Medtronic, Inc.

Given Imaging Ltd.

Other

David A Dinsmoor

Kristin N Hageman

Hank Bink

Christopher L Pulliam

Joel A Anderson

Timothy J Denison

Xin Su

Eric H Bonde

Erik R Scott

Xuan K Wei

Duane L Bourget

Todd V Smith

Forrest C M Pape

Erik J Peterson

John E Kast

Randy S Roles

Jiashu Li

Stephen J Roddy

Scott R Stanslaski

Richard T Stone

Craig L Schmidt

Christian S Nielsen

Phillip C Falkner

Gabriela C Molnar

Gordon Orvis Munns

Thomas P Miltich

Brad Conrad Tischendorf

Bernard Q Li

Chris J Paidosh

Joseph J Viavattine

Michael Jay Ebert

Andrew L Schmeling

Reginald D Robinson

Prabhakar A Tamirisa

Markus W Reiterer

Anthony M Chasensky

Shawn C Kelley

David L Thompson

Mark A Christopherson

Warren L Starkebaum

Venkat R Gaddam

Paul R Mazanec

Rogier Receveur

Vincent Larik

Daniel R Greeninger

Earle Timothy Roberts

John LaLonde

Heather Diane Orser

Mandla Thokozani Shongwe

Jason E Agran

James Kevin Carney

Dwight E Nelson

Peng Cong

Michael F Mattes

John J Grevious

Todd A Kallmyer

Thaddeus S Brink

Thomas Adamski

Robert A Corey

Blake A Hedstrom

Lance Zirpel

Matthew J Michaels

Timothy Denison

Louis P Vera-Portocarrero

Melanie D Goodman Keiser

Michael E Newell

Arun K Gupta

Receveur Rogier

Techniques are disclosed for implementing the use of electrically evoked compound action potentials (ECAPs) to adaptively adjust parameters of high frequency electrical stimulation. In one example, a medical device delivers electrical stimulation therapy comprising a train of electrical stimulation pulses to a patient, wherein the train of electrical stimulation pulses comprises a pulse frequency greater than or equal to 500 Hertz. After delivering the train of electrical stimulation pulses, the medical device ceases delivery of the high frequency electrical stimulation therapy for a predetermined period of time. During the predetermined period of time, the medical device senses an ECAP from the patient and determines, based on the sensed ECAP, a value of a parameter at least partially defining the train of electrical stimulation pulses. Responsive to the predetermined period of time elapsing, the medical device resumes delivery of the high frequency electrical stimulation according to the determined parameter.

ECAP sensing for high frequency neurostimulation

Methods, systems, and devices for implantable node are described. The method may include storing, at an implantable stimulation node, a set of stimulation profiles in a memory during a configuration phase. The method may also include receiving a stimulation command corresponding to a stimulation profile of the set of stimulation profiles during a treatment phase. The method may further include delivering stimulation based at least in part on the stimulation profile corresponding to the received stimulation command. In some cases, the system may include an implantable hub, an implantable sensing node, and a sensing device.

Implantable stimulation node configuration

Systems, devices, and techniques are described for determining stimulation parameters based on one or more stimulation thresholds (e.g., a perception threshold or a detection threshold). In one example, a medical device includes sensing circuitry configured to sense one or more ECAP signals, wherein the sensing circuitry is configured to sense each ECAP signal of the one or more ECAPs elicited by a respective control pulse of a plurality of control pulses, and the medical device includes processing circuitry configured to determine, based on the one or more ECAP signals, a stimulation level for the plurality of control pulses that achieves a stimulation threshold, determine, based on the stimulation level, a value of a stimulation parameter that at least partially defines a plurality of therapy pulses of electrical stimulation therapy, and control stimulation generation circuitry to deliver the electrical stimulation therapy according to the value of the stimulation parameter.

