value or value range with which a sensitivity to values of each of second stimulation parameter(s) on the objective function is identified by the simulation to be minimized.

Abstract: A system for delivering neurostimulation to a patient may include a personalization circuit and a pattern optimization circuit. The personalization circuit may include an assessment input to receive patient-specific information resulting from a patient survey, a calibration input configured to receive calibration information resulting from a calibration, and personalization processing circuitry. The patient-specific information may include patient dimensions of the neurostimulation. The calibration information may include the patient's response to the neurostimulation. The personalization processing circuitry may be configured to determine a personalized objective function using the patient dimensions and to determine a personalized model having a model state personalized to the patient's response to the neurostimulation.

Abstract: A system may include electrodes on at least one lead configured to be operationally positioned for use in modulating a volume of neural tissue, a neural modulation generator configured to deliver energy using at least some electrodes to modulate the volume of neural tissue, a programming system configured to program the programmed modulation parameter set, including determine electrode fractionalizations for the electrodes based on a target multipole. The programmed parameter set may include the determined electrode fractionalizations. The target multipole may be used to determine electrode fractionalizations having at least three target poles that directionally and progressively stack fractionalizations of target poles to provide a linear electric field over the volume of tissue. The neural modulation generator may be configured to use the programmed modulation parameter set to provide the linear electric field over the volume of tissue.

Abstract: A fitting algorithm for a spinal cord stimulator is disclosed, which is preferably implemented in a clinician programmer having a graphical user interface. In one example, coupling parameters indicative of coupling to neural structures are determined for each electrode in an implanted electrode array. The user interface associates different pole configurations with different anatomical targets and with different measurement techniques (subjective or objective) to gauge the effectiveness of the pole configuration at different positions in the electrode array. The pole configuration, perhaps as modified by the coupling parameters, is then steered in the array, and effectiveness is measured along with a paresthesia threshold at each position. Using at least this data, the fitting algorithm can determine one or more candidate positions in the electrode array at which a therapeutic stimulation program can be centered.

Abstract: Methods and systems for performing spinal cord stimulation in the cervical spine while sensing for an evoked response, such as an evoked synaptic action potential (ESAP) at a different location from the location of stimulation. A first lead may be positioned in the cervical spine for issuing therapy pulses, and sensing is performed at a thoracic or lumbar location, or a caudal cervical location relative to the location of stimulation. First and second leads may be used in a single system, or two separate systems, one for stimulation and another for sensing, may be used.

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: A neurostimulation system may include at least one electrode contact and a neurostimulator configured to use the at least one electrode contact to deliver a stimulation therapy to a patient using an electrical waveform that includes first phases of a first polarity and second phases of a second polarity opposite the first polarity. The neurostimulator may configured to deliver the stimulation therapy by therapeutically stimulating neural tissue using the both the first phases and the second phases of the electrical waveform. The second phases remove built up charge from the at least one electrode contact caused by the first phases, and the first phases remove built up charge from the at least one electrode contact caused by the second phases. Benefits include reducing energy consumption using the recharge pulse to activate a population of neural elements for reducing energy consumption.

Abstract: A system may include an electrode arrangement and a neurostimulator. The electrode arrangement may have a length generally in a rostral-caudal direction and a width generally in a mediolateral direction. The electrode arrangement may include a first set and a second set of electrodes spaced across the width. The neurostimulator may be configured to stimulate a sequence of locations of the patient using subsets of the first set of electrodes, and for each stimulated location in the stimulated sequence of locations identify corresponding response measures for each one of the second set of electrodes. The physiological midline may be inferred or identified from these measurements, which may be used to guide lead placement and/or programming.

Abstract: A system may include electrodes on at least one lead configured to be operationally positioned for use in modulating a volume of neural tissue, a neural modulation generator configured to deliver energy using at least some electrodes to modulate the volume of neural tissue, a programming system configured to program the programmed modulation parameter set, including determine electrode fractionalizations for the electrodes based on a target multipole. The programmed parameter set may include the determined electrode fractionalizations. The target multipole may be used to determine electrode fractionalizations having at least three target poles that directionally and progressively stack fractionalizations of target poles to provide a linear electric field over the volume of tissue. The neural modulation generator may be configured to use the programmed modulation parameter set to provide the linear electric field over the volume of tissue.

