Patent Publication Number: US-2023144889-A1

Title: System and methods to deliver hyperpolarizing waveform

Description:
PRIORITY 
     The present application claims the benefit of and priority to U.S. Provisional Application No. 63/276,020, filed Nov. 5, 2021, and entitled “SYSTEM AND METHODS TO DELIVER HYPERPOLARIZING WAVEFORM”, the contents of which is incorporated herein by reference in its entirety. 
    
    
     BACKGROUND 
     Implantable medical devices have improved medical care for patients with certain types of chronic illnesses and disorders. For example, implantable cardiac devices improve cardiac function in patients with heart disease thereby raising quality of life and reducing morality rates, Implantable neurostimulators can provide pain reduction for chronic pain patients and reduce motor difficulties in patients with Parkinson’s disease and other movement disorders. A variety of other medical devices are proposed and are in development to treat other disorders in a wide range of patients. 
     Neural activity can be influenced by electrical energy that is supplied from a stimulation system pulse generator or other waveform generator. Various patient perceptions and/or neural functions can be promoted, disrupted, or otherwise modified by applying an electrical pulses to target sites (the spinal cord, dorsal root ganglia, peripheral nerves, cortical locations, deep brain locations as examples). For example, spinal cord stimulation has been known to reduce pain levels for chronic pain patients for many years. Also, medical researchers and clinicians have attempted to treat various neurological conditions using electrical stimulation to control or affect brain functions. For example, Deep Brain Stimulation (DBS) may reduce some of the symptoms associated with Parkinson’s Disease. 
     A stimulation system pulse generator may be provided in various configurations, such as an implanted pulse generator (IPG). A typical IPG configuration comprises a surgically implanted, internally-powered pulse generator and multi-electrode lead. The implanted pulse generator may commonly be encased in a hermetically sealed housing and surgically implanted in a subclavicular location. An electrode assembly may be implanted to deliver stimulation signals to a stimulation site. The electrode assembly is coupled to the pulse generator via biocompatibly sealed lead wires. A power source, such as a battery, is contained within the housing of the pulse generator. 
     SUMMARY 
     In some embodiments, a method of providing a neurostimulation therapy to a patient, comprises: generating electrical pulses, by an implantable pulse generator (IPG), comprising respective bursts of a plurality of anodic pulses with each anodic pulse being separated by a time gap, wherein (1) the plurality of anodic pulses comprise successively increasing charge; (2) the plurality of anodic pulses are charge limited to be sub-threshold; (3) each burst of anodic pulses is followed by a discharge phase of intermittent time periods to discharge charge build up from the anodic pulses; and (4) each successive intermittent time period increases in time through the discharge phase to avoid action potential (AP) generation; and applying the generated electrical pulses to neural tissue of the patient to inhibit neural activity of the patient. 
     The foregoing has outlined rather broadly the features and technical advantages of the present invention in order that the detailed description of the invention that follows may be better understood. Additional features and advantages of the invention will be described hereinafter which form the subject of the claims of the invention. It should be appreciated by those skilled in the art that the conception and specific embodiment disclosed may be readily utilized as a basis for modifying or designing other structures for carrying out the same purposes of the present invention. It should also be realized by those skilled in the art that such equivalent constructions do not depart from the spirit and scope of the invention as set forth in the appended claims. The novel features which are believed to be characteristic of the invention, both as to its organization and method of operation, together with further objects and advantages will be better understood from the following description when considered in connection with the accompanying figures. It is to be expressly understood, however, that each of the figures is provided for the purpose of illustration and description only and is not intended as a definition of the limits of the present invention. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG.  1    depicts a neurostimulation system according to some embodiments. 
         FIG.  2    depicts a computer system according to some embodiments. 
         FIG.  3    depicts a system for monitoring and/or managing neurostimulation therapies for patients according to some embodiments. 
         FIG.  4    depicts an inhibiting waveform for neurostimulation according to some embodiments. 
         FIG.  5    depicts defining a neurostimulation therapy for a patient according to some embodiments. 
     
    
    
