This disclosure relates to a device for applying a neural stimulus. A battery supplies electrical energy at a battery voltage and an electrode applies the electrical energy to neural tissue. A circuit measures the nervous response of the tissue and a voltage converter receives the electrical energy from the battery and controls a voltage applied to the electrode based on the measured nervous response of the tissue. This direct voltage control is energy efficient because losses across a typical current mirror are avoided. Further, the control based on the measured nervous response leads to automatic compensation of impedance variation due to in-growth or change in posture. As a result, the stimulation results in a desired neural response.

Systems and methods for stimulating the sensory cortex of an individual by obtaining a neuronal stimulation signal adapted to provide a movement cue for the individual and transmitting the neuronal stimulation signal to an electric contact of a neuronal stimulation electrode that is already implanted into the brain of the individual for a purpose different from providing the movement cue. Proprioceptive information is communicated to the individual by obtaining information about the body posture of the individual and applying a neuronal stimulation signal to an afferent axon targeting a sensory neuron in the cortex of the individual. The neuronal stimulation signal is determined based on the obtained body posture information and corresponds to the proprioceptive information. A first neuronal stimulation signal providing the movement cue and a second neuronal stimulation signal providing the proprioceptive information may be applied together to the cortex of the individual.

Embodiments of the present disclosure include a method for treating a condition of a subject. An implant defining a longitudinal axis is implanted between a nerve and skin of the subject. The implant includes an insulating member disposed, along the longitudinal axis, on at least a skin-facing side of the implant. Exactly two electrodes are disposed, along the longitudinal axis, at respective portions of a nerve-facing side of the implant. While the electrodes are driven to apply a treatment that stimulates the nerve, the insulating member is used to inhibit direct stimulation of sensory nerve fibers of the skin that are adjacent to the skin-facing side of the implant. Other embodiments are also described.

A method of providing a sleep apnea nerve stimulation therapy to a subject may include detecting a respiratory waveform of the subject with a sensor. The sensor may be configured for coupling to the subject. The respiratory waveform may include a plurality of respiratory cycles each corresponding to at least one of a breath and an attempted breath of the subject. The method may also include identifying a breathing pattern within the respiratory waveform over a period of time. The breathing pattern may include a repeating pattern of a plurality of respiratory cycles followed by at least one respiratory cycle corresponding to a disordered breathing event. The method may also include generating a series of stimulation pulses with an implantable nerve stimulator configured for coupling to a hypoglossal nerve of the subject. The series of stimulation pulses may be coordinated with the breathing pattern.

Techniques are disclosed for using a cardiac signal sensed via a plurality of electrodes disposed on one or more leads implanted within an epidural space of a patient to control spinal cord stimulation (SCS) therapy. In one example, an implantable medical device (IMD) senses an electrical signal via a plurality of electrodes disposed on one or more leads implanted within an epidural space of a patient. Processing circuitry determines, from the electrical signal, one or more cardiac features indicative of activity of a heart of the patient. The processing circuitry controls, based on the one or more cardiac features, delivery of SCS therapy to the patient.

Methods, implantable devices, and systems for treating a cancer or inhibiting cancer growth or recurrence in a subject are described herein. Such methods can include electrically stimulating a thoracic splanchnic nerve (such as a greater splanchnic nerve) of the subject with a plurality of electrical pulses emitted from one or more electrodes m electrical communication with the splanchnic nerve, wherein the plurality of electrical pulses triggers one or more action potentials in the splanchnic nerve to increase circulating natural killer (NK) cells in the subject. An implantable device may include one or more electrodes configured to be in electrical communication with a thoracic splanchnic nerve of a subject with cancer, and be configured to operate the one or more electrodes to electrically stimulate the splanchnic nerve with a plurality of electrical pulses that triggers one or more action potentials in the splanchnic nerve that increase circulating NK cells.

A closed-loop implantable neurostimulator system for mitigating chronic pain, the closed-loop implantable neurostimulator system including a neuromodulation device comprising one or more electrodes configured to measure a physiological signal of a subject and deliver an electrical stimulation signal to a target area in the subject and a controller, in communication with the one or more electrodes, comprising a processor and a computer-readable memory storing a trained healthy computer model, the controller configured to analyze the physiological signal that is measured using the trained healthy computer model to identify a corrective electrical stimulation signal that, when delivered by the one or more electrodes to the target area, reduces pathological neuronal events in the target area while preserving acute pain response.

Methods and systems for treating sleep apnea using electrical stimulation to a patient's upper and/or lower respiratory nerve or muscle are described. A stimulation regimen can be used to achieve upper airway patency and/or rhythmic air flow in a coordinated fashion during sleep. In some cases, diaphragm activity is monitored to determine whether sufficient upper airway patency and/or rhythmic air flow is achieved and maintained. The stimulation regimen may be adjusted based on the diaphragm activity. In some cases, the system includes modularized components so that the components can be customized to an individual's needs.

Systems, devices, and techniques are described for determining a posture state of a patient based on detected evoked compound action potentials (ECAPs). In one example, a medical device includes stimulation circuitry configured to deliver electrical stimulation and sensing circuitry configured to sense a plurality of evoked compound action potential (ECAP) signals. The medical device also includes processing circuitry configured to control the stimulation circuitry to deliver a plurality of electrical stimulation pulses having different amplitude values, control the sensing circuitry to detect, after delivery of each electrical stimulation pulse of the plurality of electrical stimulation pulses, a respective ECAP signal of the plurality of ECAP signals, and determine, based on the plurality of ECAP signals, a posture state of the patient.

Apnea events may be detected based on a primary biomarker, e.g., respiration, in the one or more physiological signals. The apnea events may be characterized as one of an obstructive sleep apnea (OSA) event, a central sleep apnea (CSA) event, or a combination OSA/CSA event based on a secondary biomarker, e.g., a frequency spectrum or a morphology of the respirations in the one or more physiological signals. A first electrical stimulation may be provided to treat OSA in response to a first one or more of the apnea events being characterized as OSA events. A second electrical stimulation may be provided to treat CSA in response to a second one or more of apnea events being characterized as CSA events. A third electrical stimulation may be provided to treat combination OSA/CSA in response to a third one or more of the apnea events being characterized as combination OSA/CSA events.