Sub-threshold stimulation based on ECAP detection

Systems, devices, and techniques for adjusting electrical stimulation are described. For example, processing circuitry is configured to receive, via a sensing electrode located at a target region of a patient, a plurality of evoked compound action potential (ECAP) signals elicited from respective electrical stimuli delivered to the patient; determine, based on the plurality of ECAP signals, an aggressor category for at least some ECAP signals of the plurality of ECAP signals, the aggressor category determined from a plurality of aggressor categories; determine, based on the aggressor category, a set of control policy parameters that at least partially define closed-loop control of stimulation therapy; and controlling delivery of the stimulation therapy according to at least the set of control policy parameters and one or more subsequent ECAP signals.

Hybrid control policy for ECAP-servoed neuromodulation

Systems, devices, methods, and techniques are described for using evoked compound action potential (ECAP) signals to determine an implant location for a lead. An example method includes receiving first information representative of a first evoked compound action potential (ECAP) signal sensed in response to a first control stimulus delivered to a first location adjacent to a spinal cord of a patient. The method also includes receiving, second information representative of a second ECAP signal in response to a second control stimulus delivered to a second location adjacent to the spinal cord of the patient. Additionally, the method includes outputting a first indication of the first information representative of the first ECAP signal and a second indication of the second information representative of the second ECAP signal.

Implantable lead location using ECAP

Systems, devices, methods, and techniques are described for using evoked compound action potential (ECAP) signals to monitor lead position and/or detect lead migration. An example system includes sensing circuitry configured to sense an ECAP signal, and processing circuitry. The processing circuitry controls the sensing circuitry to detect, after delivery of an electrical stimulation pulse, a current ECAP signal, and determines one or more characteristics of the current ECAP signal. The processing circuitry also compares the one or more characteristics of the current ECAP signal to corresponding one or more characteristics of a baseline ECAP signal, and determines, based on the comparison, a migration state of the electrodes delivering the electrical stimulation pulse. Additionally, the processing circuitry outputs, based on the migration state, an alert indicative of migration of the electrodes.

Implantable lead migration monitoring using ECAP

Systems, devices, and techniques are described for adjusting electrical stimulation based on detected ECAPs. In one example, a medical device includes processing circuitry configured to control stimulation circuitry to deliver a first electrical stimulation pulse and sensing circuitry to detect, after delivery of the first electrical stimulation pulse, an ECAP signal. The processing circuitry may be configured to determine a characteristic value of the ECAP signal, determine an ECAP differential value that indicates whether the characteristic value of the ECAP signal is one of greater than a selected ECAP characteristic value or less than the selected ECAP characteristic value, determine, based on the ECAP differential value, a gain value, determine, based on the gain value, a parameter value that at least partially defines a second electrical stimulation pulse, and control the stimulation circuitry to deliver the second electrical stimulation pulse according to the parameter value.

Hysteresis compensation for detection of ECAPs

Devices, systems, and techniques are described for selecting an evoked compound action potential (ECAP) growth curve based on a posture of a patient. The ECAP growth curve defines a relationship between a parameter defining delivery of stimulation pulses delivered to the patient and a parameter of an ECAP signal of a nerve of a patient elicited by a stimulation pulse. In one example, a medical device detects a posture of a patient and selects an ECAP growth curve corresponding to the detected posture. The medical device selects, based on the ECAP growth curve corresponding to the detected posture and a characteristic of a detected ECAP signal, a value for a parameter for defining delivery of the stimulation pulses to the patient and controls delivery of the stimulation pulses according to the selected value for the parameter.

Posture-based control of electrical stimulation therapy

This disclosure relates to methods, devices, and systems for delivering and adjusting stimulation therapy. In one example, a method comprising delivering, by a stimulation electrode, electrical stimulation as a candidate therapy to a patient according to a set of candidate therapy parameters, the stimulation electrode located in proximity to the dorsal column of a patient; sensing, by a sensing electrode, an electrically evoked compound action potential (eECAP) signal in response to the delivery of the electrical stimulation; and classifying, by a processor, the sensed eECAP signal generated in response to the application of the candidate therapy relative to an eECAP baseline is disclosed.

