A medical device is configured to deliver a series of electrical stimulation pulses including opposing polarity pulses. The medical device delivers a charge balancing pulse by modifying every nth pulse of the electrical stimulation pulses to reduce a net charge delivered over the series of electrical stimulation pulses. In some examples, the medical device may be an implantable medical device that is coupled to an extra-cardiovascular lead for delivering the cardiac pacing pulses.

A system for nerve stimulation is provided; it comprises a nerve stimulation device configured to execute a set of nerve stimulation instructions for generating electrical pulses for nerve stimulation of a patient. A user electronic device is configured to generate the set of nerve stimulation instructions; and send the set of nerve stimulation instructions wirelessly to the nerve stimulation device.

Devices, systems, and techniques for controlling electrical stimulation therapy are described. In one example, a system may include processing circuitry configured to control a medical device to deliver a first electrical stimulation according to a first value of a first stimulation parameter of the plurality of stimulation parameters and a first value of a second parameter of the plurality of stimulation parameters, receive an input representative of an efficacy of the first electrical stimulation delivered to the patient according to the first value of the first stimulation parameter and the first value of the second parameter, select, based on the input and the relationship between the plurality of stimulation parameters, a second value of at least one of the first stimulation parameter or the second stimulation parameter, and control the medical device to deliver a second electrical stimulation according to the second value.

Simulation electrode assemblies for applying bilateral stimulation, for example stimulating both the left and right hypoglossal nerves of a patient in the treatment of sleep disordered breathing. In some methods, a stimulation electrode assembly is inserted through an incision at a side of the patient and implanted at a location extending across the patient's mid-line.

Disclosed is a method for stimulating neural tissue, where the neural tissue includes one or more neurons genetically modified to express a light-sensitive protein. The method comprises applying a light stimulus and an electrical stimulus to the neural tissue, thereby triggering membrane depolarisation in at least one of the neurons. Also disclosed is an apparatus for applying the disclosed method. The apparatus includes a light-stimulation device for selectively applying a light stimulus and an electrical-stimulation device for selectively applying an electrical stimulus to the neural tissue.

A method of treating a patient and an external programmer for use with a neurostimulator. Electrical stimulation energy is conveyed into tissue of the patient via a specified combination of a plurality of electrodes, thereby creating one or more clinical effects. An influence of the specified electrode combination on the clinical effect(s) is determined. An anatomical region of interest is displayed in registration with a graphical representation of the plurality of electrodes. The displayed anatomical region of interest is modified based on the determined influence of the specified electrode combination on the clinical effect(s).

Systems and methods are provided for delivering neurostimulation therapies to patients for treating chronic heart failure. A neural fulcrum zone is identified and ongoing neurostimulation therapy is delivered within the neural fulcrum zone. The implanted stimulation device includes a physiological sensor for monitoring the patient's response to the neurostimulation therapy on an ambulatory basis over extended periods of time and a control system for adjusting stimulation parameters to maintain stimulation in the neural fulcrum zone based on detected changes in the physiological response to stimulation.

Techniques to help improve efficiency or effectiveness of treating a disorder such as RLS or PLMD, such as by issuing neural electrostimulations to a particular patient, while varying one or more amplitude parameters (e.g., at least one of electrostimulation current amplitude, electrostimulation voltage amplitude, or electrostimulation pulsewidth duration). A corresponding patient-subjective or patient-objective response can be observed. A characteristic electrostimulation intensity relationship can be generated, for example, based on the determined respective at least one of RLS or PLMD response indication threshold amplitude parameters and the plurality of corresponding neural electrostimulation durations. Once this characteristic electrostimulation intensity relationship has been generated, it can then be used to control issuing subsequent neural electrostimulations to the particular patient according to (1) at least one goal and (2) a variable operating point based upon the generated characteristic electrostimulation intensity relationship.

Techniques for therapy delivery are described. A processing circuit may adjust a first therapy parameter from a first level to a second level, and responsive to the adjustment of the first therapy parameter, compare a level of an evoked compound action potential (ECAP) generated from therapy delivery based on the adjusted first therapy parameter to an ECAP threshold. The processing circuit may adjust a second therapy parameter from a third level to a fourth level based on the comparison. The second therapy parameter is different than the first therapy parameter. The processing circuit may cause therapy delivery with the first therapy parameter at the second level and the second therapy parameter at the fourth level.

Systems and techniques are disclosed to adjust programming of an implantable electrical neurostimulation device for treating chronic pain of a human subject, through the use of a dynamic model adapted to identify pain treatment parameters for a human patient and determine a best device operational program to implement the pain treatment parameters to address the chronic pain condition. In an example, the system to adjust programming of the neurostimulation device performs operations that: obtain data related to a state of pain of the human subject; identify pain treatment parameters using a dynamic model adapted to evaluate the pain treatment parameters in the human subject over a time period, based on the data related to the state of pain; and select a neurostimulation program for the neurostimulation device, corresponding to at least a portion of the identified pain treatment parameters.