This disclosure relates to devices, systems, and methods for autotitrating stimulation parameters. In one example, a method includes controlling an implantable medical device to deliver electrical stimulation to a patient according to a plurality of electrical stimulation parameter sets, each electrical stimulation parameter set of the plurality of electrical stimulation parameter sets defining a respective electrical stimulation signal deliverable to the patient, obtaining, by one or more processors and for each electrical stimulation parameter set of the plurality of electrical stimulation parameter sets, a respective signal representative of an electrical response sensed from the patient in response to the electrical stimulation delivered to the patient according to the respective electrical stimulation parameter set, and determining, by the one or more processors and based on the obtained respective signals, a primary electrical stimulation parameter set that defines electrical stimulation therapy deliverable to the patient by the implantable medical device.

This disclosure relates to devices, systems, and methods for autotitrating stimulation parameters. In one example, a method includes controlling an implantable medical device to deliver electrical stimulation to a patient according to a plurality of electrical stimulation parameter sets, each electrical stimulation parameter set of the plurality of electrical stimulation parameter sets defining a respective electrical stimulation signal deliverable to the patient, obtaining, by one or more processors and for each electrical stimulation parameter set of the plurality of electrical stimulation parameter sets, a respective signal representative of an electrical response sensed from the patient in response to the electrical stimulation delivered to the patient according to the respective electrical stimulation parameter set, and determining, by the one or more processors and based on the obtained respective signals, a primary electrical stimulation parameter set that defines electrical stimulation therapy deliverable to the patient by the implantable medical device.

Disclosed is an assisted programming system for a neuromodulation device that is configured to assist a clinician to efficiently program the neuromodulation device for a particular patient. In particular, the assisted programming system comprises a processor configured to ramp a stimulus intensity parameter to or from a predetermined target intensity while the neural stimuli are delivered by the device according to the ramping value of the stimulus intensity parameter. The ramp traverses stimulus intensities below a predetermined threshold at a faster rate than stimulus intensities above the predetermined threshold. The effect is to improve the apparent responsiveness of the neuromodulation device by reducing the amount of time spent traversing stimulus intensities below a perception threshold, while avoiding a sensation of abruptness.

Disclosed are devices, systems and methods for neural signal detection of immune responses. In some aspects, a system includes a processing unit: a receiving unit configured to receive at least one sensor signal from a wearable sensor, where the wearable sensor is configured to detect at least one neural signal of a patient; and a tangible non-transitory computer readable medium having instructions configured to cause the processing unit to automatically receive a data signal from the receiving unit, automatically detect an immune response based at least in part on the data signal, automatically create a notification based at least in part on the immune response, and automatically present the notification to a user of the system.

Disclosed are devices, systems and methods for neural signal detection of immune responses. In some aspects, a system includes a processing unit: a receiving unit configured to receive at least one sensor signal from a wearable sensor, where the wearable sensor is configured to detect at least one neural signal of a patient; and a tangible non-transitory computer readable medium having instructions configured to cause the processing unit to automatically receive a data signal from the receiving unit, automatically detect an immune response based at least in part on the data signal, automatically create a notification based at least in part on the immune response, and automatically present the notification to a user of the system.

A method for performing percutaneous spinal interbody fusion on a spine of a patient can include inserting without direct visualization a neuro-monitoring dilating probe into the patient, performing neuro-monitoring via the neuro-monitoring dilating probe, advancing the neuro-monitoring dilating probe into a disc space, passing a second dilator over the neuro-monitoring dilating probe, and advancing the second dilator into the disc space. A kit for performing percutaneous spinal interbody fusion can include a neuro-monitoring dilating probe, a second dilator, a tissue removal tool, an access portal comprising an adjustable depth stop, and a discectomy verification device.

A method for monitoring blood pressure includes sensing and storing sympathetic nerve activity data of a patient via a recording lead of an implantable medical device. Changes in sympathetic nerve activity from the nerve activity data are determined. Corresponding changes in blood pressure are determined from the changes in sympathetic nerve activity. An alert signal and/or modification of therapy can be provided.

Approaches for characterizing a phrenic stimulation threshold, a cardiac capture threshold, a maximum device parameter, and a minimum device parameter are described. A plurality of cardiac pacing pulses can be delivered by using a cardiac pacing device, a pacing parameter of the plurality of cardiac pacing pulses being changed between delivery of at least some of the pulses. One or more sensor signals can be evaluated to detect stimulation of the phrenic nerve by one or more of the plurality of cardiac pacing pluses. The evaluation of the one or more sensor signals and the pacing parameter can be compared to determine if a phrenic stimulation threshold is at least one of higher than a maximum device parameter and lower than a minimum device parameter.

A medical device system and method for determining pacing threshold data that includes a cardiac capture sensor, a phrenic nerve stimulation sensor, a pulse generator selectively coupled to a plurality of electrode vectors to deliver a phrenic nerve stimulation pulse, and a processor coupled to the cardiac capture sensor, the phrenic nerve stimulation sensor and the pulse generator and configured to deliver the phrenic nerve stimulation pulse along the plurality of electrode vectors, determine, for each vector of the plurality of vectors, whether phrenic nerve stimulation is detected in response to the delivered phrenic nerve stimulation, deliver a pacing pulse along only the vectors of the plurality of vectors that phrenic nerve stimulation is determined not to be detected, and determine pacing capture thresholds in response to the delivered pacing pulse.

In various method embodiments, a neural activity signal is sensed, a feature from the sensed neural activity signal is extracted, and a neural marker for the extracted feature is created. The neural marker includes information regarding the extracted feature. Various device embodiments comprise a port to receive a neural activity signal, and a feature extractor adapted to receive and process the neural activity signal to produce a neural marker that includes information for the neural activity signal. Various device embodiments comprise a display, a memory adapted to store a neural marker associated with a sensed neural activity signal, and a controller adapted to communicate with the memory and the display to provide a representation of the neural marker on the display.