Dorsal spinal column characterization with evoked potentials

Devices, systems, and techniques for controlling electrical stimulation therapy are described. In one example, a system may be configured to deliver electrical stimulation therapy to a patient, the electrical stimulation therapy comprising a plurality of therapy pulses at a predetermined pulse frequency over a period of time and deliver, over the period of time, a plurality of control pulses interleaved with at least some therapy pulses of the plurality of therapy pulses. The system may also be configured to sense, after one or more control pulses and prior to an immediately subsequent therapy pulse of the plurality of therapy pulses, a respective evoked compound action potential (ECAP), adjust, based on at least one respective ECAP, one or more parameter values that at least partially defines the plurality of therapy pulses, and deliver the electrical stimulation therapy to the patient according to the adjusted one or more parameter values.

ECAP based control of electrical stimulation therapy

Systems, devices, and techniques are described for determining a posture state of a patient based on detected evoked compound action potentials (ECAPs). In one example, a medical device includes stimulation circuitry configured to deliver electrical stimulation and sensing circuitry configured to sense a plurality of evoked compound action potential (ECAP) signals. The medical device also includes processing circuitry configured to control the stimulation circuitry to deliver a plurality of electrical stimulation pulses having different amplitude values, control the sensing circuitry to detect, after delivery of each electrical stimulation pulse of the plurality of electrical stimulation pulses, a respective ECAP signal of the plurality of ECAP signals, and determine, based on the plurality of ECAP signals, a posture state of the patient.

Determining posture state from ECAPs

Example systems for positioning an implantable electrode may include a stimulation circuitry, a sensing circuitry, and processing circuitry. The stimulation circuitry may generate electrical stimulation deliverable to a patient. The sensing circuitry may sense electromyographic (EMG) responses. The processing circuitry may control the stimulation circuitry to deliver the electrical stimulation at a plurality of different stimulation metric levels at each of a plurality of different positions. The processing circuitry may sense, via the sensing circuitry, electromyographic (EMG) responses to the electrical stimulation. The processing circuitry may score one or more of the different positions for chronic implantation of at least one implantable electrode. The scoring may be based on a stimulation metric level greater than a predetermined metric threshold sufficient to evoke at least some of the sensed EMG responses, and a level of the at least some of the sensed EMG responses.

Lead placement for nerve stimulation

A medical device system includes an IMD configured to deliver a plurality of stimulation vectors and processing circuitry. The processing circuitry is configured to determine strength-duration curve data for the plurality of stimulation vectors, the strength-duration curve data representing, for respective pulse widths and stimulation vectors, a corresponding strength of electrical stimulation that evokes a physiological response, compare respective slopes of the strength-duration curve data for the plurality of stimulation vectors to one another, select at least one stimulation vector of the plurality of stimulation vectors based on the comparison of the respective slopes of the strength-duration curve data for the plurality of stimulation vectors, and cause the IMD to deliver the electrical stimulation to a neural target via the selected at least one stimulation vector.

Stimulation vector selection using pulse width data

Systems, devices, and techniques for adjusting electrical stimulation based on a posture state of a patient are described. For example, a system may include sensing circuitry configured to sense an ECAP signal and processing circuitry configured to control delivery of the electrical stimulation to a patient according to a first value of a stimulation parameter and determine a characteristic value of the ECAP signal. The processing circuitry may also be configured to receive, from a sensor, a posture state signal representing a posture state of the patient, determine, based on the posture state signal, a gain value for the stimulation parameter, adjust, based on the characteristic value of the ECAP signal and the gain value, the first value of the stimulation parameter to a second value of the stimulation parameter, and control delivery of the electrical stimulation according to the second value of the stimulation parameter.

ECAP and posture state control of electrical stimulation

Systems, devices, and techniques include analyzing evoked compound action potentials (ECAP) signals to assess the effect of a delivered electrical stimulation signal. In one example, a system includes processing circuitry configured to receive ECAP information representative of an ECAP signal sensed by sensing circuitry, and determine, based on the ECAP information, that the ECAP signal includes at least one of an N2 peak, P3 peak, or N3 peak. The processing circuitry may then control delivery of electrical stimulation based on at least one of the N2 peak, P3 peak, or N3 peak.

Analyzing ECAP signals

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Saint Paul, MN, United States of America

David A Dinsmoor