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: A system may include a plurality of electrodes and a neural modulation device configured to deliver energy using at least some of the plurality of electrodes to modulate the volume of neural tissue. The neural modulation device may be configured to deliver the energy according to a modulation parameter set. The system may include a programming system configured to program the neural modulation device with the modulation parameter set for use to deliver the energy. The energy corresponds to a broad-spectrum signal having a plurality of frequency ranges, and the programming system is configured to receive user input for targeting energy to a volume of tissue, determine a stimulation configuration, including the modulation parameter set, based on the user input, and deliver the energy corresponding to the broad-spectrum signal using the plurality of electrodes according to the determined stimulation configuration.

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 providing sub-perception Spinal Cord Stimulation therapy using low frequency pulses. The waveforms comprise anodic and cathodic pulses which are effectively monophasic in nature, although low-level, non-therapeutic charge recovery can also be used.

Abstract: A fitting algorithm for a spinal cord stimulator is disclosed, which is preferably implemented in a clinician programmer having a graphical user interface. In one example, coupling parameters indicative of coupling to neural structures are determined for each electrode in an implanted electrode array. The user interface associates different pole configurations with different anatomical targets and with different measurement techniques (subjective or objective) to gauge the effectiveness of the pole configuration at different positions in the electrode array. The pole configuration, perhaps as modified by the coupling parameters, is then steered in the array, and effectiveness is measured along with a paresthesia threshold at each position. Using at least this data, the fitting algorithm can determine one or more candidate positions in the electrode array at which a therapeutic stimulation program can be centered.

Abstract: An example of a system for delivering neurostimulation may include a programming control circuit and a stimulation control circuit. The programming control circuit may be configured to generate stimulation parameters controlling delivery of the neurostimulation according to a stimulation configuration. The stimulation control circuit may be configured to specify the stimulation configuration, and may include volume definition circuitry and stimulation configuration circuitry. The volume definition circuitry may be configured to determine one or more test volumes, determine a clinical effect resulting from the one or more test volumes each being activated by the neurostimulation, and determine a target volume using the determined clinical effect. The stimulation configuration circuitry may be configured to generate the specified stimulation configuration for activating the target volume.

Abstract: An example of a system to program a neuromodulator to deliver neuromodulation to a neural target using a plurality of electrodes may comprise a programming control circuit configured to determine target energy allocations for the plurality of electrodes based on at least one target pole to provide a target sub-perception modulation field, and normalize the target sub-perception modulation field, including determine a time domain scaling factor to account for at least one property of a neural target or of a neuromodulation waveform, and apply the time domain scaling factor to the target energy allocations.

Abstract: Systems and methods for using spinal cord stimulation (SCS) for controlling orthostatic hypotension in a patient are described. Embodiments are configured to monitor for changes in the patient's state and apply stimulation when needed. The change in state may be a change in the patient's inertial state, such as a change in posture, activity, or the like. The change in state may also be indicated based on sensed neural activity. Embodiments provide closed-loop feedback control of the stimulation.

Abstract: Systems and methods for optimizing neuromodulation field design for pain therapy are discussed. An exemplary neuromodulation system includes an electrostimulator to stimulate target tissue to induce paresthesia, a data receiver to receive pain data including pain sites experiencing pain, and to receive patient feedback on the induced paresthesia including paresthesia sites experiencing paresthesia. The neuromodulation system includes a processor circuit configured to generate a spatial correspondence indication between the pain sites and the paresthesia sites over one or more dermatomes, determine an anodic weight and a cathodic weight for each of multiple electrode locations using the spatial correspondence indication, and generate a stimulation field definition for neuromodulation pain therapy.

Abstract: A system may include a neuromodulator and a programmer configured to program the neuromodulator to deliver neuromodulation according to a modulated neurostimulation parameter setting. The modulated neurostimulation parameter setting may include a first modulated neurostimulation parameter waveform and a second modulated neurostimulation parameter waveform, and a phase offset between the first and the second modulated neurostimulation parameter waveforms.

Abstract: A sensing electrode selection algorithm is disclosed for use with an implantable pulse generator having an electrode array. The algorithm automatically selects optimal sensing electrodes in the array to be used with a pre-determined stimulation therapy appropriate for the patient. The algorithm preferably senses stimulation artifacts using different sensing electrodes, and more specifically different sensing electrode pairs as is appropriate when differential sensing is used. The algorithm further preferably senses these stimulation artifacts with the patient placed in two or more postures. The algorithm processes the stimulation artifact features measured at the different sensing electrodes and at the different postures to automatically determine one or more sensing electrode pairs that best distinguishes the two or more postures given the prescribed stimulation therapy.