An external control device and method for programming an implantable neuromodulator coupled to an electrode array implanted adjacent tissue of a patient having a medical condition. Electrical modulation energy is conveyed to tissue of the patient in accordance with a series of modulation parameter sets. The patient perceives paresthesia in response to the conveyance of the electrical modulation energy to the tissue in accordance with at least one of the modulation parameter sets. One of the modulation parameter set(s) is identified based on the perceived paresthesia. Another modulation parameter set is derived from the identified modulation parameter set. Electrical modulation energy is conveyed to the tissue of the patient in accordance with the other modulation parameter set without causing the patient to perceive paresthesia.

An external control device, neuromodulation system, and method of providing therapy to a patient. Electrical modulation energy is delivered to a target tissue site of the patient at a programmed amplitude value, thereby providing therapy to the patient without the perception of paresthesia. Electrical modulation energy is delivered to the patient at a series of incrementally increasing amplitude values relative to the programmed amplitude value until the patient perceives paresthesia. A decreased amplitude value is automatically computed as a function of one of the series of incrementally increased amplitude values at which the delivered electrical modulation caused the patient to perceive the paresthesia. Electrical modulation energy is delivered to the target tissue site of the patient at the computed amplitude value, thereby providing therapy to the patient without the perception of paresthesia.

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.

In some examples, a medical device is configured to automatically determine a paresthesia threshold or a perception threshold of a patient in a second posture based on the paresthesia threshold or perception threshold of that patient in a first posture. The medical device may deliver an electrical stimulation signal to a patient and determine the paresthesia threshold or perception threshold for the patient in the first posture. The medical device may change the intensity of the electrical signal and receive an indication from the patient that they are experiencing paresthesia or perceiving the electrical stimulation signal. The medical device may then automatically determine a predicted paresthesia threshold or predicted perception threshold for a second posture based on the paresthesia threshold or perception threshold.

A method is disclosed for programming a patient's stimulator device using an external device. The method provides a Graphical User Interface (GUI) on the external device that allows the patient to select from a plurality of displayed stimulation modes to program stimulation provided by one or more electrodes of the stimulator device. The external device stores a model derived for the patient, which model comprises information indicative of a plurality of frequency/pulse width/amplitude coordinates predicted to provide optimal stimulation for the patient. Each stimulation mode corresponds with a subset of coordinates defined in accordance with the plurality of coordinates in the model. Selection of one of the stimulation modes limits programming the stimulator device with coordinates that are within the corresponding subset of coordinates.

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 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 stimulation therapy system dynamically modifies therapy intensity based on measured neurotransmitter levels. In some examples, the system delivers, via an electrode implanted in a brain of a patient and stimulation circuitry, an electrical stimulus; monitors an electrical current generated by the stimulation circuitry to deliver the electrical stimulus; determines, based on the electrical current, a value representative of a concentration of dopamine in the brain of the patient; determines, based on the value representative of the concentration of dopamine, a value for one or more stimulation parameters that at least partially define electrical stimulation therapy; and delivers, via the electrode, the electrical stimulation therapy.

A medical device with closed-loop responsive stimulation may include techniques to mitigate the impact on the therapy output of noise coupled into the medical device. A medical device according to this disclosure may determine the presence of noise and alter the closed loop policy to provide the necessary therapy to the patient and avoid prolonged under stimulation caused by the noise. The medical device may continue therapy, while testing for noise. When the device determines the noise level no longer affects the output therapy, the device may return the closed loop policy to a no-noise mode of operation. The medical device may also include techniques to mitigate the impact of manual adjustment while the medical device is subject to noise or is responding to changes in the patient's physiological signals.

In some examples, a technique for delivering electrical stimulation therapy to a patient includes determining, by processing circuitry, one or more cycle settings associated with delivery of the electrical stimulation therapy, determining, by the processing circuitry, a cycle time period associated with each cycle setting, and delivering, by a medical device, electrical stimulation therapy based on the determined cycle settings and the determined cycle time periods. Each cycle setting may define an on-cycle, during which electrical stimulation is delivered, and an off-cycle, during which electrical stimulation is not delivered. The technique further may include delivering electrical stimulation to the patient to provide one or more reminders to the patient, such as a reminder to void or a reminder of the existence of electrical stimulation.

A device for neurostimulation includes a pulse generator for generating current having pulses and at least one first pair of electrodes connected to the pulse generator. The device provides a user-programmable therapy strength parameter configuration and at least two current parameter configurations for neurostimulation stored in the pulse generator. The current parameter configurations are controlled by the therapy strength configuration, at least one of the current parameter configurations is associated with a level of paresthesia sensation of a patient and at least one of the current parameter configurations is associated with a paresthesia-free therapy for the patient. The association between therapy strength parameter and current parameter configurations uniquely adjusts the current parameter configurations based on paresthesia or paresthesia-free intent, when neurostimulation is performed using parameter configurations. Particularly, the current parameter configurations include parameters such as pulse trains, pulse frequencies, duty cycling, and amplitudes of the current.