Abstract: Systems and methods for schedule neuromodulation therapy are disclosed. An exemplary system comprises an electrostimulator and a controller. The electrostimulator can be configured to provide electrostimulation to a neural target of a patient. The controller circuit can be operably connected to the electrostimulator. The controller circuit can be configured to determine an activity parameter based on a schedule parameter of the patient, wherein the schedule parameter is associated with a schedule of the patient; determine stimulation parameters based on the activity parameter; and deliver the electrostimulation to the neural target of the patient using the stimulation parameters.

Abstract: A system for delivering neurostimulation from a stimulation device to a targeted area on a patient may include a programming control circuit and a stimulation programming circuit. The programming control circuit may be configured to generate information for programming the stimulation device to control the delivery of the neurostimulation according to a stimulation program. The stimulation programming circuit may be configured to receive a stimulation field and a stimulation coverage and to determine the stimulation program by including at least one dynamic stimulation pattern configured to expand the stimulation coverage resulting from delivering the neurostimulation to the stimulation field. The stimulation coverage is a portion of the targeted area effectively stimulated by the neurostimulation delivered to the stimulation field. The dynamic stimulation pattern is defined by at least one time-varying stimulation waveform parameter of the stimulation waveform parameters.

Abstract: Methods and systems for providing deep brain stimulation (DBS) for a patient are described. Evoked potentials (EPs) evoked by the stimulation are recorded and compared to modeled EPs. The modeled EPs are determined based on an overlap of stimulation field models (SFMs) for a given set of stimulation parameters with a target volume of the patient's brain, the target region being the source of the EPs. The target volume may include the patient's subthalamic nucleus (STN), for example. The modeled EPs are used to predict electrical signals that will be sensed at recording electrodes of an electrode lead. The recorded EPs can be compared to the modeled electrical signals to guide aspects of the stimulation therapy.

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: This document discusses a neurostimulation device. The neurostimulation device includes a stimulation circuit; a sensing circuit to sense evoked synaptic activity potential (ESAP) signals when coupled to the implantable lead, and a control circuit. The control circuit is configured to initiate delivery of neurostimulation energy by the stimulation circuit, initiate sensing by the sensing circuit of ESAP signals produced by the delivery of neurostimulation energy, change at least one parameter of the neurostimulation energy and continue the sensing of the ESAP signals, compare the sensed ESAP signals to a stored best sensed ESAP signal, wherein the best sensed ESAP signal was previously sensed at a recorded anatomical location using a different trial lead, and determine neurostimulation therapy parameters including a neurostimulation location to produce a best match ESAP signal at the recorded anatomical location that is a closest match to the stored best sensed ESAP signals.

Abstract: Methods and systems for programming stimulation parameters for an implantable medical device for neuromodulation, such as spinal cord stimulation (SCS) are disclosed. The stimulation parameters define user-configured waveforms having at least a first phase having a first polarity and a second phase having a second polarity, wherein the first and second phases are separated by an interphase interval (IPI). By delivering user-configured waveforms with different IPIs, stimulation geometry, and other waveform settings, therapeutic asynchronous activation of dorsal column fibers can be obtained.

Abstract: Methods and systems for optimizing and/or maintaining stimulation during deep brain stimulation (DBS) are described. The methods and systems involve determining evoked neural responses, namely evoked resonant neural activity (ERNA) evoked in a patient's brain by the stimulation. ERNA features corresponding to the patient's brain state during the absence and during the presence of therapeutic stimulation are determined. The ERNA features are used to guide and to maintain stimulation parameters for therapeutic stimulation.

Abstract: Methods and systems for delivering a therapy and observing one or more metrics of autonomic function. Spinal cord stimulation may be initiated, and patient response monitored using one or more metrics of autonomic function, including heart rate, heart rate variability, or other markers. Therapy intensity may be increased or decreased, or therapy may be changed to use a different program, or therapy may be ceased, depending on changes in the observed metrics of autonomic function.

Abstract: Systems and techniques are disclosed for determining and implementing neurostimulation programming, based on sensing and therapy capabilities. An example technique includes: identifying an arrangement for a plurality of electrical contacts of one or more implanted leads; identifying neurostimulation parameters for delivering therapy to a neurostimulation location using a first set of electrical contacts of the arrangement; determining a sensing capability for sensing an evoked response to the therapy delivered to the neurostimulation location, using a second set of electrical contacts of the arrangement, and determining the sensing capability based on the arrangement and the neurostimulation parameters; and changing at least a portion of the neurostimulation parameters for delivering the therapy, in response to a determination that the sensing capability is not available at the neurostimulation location.

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: 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 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: 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 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 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.