The present disclosure provides a device for state-dependent pudendal nerve stimulation for bladder control in a subject and methods of making and using the same.

Methods and systems for assisting a patient to reprogram parameters of an implantable medical device, such as a spinal cord stimulator, are disclosed. A patient may use an external controller, which may be either a dedicated device or a personal computing device, to interact with their implantable medical device and evaluate the efficacy of their therapy. If the efficacy diminishes, the patient may use their external controller to adjust either the neural dosage (i.e., frequency, pulse width, and/or amplitude) and/or the location at which stimulation is provided. A reprogramming assistant is provided, which guides the patient in adjusting their stimulation using their external controller. The patient may use supra-perception or sub-perception stimulation for the adjustment. The implantable medical device may include pre-programmed rescue programs to assist the patient in recovering the efficacy of their therapy.

A neuromodulation system for use with electrodes to modulate a volume of neural tissue may include a waveform generator and a controller. The waveform generator may be configured to be electrically connected to the electrodes and provide an electrical waveform through at least some of the electrodes to provide a neuromodulation therapy. The controller may be configured to use a program to control the waveform generator to deliver a neuromodulation therapy by delivering both a fast-acting sub-perception neuromodulation and a slow-acting sub-perception neuromodulation. The fast-acting neuromodulation has a wash-in transition period less than a first time duration, and the slow-acting sub-perception neuromodulation has a wash-in transition period more than a second time duration, the second time duration being longer than the first time duration.

Methods and systems for programming stimulation parameters for an implantable medical device for neuromodulation, such as spinal cord stimulation (SCS) are disclosed. The stimulation parameters define user-configured waveforms having at least a first phase having a first polarity and a second phase having a second polarity, wherein the first and second phases are separated by an interphase interval (IPI). By delivering user-configured waveforms with different IPIs, stimulation geometry, and other waveform settings, therapeutic asynchronous activation of dorsal column fibers can be obtained.

A neuromodulation system configured for providing sub-threshold neuromodulation therapy to a patient. The neuromodulation system comprises a neuromodulation lead having at least one electrode configured for being implanted along a spinal cord of a patient, a plurality of electrical terminals configured for being respectively coupled to the at least one electrode, modulation output circuitry configured for delivering sub-threshold modulation energy to active ones of the at least one electrode, and control/processing circuitry configured for selecting a percentage from a plurality of percentages based on a known longitudinal location of the neuromodulation lead relative to the spinal cord, computing an amplitude value as a function of the selected percentage, and controlling the modulation output circuitry to deliver sub-threshold modulation energy to the patient at the computed amplitude value.

A method of modulating neural activity using a combination of electrical and optical stimulation transmitted via a gold nanoparticle covered nanoelectrode is presented. The combination of short-duration green visible light optical pulses with the complementary sub-threshold level electric current pulses are capable of producing action potentials in neurons. Cells were found to have a greater than a 5 survival rate using this hybrid stimulation method as compared to pure plasmonic/optical stimulation. The cell stimulation success rate was 3 greater with hybrid stimulation.

Methods and systems for testing and treating spinal cord stimulation (SCS) patients are disclosed. Patients are eventually treated with sub-perception (paresthesia free) therapy. However, supra-perception stimulation is used during sweet spot searching during which active electrodes are selected for the patient. This allows sweet spot searching to occur much more quickly and without the need to wash in the various electrode combinations that are tried. After selecting electrodes using supra-perception therapy, therapy is titrated to sub-perception levels using the selected electrodes. Such sub-perception therapy has been investigated using pulses at or below 10 kHz, and it has been determined that a statistically significant correlation exists between pulse width (PW) and frequency (F) in this frequency range at which SCS patients experience significant reduction in symptoms such as back pain. Beneficially, sub-perception stimulation at such low frequencies significantly lowers power consumption in the patient's neurostimulator.

The techniques of the disclosure describe example medical devices, systems, and methods for delivering stimulation therapy comprising a first set of a plurality of pulses having a first amplitude, and a second set of a plurality of pulses having a second amplitude greater than the first amplitude. The second amplitude is adjusted to an adjusted second amplitude based on second amplitude being less than or greater than activation threshold. The first amplitude is adjusted based on adjusted second amplitude, and therapy is delivered based at least one the adjusted first amplitude.

A method is disclosed for programming a patient's stimulator device using an external device. The method obtains information such as a model at the external device, wherein the information is specific to the patient, wherein the information comprises a range or volume of stimulation parameters determined based on testing of the patient that preferably provide sub-perception therapy; and providing from the external device instructions for execution at the stimulator device, the instructions specifying an amplitude, a pulse width, and a frequency of stimulation pulses to be provided at one of more of electrodes in an electrode array of the patient's stimulator device, wherein the instructions vary over time at least one of the amplitude, pulse width, and frequency within the range or volume. Varying at least one of these parameters helps in preventing the patient's neural tissue from become habituated when compared to stimulation that is provided without variance.

The techniques described herein are example medical devices, systems, and methods for sensing evoked potentials in a tissue of the patient, and, based on the sensed evoked potentials, adjusting one or more parameters defining the electrical stimulation therapy delivered to the patient. In one example, a system controls delivery of an electrical stimulation therapy from an implantable medical device to a patient according to at least one therapy program, wherein the electrical stimulation therapy is configured to provide pain relief to the patient without substantially resulting in paresthesia perceived by the patient. The system periodically adjusts the electrical stimulation therapy delivered to the patient in response to detected compound action potentials, wherein the adjustment to the electrical stimulation therapy is configured to eliminate action potentials in tissue of the patient evoked by the delivered electrical stimulation, and wherein the controlling and the adjusting are performed via one or more processors.