A medical device with closed-loop responsive stimulation may include techniques to mitigate the impact on the therapy output of noise coupled into the medical device. A medical device according to this disclosure may determine the presence of noise and alter the closed loop policy to provide the necessary therapy to the patient and avoid prolonged under stimulation caused by the noise. The medical device may continue therapy while testing for noise. When the device determines the noise level no longer affects the output therapy, the device may return the closed loop policy to a no-noise mode of operation. The medical device may also include techniques to mitigate the impact of manual adjustment while the medical device is subject to noise or is responding to changes in the patient's physiological signals.

The present disclosure provides systems and methods relating to neuromodulation. In particular, the present disclosure provides systems and methods for evaluating the efficacy of neuromodulation therapy using evoked potential (EPs). The systems and methods disclosed herein facilitate the evaluation of both parameter-dependent and system-dependent changes in EPs as indicators of therapeutic efficacy.

A cryoprotective composition configured to be applied during cryotreatment of a patient includes at least one biodegradable and/or bioerodible fluid agent and at least one non-toxic cryoprotectant agent. A therapeutically effective amount of the cryoprotective composition deposited in a body space of the patient in proximity to the cryotreatment remains within at least a portion of the body space for a duration of the cryotreatment. At least a portion of a body tissue proximate to the body space is viable after the cryotreatment. A method of protecting a surgical site during prostate cryosurgery is also provided. The method includes injecting a therapeutically effective amount of the cryoprotective composition into the body space, wherein the body space is a periprostatic space of a patient.

A method of evaluating a neural response, comprising applying electrical stimulation to a recipient, obtaining from read electrodes read data resulting from the applied stimulation, obtaining an artefact model based at least in part on the read data, and obtaining neural response data by comparing the read data to the artefact model.

A method of evaluating a neural response, comprising applying electrical stimulation to a recipient, obtaining from read electrodes read data resulting from the applied stimulation, obtaining an artefact model based at least in part on the read data, and obtaining neural response data by comparing the read data to the artefact model.

Systems, devices, and methods for using vagus nerve stimulation to treat demyelination disorders and/or disorder of the blood brain barrier are described. The vagus nerve stimulation therapy described herein is configured to reduce or prevent demyelination and/or promote remyelination to treat various disorders related to demyelination, such as multiple sclerosis. A low duty cycle stimulation protocol with a relatively short on-time and a relatively long off-time can be used.

Systems, devices, methods, and techniques are described for phase misalignment correction for evoked compound action potential (ECAP) measurement from alternating polarity stimulation. An example system includes processing circuitry that receives a first ECAP signal elicited by a first polarity configuration of stimulus electrodes and receives a second ECAP signal elicited by a second polarity configuration of the stimulus electrodes opposite the first polarity configuration. The processing circuitry also generates an adjusted second ECAP signal by temporally aligning at least a portion of the second ECAP signal to at least a portion of the first ECAP signal, and generates a composite ECAP signal based on the first ECAP signal and the adjusted second ECAP signal. Additionally, the processing circuitry outputs the composite ECAP signal.

Certain methods and systems described herein use a transducer used to produce ablation energy (aka denervation energy) to also evoke a neural response before and/or after denervation energy is delivered. Rather than the neural response being invoked in response to electrical stimulus, it is invoked in response to the transducer (e.g., RF, microwave, or ultrasound transducer) being used to sufficiently heat the nerves in tissue surrounding a biological lumen to an extent that a neural response is evoked without denervating the nerves. That is, the transducer used for performing ablation (aka denervation) is also used to evoke a neural response prior to (and/or after) ablation is performed, by using the transducer to sufficiently heat the nerves in the tissue surrounding the biological lumen to an extent that a neural response is evoked without denervating the nerves. This can reduce the catheter production complexity and costs. Other embodiments are also disclosed.

Certain methods and systems described herein use a transducer used to produce ablation energy (aka denervation energy) to also evoke a neural response before and/or after denervation energy is delivered. Rather than the neural response being invoked in response to electrical stimulus, it is invoked in response to the transducer (e.g., RF, microwave, or ultrasound transducer) being used to sufficiently heat the nerves in tissue surrounding a biological lumen to an extent that a neural response is evoked without denervating the nerves. That is, the transducer used for performing ablation (aka denervation) is also used to evoke a neural response prior to (and/or after) ablation is performed, by using the transducer to sufficiently heat the nerves in the tissue surrounding the biological lumen to an extent that a neural response is evoked without denervating the nerves. This can reduce the catheter production complexity and costs. Other embodiments are also disclosed.

Methods and systems for implanting stimulation leads in a patient's brain are disclosed. The methods and systems use sensed evoked resonant neural activity (ERNA) evoked in neural regions of the brain to guide the implantation and positioning of the stimulation lead(s). In addition to providing surgical support during lead implantation, the ERNA information can be used to facilitate stimulation parameter fitting and maintenance of effective therapeutic stimulation.