Abstract: A method of controlling operation of a neurostimulation device comprises receiving, by the neurostimulation device, an indication of a physiological search area of a subject for delivering electrical neurostimulation and a prioritized search list of neurostimulation parameters for neurostimulation therapy delivered to the search area; delivering the neurostimulation therapy to the search area and varying the neurostimulation parameters according to the parameter priority, wherein a highest priority parameter is varied first while lower priority parameters are held constant; determining the optimum value of the highest priority parameter; delivering neurostimulation to the search area using the determined optimum value of the highest priority parameter and varying one or more lower priority parameters according to the parameter priority; and determining optimum lower priority parameters for the neurostimulation.

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: A system may include neuromodulation electrode contacts, a waveform generator, and a controller. The neuromodulation electrode contacts may be configured and arranged for use in delivering neuromodulation to a target peripheral nerve, where the target peripheral nerve includes a plurality of fibers, and the plurality of neuromodulation electrode contacts is configurable into a plurality of electrode configurations for stimulating different subsets of fibers within the plurality of fibers. The waveform generator may be configured for use to generate neuromodulation energy.

Abstract: A method for determining an intensity index for electrical stimulation includes receiving stimulation information; determining a stimulation field from the stimulation information; determining at least one stimulation field function using the stimulation field; and analyzing the determined at least one stimulation field function to determine the intensity index. The intensity index corresponds to a stimulation target and indexes at least one dosing reference for electrical stimulation for that stimulation target.

Abstract: A system may include a neuromodulator, a local field potential sensor, a feature extractor, a comparator and control circuitry. The neuromodulator may be configured to use neuromodulation parameters to deliver a neuromodulation signal to neural tissue in or near a spinal cord. The LFP sensor may be configured to sense local field potentials within a spinal cord or a peripheral nerve that are indicative of spinal cord oscillations. The feature extractor may be configured to extract one or more features for the local field potentials indicative of the spinal cord oscillations. The comparator may be configured to provide a comparison of the one or more extracted features to corresponding one or more setpoints. The control circuitry may be configured to control the delivery of the neuromodulation signal based on the comparison.

Abstract: External system software is disclosed that automatically varies the location at which stimulation is applied to the patient in an Implantable Pulse Generator (IPG). Location variation occurs in an area defined with reference to the electrode array, and may occur randomly or via pre-defined path within the area. Preferably the area is defined around a single location deemed optimal for the patient. Parameters relating to the area and to how often the stimulation is moved can be set automatically or manually by a user of the software. The area may be defined using a probability distribution function (PDF) that tends to keep the stimulation at or close to an optimal position, while still allowing the location to be set anywhere in the area. The area may also be defined in the software using measured parameters indicative of the effectiveness of stimulation at different locations.

Abstract: Systems and methods for closed-loop control of electrostimulation while avoiding, or maintaining a substantially low level of, evoked neural activity are disclosed. A system comprises an electrostimulator to deliver a stimulation pulse train, a sensing circuit to sense evoked responses to respective pulses in the pulse train, and a controller to detect an evoked neural activity from an averaged evoked response by averaging evoked responses to respective pulses. The averaging operation can be controlled by a noise level of the averaged evoked response, or by a count of epochs (pulses) being used for averaging. Responsive to the evoked neural activity satisfying a detection criterion, the controller recursively adjusts stimulation parameters until the detection criterion is no longer satisfied. The electrostimulator delivers electrostimulation according to the recursively adjusted stimulation parameters.

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 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 proving spinal cord stimulation (SCS) for treating pain in a patient are described. Embodiments of the described methods and systems can provide sub-perception SCS that has a fast wash-in time by using stimulation parameters that activate surround inhibition in the patient. Measuring retrograde potentials evoked by the stimulation can be performed to facilitate choosing the best stimulation parameters, in particular, the best stimulating electrode contact configurations for activating surround inhibition. For example, peripheral electrodes may be placed at the center of the patient's pain (within a local receptive field (LRF), with respect to the patient's pain center) and within an area surrounding the patient's pain center (within a surrounding receptive field (SRF), with respect to the patient's pain center). Retrograde evoked potentials measured and the SRF and/or the LRF can be used to guide the selection of the stimulation parameters.

Abstract: Techniques are described for providing a therapeutic pseudo-constant DC current in an implantable stimulator using pulses whose positive and negative phases are not charge balanced. Such charge imbalanced pulses act to charge any capacitance in the current path between selected electrode nodes, such as the DC-blocking capacitors and/or any inherent capacitance such as those present at the electrode/tissue interface. These charged capacitances act during quiet periods between the pulses to induce a pseudo-constant DC current. Beneficially, these DC currents can be small enough to stay within charge density limits and hence not corrode the electrode or cause tissue damage, and further can be controlled to stay within such limits or for other reasons. Graphical user interface (GUI) aspects for generating the charge imbalanced pulses and for determining and/or controlling the pseudo-constant DC current are also provided.

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: 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: An example of a system for delivering neurostimulation energy may include a programming control circuit and a user interface. The programming control circuit may be configured to generate stimulation parameters according to a neurostimulation program including a pattern of interferential stimulation configured to effect asynchronous and/or non-regular activation of nerve fibers by simultaneously delivering a first stimulation current having a first waveform with a first frequency using a first electrode configuration and a second stimulation current having a second waveform with a second frequency using a second electrode configuration.

Abstract: A method for estimating neural activation arising from stimulation by a stimulation system includes identifying different neural elements stimulated by the stimulation; obtaining a neural response signal resulting from the stimulation by the stimulation system; and decomposing the neural response signal to estimate neural activation of each of the different neural elements.

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 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: A system may include a stimulator, sensing circuitry and a controller. The stimulator may be operably connected to at least one stimulation electrode, and configured to deliver an electrical waveform for an electrical therapy using the at least one stimulation electrode. The sensing circuitry may be operably connected to at least one sensing electrode, and configured to sense electrical potentials that are evoked by the electrical waveform to provide sensed evoked signals. The controller may be operably connected to the stimulator and the sensing circuitry. The controller may be configured to automatically define a sampling window, sample the sensed evoked potentials during the sampling window to provide sampled values, detect at least one feature from the sampled values, and automatically provide feedback for closed-loop control of the electrical therapy based on the at least one feature.

Abstract: An example of a neurostimulation system may include a programming control circuit, a sensing circuit, and a stimulation control circuit. The programming control circuit may be configured to generate stimulation parameters controlling delivery of neurostimulation according to stimulation waveform(s) and stimulation field(s). The sensing circuit may be configured to sense signals. The stimulation control circuit may be configured to determine the stimulation waveform(s) and the stimulation field(s) based on a lead configuration and may be configured to determine first and second electrodes of respective first and second leads, receive first and second signals sensed using the first and second electrodes, detect corresponding signal features from the first and second signals, determine a feature delay between the detected signal features, and determine a need for adjusting the lead configuration using the feature delay. The signal features are associated with a response of the patient to the neurostimulation.

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.