Devices, systems, or methods include generating, by stimulation generation circuitry, a first train of electrical stimulation pulses at a first frequency to a first target tissue; and generating, by the stimulation generation circuitry, a second train of electrical stimulation pulses at a second frequency to a second target tissue different from the first target tissue, wherein at least some electrical stimulation pulses of the first train of electrical stimulation pulses are interleaved with at least some electrical stimulation pulses of the second tram of electrical stimulation pulses. At least the first target tissue is associated with a spinal cord of a patient, and the second target tissue is associated with at least one of a peripheral nerve or a nerve root of the patient.

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.

Leakage of signal between conduction paths of an implantable medical lead or lead and lead extension combination is detected. A stimulation signal is provided via one electrode. Two other electrodes sense the stimulation signal. A difference in amplitude of the two sensed signals is determined and based on this difference, leakage is detected. A sensing circuit may use differential amplification of the two signals and compare a resulting output signal to a leakage threshold. When the amplitude of the output signal exceeds the leakage threshold, then leakage is occurring between the conduction path providing the stimulation and one of the conduction paths used for sensing. Other techniques for determining leakage from the difference may also be used such as comparing the amplitudes of the two sensed signals and providing a value that is based on the comparison to indicate whether leakage is present.

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.

A device for neurostimulation including an electrode structure for delivering stimulation pulses to a nerve as well as for processing and extracting evoked compound action potentials, wherein the electrode structure comprises at least a first anode, at least a second anode opposing the first anode and a plurality of cathodes arranged between said anodes, wherein said cathodes are asymmetrically arranged with respect to said at least first and second anode to permit evoked compound action potential sensing via the anode electrodes simultaneously with stimulation.

Leakage of signal between conduction paths of an implantable medical lead or lead and lead extension combination is detected. A stimulation signal is provided via one electrode. Two other electrodes sense the stimulation signal. A difference in amplitude of the two sensed signals is determined and based on this difference, leakage is detected. A sensing circuit may use differential amplification of the two signals and compare a resulting output signal to a leakage threshold. When the amplitude of the output signal exceeds the leakage threshold, then leakage is occurring between the conduction path providing the stimulation and one of the conduction paths used for sensing. Other techniques for determining leakage from the difference may also be used such as comparing the amplitudes of the two sensed signals and providing a value that is based on the comparison to indicate whether leakage is present.

A neuromodulation system and method of providing sub-threshold therapy to a patient. An anodic perception threshold of super-threshold electrical energy and a cathodic perception threshold of super-threshold electrical energy are determined for a plurality of electrode sets. A ratio between the anodic perception threshold and the cathodic perception threshold is calculated for each of the electrode sets. An effective electrode set is selected based on the ratio between the anodic perception threshold and the cathodic perception threshold.

A system and method are described for stimulating excitable tissue. The system includes a monopolar stimulation source that generates a sub-threshold field in the vicinity of the excitable tissue, the sub-threshold field being below a threshold at which activation of the excitable tissue occurs. One or more local stimulation sources generate a local field, which in combination with the sub-threshold field exceeds the threshold of the excitable tissue.

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 is configured to receive, for each electrode combination of a plurality of electrode combinations, information representing a signal sensed in response to first electrical stimulation delivered to a patient via a lead, wherein the plurality of electrode combinations comprise different electrode combinations comprising electrode disposed at different positions around a perimeter of the lead implanted in the patient. The system may also be configured to determine, based on the information for each electrode combination of the plurality of electrode combinations, values for a threshold at different locations around the perimeter of the lead and determine, based on the values for the threshold, one or more stimulation parameter values that at least partially define second electrical stimulation deliverable to the patient via the lead.

An example of a system to program a neuromodulator to deliver neuromodulation to a neural target using a plurality of electrodes may comprise a programming control circuit configured to determine target energy allocations for the plurality of electrodes based on at least one target pole to provide a target sub-perception modulation field, and normalize the target sub-perception modulation field, including determine a time domain scaling factor to account for at least one property of a neural target or of a neuromodulation waveform, and apply the time domain scaling factor to the target energy allocations.