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.

Devices, systems and methods are described for providing muscle contraction stimulation therapy to treat myriad diseases, including heart failure, Type 2 diabetes, and peripheral vascular disease using a skin patch or implantable stimulator that includes a multiplicity of electrodes, a processor, a stimulation circuit, one or more sensors and programming for a patient interface unit, wherein the processor is programmed to control selection of a subset of the multiplicity of electrodes and of operation of the stimulation circuit responsive to an indication of an adverse physiologic response. The indication of patient discomfort may be determined by monitoring a physiologic parameter of the subject using the one or more sensors, by direct input from the subject via the patient interface unit programming, or a combination thereof. The devices, systems and methods also provide for automatically optimizing the stimulation parameters applied by the stimulation circuit responsive to feedback from the one or more sensors and/or by using direct input from the subject.

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 document discusses, among other things, systems and methods for managing pain in a subject. A system may include one or more sensors configured to sense from the subject information corresponding to emotional reaction to pain, such as emotional expression. The emotional expression includes facial or vocal expression. A pain analyzer circuit may generate a pain score using signal metrics of facial or vocal expression extracted from the sensed information. The pain score may be output to a user or a process. The system may additionally include a neurostimulator that can adaptively control the delivery of pain therapy by automatically adjusting stimulation parameters based on the pain score.

A device and/or method to determine a sleep-wake status, such as in association with sleep disordered breathing (SDB) care.

Devices, systems, and techniques are disclosed for managing electrical stimulation therapy and/or sensing of physiological signals such as brain signals. For example, a system may assist a clinician in identifying one or more electrode combinations for sensing a brain signal. In another example, a user interface may display brain signal information and values of a stimulation parameter at least partially defining electrical stimulation delivered to a patient when the brain signal information was sensed.

Methods and circuitry for calibrating stimulation circuitry in an implantable stimulator device (ISD) is disclosed. The ISD can sense neural response to the stimulation, and use an algorithm to assess those responses and determine a therapeutic window for a particular stimulation parameter, such as amplitude. Stimulation circuitry in the ISD is programmed with information indicative of the determined therapeutic window, such as by programming a minimum and/or maximum current amplitude. As well as restricting operation of the stimulation circuitry to within the therapeutic amplitude window, such programming calibrates the stimulation circuitry and allows an expanded range of, or all of, amplitude values supported by the stimulation circuitry to be used, which allows the amplitude to be incremented in smaller current increments.

Modulation of neural signaling of a pancreas-related sympathetic nerve is capable of improving glycaemic control by inhibiting T cell activation or migration to the pancreas, and hence providing a way of treating or preventing type 1 diabetes.

Disclosed is an implantable device for lead offset determination, comprising first and second electrode leads. A stimulus is delivered from one lead to tissue, and a signal is sensed from the tissue by the other lead. The sensed signal is processed to produce a measure of a stimulus artefact present in the signal. The stimulus artefact measure is used to produce a measure of an offset between the first electrode lead and the second electrode lead, such as by applying a distance-squared. analytical model to measures of stimulus artefact obtained from at least two sense electrodes. And/or, a compound action potential evoked by the stimulus is sensed from neural tissue, a latency of the evoked compound action potential is measured, and a measure of an offset between the first electrode lead and the second electrode lead is produced from the latency.

One aspect of the present disclosure relates to a system that can modulate the intensity of a neural stimulation signal over time. A pulse generator can be configured to generate a stimulation signal for application to neural tissue of an individual and modulate a parameter related to intensity of a pattern of pulses of the stimulation signal over time. An electrode can be coupled to the pulse generator and configured to apply the stimulation signal to the neural tissue. A population of axons in the neural tissue can be recruited with each pulse of the stimulation signal.