A system and method for determining an access trajectory to a target site to safely place a surgical access instrument (e.g., guide wire, dilator, cannula, etc.) through a tissue (e.g., muscle, fat, brain, liver, lung, etc.) without damaging nearby neurovascular structure is described herein. The trajectory determination system includes a nerve stimulation probe and a dilator guide having a plurality of guide channels and registerable to an operating table in a fixed orientation. Motor nerve stimulation (e.g., EMG, MMG) is performed with the stimulation probe positioned in each of said plurality of guide channels to generate a map of nerve locations within intervening anatomical structures (e.g., muscle, bone, etc.) between the dilator guide and the surgical target site. Available access pathways are determined based on the nerve location data and displayed on a display unit.

A neurostimulation system senses electrographic signals from the brain of a patient, extracts features from the electrographic signals, and when the extracted features satisfy certain criteria, detects a neurological event type. A mapping function relates the detected neurological event type to a stimulation parameter subspace and a default stimulation parameter set where the values of the stimulation parameters define an instance of stimulation therapy for the patient. The decision whether to implement a stimulation parameter subspace or a default stimulation parameter set may be informed by integrating other information about a state of the patient. A stimulation parameter subspace or stimulation parameter set may optimized by testing it against various thresholds until certain effectiveness criteria is satisfied. The neurological event type may be one of several electrographic seizure onset types.

A computer implemented method and system is provided for managing neural stimulation therapy. The method comprises under control of one or more processors configured with program instructions. The method delivers a series of candidate stimulation waveforms having varied stimulation intensities to at least one electrode located proximate to nervous tissue of interest. A parameter defines the candidate stimulation waveforms is changed to vary the stimulation intensity. The method identifies a first candidate stimulation waveform that induces a paresthesia-abatement effect, while continuing to induce a select analgesic effect. The method further identifies a second candidate stimulation waveform that does not induce the select analgesic effect. The method sets a stimulation therapy based on the first and second candidate stimulation waveforms.

An implantable medical system may provide atrioventricular synchronous pacing using the ventricular septal wall. The system may include a ventricular electrode coupled to an intracardiac housing or a first medical lead implantable in the ventricular septal wall of the patient's heart to deliver cardiac therapy to or sense electrical activity of the left ventricle of the patient's heart and a right atrial electrode coupled to a leadlet or second medical lead to deliver cardiac therapy to or sense electrical activity of the right atrium of the patient's heart. A right ventricular electrode may be coupled to the intracardiac housing or the first medical lead and implantable in the ventricular septal wall of the patient's heart to deliver cardiac therapy to or sense electrical activity of the right ventricle of the patient's heart.

A computer brain interface (CBI) device of an individual is self-calibrated. A neurostimulation test signal is generated based on a selected set of test signal parameters. The neurostimulation signal is applied to the afferent sensory nerve fibers to elicit a bioelectric response via a neurostimulation interface operably connected to or integrated with the CBI device. The neurostimulation interface senses the bioelectric responses of the stimulated afferent sensory nerve fibers. The CBI devices determines, based on the sensed bioelectric responses, whether an excitation behavior of the stimulated afferent sensory nerve fibers with respect to the neurostimulation interface has changed. When the excitation behavior has changed, a set of recalibrated neurostimulation signal parameters is determined based on the sensed bioelectric responses. The CBI device is operated using the recalibrated neurostimulation signal parameters to communicate information to the individual via neurostimulation of the afferent sensory nerve fibers.

In some examples, a medical system includes one or more trialing leads implanted within a patient, one or more sensors configured to determine a value for a sensed parameter indicative of an activity level of the patient, and processing circuitry. The processing circuitry may be configured to receive the value from the one or more sensors, determine whether the value is outside a threshold range, and—in response to determining that the value is outside the threshold range—generate information indicating a status of the one or more trialing leads. In some examples, processing circuitry may be configured to output an alert warning that patient movement could dislodge, or has already dislodged, the one or more trialing leads.

A patient external controller is provided for controlling sub-perception stimulation provided by a patients implantable stimulator device having an electrode array. Control circuitry in the controller renders a graphical user interface (GUI), including a location at which the sub-perception stimulation is provided within the electrode array, and a pre-defined region in which the location can be moved. The pre-defined region may be constrained to less than the entire electrode array. The control circuitry receives one or more first inputs to move the location of the sub-perception stimulation within the region and to program the stimulator to move the sub-perception stimulation to the moved location in the electrode array. The control circuitry can enable adjustment of an amplitude of the sub-perception stimulation to a value that is less than or equal to a perception threshold. Once moved, the sub-perception stimulation an be stored as a second stimulation program.

Systems and methods for providing a trial neurostimulation to a patient for assesssing suitability of a permanently implanted neurostimulation are provided herein. In one aspect, a trial neurostimulation system includes an EPG patch adhered to a skin surface of a patient and connected to a lead extending through a percutaneous incision to a target tissue location. The EPG may be a modified version of the IPG used in the permanent system, the EPG may be smaller and/or lighter than the corresponding IPG device. The EPG and a lead extension may be sealed to allow improved patient mobility and reduced risk of infection. The EPG may be compatible with wireless systems used to control and monitor the IPG such that operation and control of the EPG is substantially the same in each system to allow seemless conversion to the permanently implanted system.

The present invention provides improved methods for positioning of an implantable lead in a patient with an integrated EMG and stimulation clinician programmer. The integrated clinician programmer is coupled to the implantable lead, wherein the implantable lead comprises at least four electrodes, and to at least one EMG sensing electrode minimally invasively positioned on a skin surface or within the patient. The method comprises delivering a test stimulation at a stimulation amplitude level from the integrated clinician programmer to a nerve tissue of the patient with a principal electrode of the implantable lead. Test stimulations are delivered at a same stimulation amplitude level for a same period of time sequentially to each of the four electrodes of the implantable lead. A stimulation-induced EMG motor response is recorded with the integrated clinician programmer for each test stimulation on each electrode of the implantable lead via the at least one pair of EMG sensing electrodes so as to facilitate initial positioning of the implantable lead at a target stimulation region.

A neuromodulation system and method of providing sub-threshold modulation therapy. Electrical modulation energy is delivered to a target tissue site of the patient at a programmed intensity value, thereby providing therapy to a patient without perception of stimulation. In response to an event, electrical modulation energy is delivered at incrementally increasing intensity values. At least one evoked compound action potential (eCAP) is sensed in a population of neurons at the target tissue site of the patient in response to the delivery of the electrical modulation energy at the incrementally increasing intensity values. One of the incrementally increased intensity values is selected based on the sensed eCAP(s). A decreased intensity value is automatically computed as a function of the selected intensity value. Electrical modulation energy is delivered to the target tissue site of the patient at the computed intensity value, thereby providing sub-threshold therapy to the patient.