Controlling electrical stimulation therapy
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.
1. A medical device system comprising:
a stimulation generator configured to deliver electrical stimulation to a patient; and
a processor configured to:
at a first time, control delivery of the electrical stimulation from the stimulation generator to the patient according to at least one therapy program, wherein the electrical stimulation is configured to provide pain relief to the patient and configured to reduce paresthesia perceived by the patient;
at a second time subsequent to the first time, determine, in response to controlling the delivery of the electrical stimulation according to the at least one therapy program, that the electrical stimulation causes evoked compound action potentials (ECAPs) to be detected in the patient; and
adjust the electrical stimulation in response to determining that the ECAPs were detected, wherein the adjustment to the electrical stimulation is configured to prevent subsequent ECAPs in the patient.
2. The system of claim 1 , wherein the processor is configured to adjust the electrical stimulation by adjusting one or more stimulation parameters of the at least one therapy program.
3. The system of claim 2 , wherein the processor is further configured to titrate the one or more stimulation parameters of the electrical stimulation to determine a therapy program that does not evoke an ECAP in the patient.
4. The system of claim 1 , further comprising one or more sensors configured to detect the ECAPs in the patient evoked by the electrical stimulation.
5. The system of claim 1 , further comprising a sensor configured to detect a patient event, wherein the processor is configured to adjust the electrical stimulation in response to the detected patient event.
6. The system of claim 1 , further comprising a sensor configured to detect at least one of a change in a posture state of the patient or coughing by the patient.
7. The system of claim 6 , wherein the sensor comprises at least one of an accelerometer sensor, a pressure sensor, a posture sensor, or a respiratory function sensor.
8. The system of claim 1 , wherein the processor is configured to periodically adjust the electrical stimulation in response to the detected ECAPs after expiration of a predetermined time period.
9. The system of claim 1 , wherein the processor is further configured to:
in response to determining that the ECAPs were detected, suspend the electrical stimulation for a predetermined time period;
after the predetermined time period, determine whether an electrical activity of the tissue of the patient is less than a compound action potential threshold; and
responsive to determining that the electrical activity of the patient is less than the compound action potential threshold, adjust and control delivery of the electrical stimulation to the patient.
10. The system of claim 1 , wherein the electrical stimulation includes a frequency greater than 1 Hertz and less than 10,000 Hertz.
11. The system of claim 1 , wherein the electrical stimulation includes a frequency greater than 1 Hertz and less than 1,500 Hertz.
12. The system of claim 1 , wherein the electrical stimulation configured to provide pain relief to the patient and configured to reduce paresthesia perceived by the patient is further configured to provide pain relief to the patient while resulting in no paresthesia perceived by the patient.
13. The system of claim 1 , wherein to adjust the electrical stimulation in response to the detected ECAPs, the processor is configured to, only in response to detecting an electrically evoked compound action potential, adjust the electrical stimulation to prevent the subsequent ECAPs in the patient.
14. The system of claim 1 , wherein, to prevent the subsequent ECAPs in the patient, the processor is configured to adjust at least one parameter of the electrical stimulation until the ECAPs are no longer detected.
15. A method comprising:
at a first time, controlling, by a processor of a medical device, delivery of electrical stimulation from a stimulation generator to a patient according to at least one therapy program, wherein the electrical stimulation is configured to provide pain relief to the patient and configured to reduce paresthesia perceived by the patient;
at a second time subsequent to the first time, determining, by the processor in response to controlling the delivery of the electrical stimulation according to the at least one therapy program, that the electrical stimulation causes evoked compound action potentials (ECAPs) to be detected in the patient; and
adjusting, by the processor in response to determining that the ECAPs were detected, the electrical stimulation, wherein the adjustment to the electrical stimulation is configured to prevent subsequent ECAPs in the patient.
16. The method of claim 15 , wherein adjusting the electrical stimulation comprises adjusting, by the processor, one or more stimulation parameters of the at least one therapy program.
17. The method of claim 16 , further comprising titrating, by the processor, the one or more stimulation parameters to determine a therapy program that does not evoke ECAPs in the patient.
18. The method of claim 15 , wherein periodically adjusting the electrical stimulation delivered to the patient in response to the detected ECAPs comprises periodically adjusting, by the processor, the electrical stimulation in response to the detected ECAPs after expiration of a predetermined time period.
19. A non-transitory, computer-readable medium comprising instructions that, when executed, cause a processor of a medical device to:
at a first time, control delivery of electrical stimulation from a stimulation generator to a patient according to at least one therapy program, wherein the electrical stimulation therapy is configured to provide pain relief to the patient and configured to reduce paresthesia perceived by the patient;
at a second time subsequent to the first time, determine, in response to controlling the delivery of the electrical stimulation according to the at least one therapy program, that the electrical stimulation causes evoked compound action potentials (ECAPs) to be detected in the patient; and
adjust, in response to determining that the ECAPs were detected, the electrical stimulation, wherein the adjustment to the electrical stimulation is configured to prevent subsequent ECAPs in the patient.