     DETAILED DESCRIPTION 
     Neurostimulation systems are devices that generate electrical pulses and deliver the pulses to neural tissue of a patient to treat a variety of disorders. One category of neurostimulation systems is deep brain stimulation (DBS). In DBS, pulses of electrical current are delivered to target regions of a subject’s brain, for example, for the treatment of movement and effective disorders such as PD and essential tremor. Another category of neurostimulation systems is spinal cord stimulation (SCS) which is often used to treat chronic pain such as Failed Back Surgery Syndrome (FBSS) and Complex Regional Pain Syndrome (CRPS). Dorsal root ganglion (DRG) stimulation is another example of a neurostimulation therapy in which electrical stimulation is provided to the dorsal root ganglion structure that is just outside of the epidural space. DRG stimulation is generally used to treat chronic pain. 
     Neurostimulation systems generally include a pulse generator and one or more leads. A stimulation lead includes a lead body of insulative material that encloses wire conductors. The distal end of the stimulation lead includes multiple electrodes or contacts for application of electrical pulses to patient tissue. The electrodes or contacts are electrically coupled to the wire conductors of a respective stimulation lead. The proximal end of the lead body includes multiple terminals (also electrically coupled to the wire conductors) that are adapted to receive electrical pulses. In DBS systems, the distal end of the stimulation lead is implanted within the brain tissue to deliver the electrical pulses. The stimulation leads are then tunneled to another location within the patient’s body to be electrically connected with a pulse generator or, alternatively, to an “extension.” The pulse generator is typically implanted in the patient within a subcutaneous pocket created during the implantation procedure. 
     The pulse generator is typically implemented using a metallic housing (or can) that encloses circuitry for generating the electrical stimulation pulses, control circuitry, communication circuitry, a rechargeable or primary cell battery, etc. The pulse generating circuitry is coupled to one or more stimulation leads through electrical connections provided in a “header” of the pulse generator. Specifically, feedthrough wires typically exit the metallic housing and enter into a header structure of a moldable material. Within the header structure, the feedthrough wires are electrically coupled to annular electrical connectors. The header structure holds the annular connectors in a fixed arrangement that corresponds to the arrangement of terminals on the proximal end of a stimulation lead. 
     Stimulation system  100  is shown in  FIG.  1    according to some embodiments. Stimulation system  100  generates electrical pulses for application to tissue of a patient to treat one or more disorders of the patient. System  100  includes an implantable pulse generator (IPG)  150  that is adapted to generate electrical pulses for application to tissue of a patient. Examples of commercially available implantable pulse generators include the PROCLAIM XR™ and INFINITY™ implantable pulse generators (available from ABBOTT, PLANO TX). Commercially available IPGs may be adapted (using suitable software instructions, programmable parameters, logic circuits, other circuits, and/or the like) according to the disclosures in this application. Alternatively, system  100  may include an external pulse generator (EPG) positioned outside the patient’s body. IPG  150  typically includes a metallic housing (or can) that encloses a controller  151 , pulse generating circuitry  152 , a battery  153 , far-field and/or near field communication circuitry  154  (e.g., BLUETOOTH communication circuitry), sensing circuitry  155 , and other appropriate circuitry and components of the device. Controller  151  typically includes a microcontroller or other suitable processor for controlling the various other components of the device. Software code is typically stored in memory of IPG  150  for execution by the microcontroller or processor to control the various components of the device. 
     IPG  150  may comprise one or more attached extension components  170  or be connected to one or more separate extension components  170 . Alternatively, one or more stimulation leads  110  may be connected directly to IPG  150 . Within IPG  150 , electrical pulses are generated by pulse generating circuitry  152  and are provided to switching circuitry. The switching circuit connects to output wires, metal ribbons, traces, lines, or the like (not shown) from the internal circuity of pulse generator  150  to output connectors (not shown) of pulse generator  150  which are typically contained in the “header” structure of pulse generator  150 . Commercially available ring/spring electrical connectors are frequently employed for output connectors of pulse generators (e.g., “Bal-Seal” connectors). The terminals of one or more stimulation leads  110  are inserted within connector portion  171  for electrical connection with respective connectors or directly within the header structure of pulse generator  150 . Thereby, the pulses originating from IPG  150  are conducted to electrodes  111  through wires contained within the lead body of lead  110 . The electrical pulses are applied to tissue of a patient via electrodes  111 . 
     For implementation of the components within IPG  150 , a processor and associated charge control circuitry for an implantable pulse generator is described in U.S. Pat. No. 7,571,007, entitled “SYSTEMS AND METHODS FOR USE IN PULSE GENERATION,” which is incorporated herein by reference. Circuitry for recharging a rechargeable battery of an implantable pulse generator using inductive coupling and external charging circuits are described in U.S. Pat. No. 7,212,110, entitled “IMPLANTABLE DEVICE AND SYSTEM FOR WIRELESS COMMUNICATION,” which is incorporated herein by reference. 
     An example and discussion of “constant current” pulse generating circuitry is provided in U.S. Pat. Publication No. 2006/0170486 entitled “PULSE GENERATOR HAVING AN EFFICIENT FRACTIONAL VOLTAGE CONVERTER AND METHOD OF USE,” which is incorporated herein by reference. One or multiple sets of such circuitry may be provided within IPG  150 . Different pulses on different electrodes may be generated using a single set of pulse generating circuitry using consecutively generated pulses according to a “multi-stimset program” as is known in the art. Alternatively, multiple sets of such circuitry may be employed to provide pulse patterns that include simultaneously generated and delivered stimulation pulses through various electrodes of one or more stimulation leads as is also known in the art. Various sets of parameters may define the pulse characteristics and pulse timing for the pulses applied to various electrodes as is known in the art. Although constant current pulse generating circuitry is contemplated for some embodiments, any other suitable type of pulse generating circuitry may be employed such as constant voltage pulse generating circuitry. 
     Stimulation lead(s)  110  may include a lead body of insulative material about a plurality of conductors within the material that extend from a proximal end of lead  110  to its distal end. The conductors electrically couple a plurality of electrodes  111  to a plurality of terminals (not shown) of lead  110 . The terminals are adapted to receive electrical pulses and the electrodes  111  are adapted to apply stimulation pulses to tissue of the patient. Also, sensing of physiological signals may occur through electrodes  111 , the conductors, and the terminals. Additionally or alternatively, various sensors (not shown) may be located near the distal end of stimulation lead  110  and electrically coupled to terminals through conductors within the lead body  172 . Stimulation lead  110  may include any suitable number and type of electrodes  111 , terminals, and internal conductors. 
     External controller device  160  is a device that permits the operations of IPG  150  to be controlled by a user after IPG  150  is implanted within a patient. Also, multiple controller devices may be provided for different types of users (e.g., the patient or a clinician). Controller device  160  can be implemented by utilizing a suitable handheld processor-based system that possesses wireless communication capabilities. Software is typically stored in memory of controller device  160  to control the various operations of controller device  160 . The interface functionality of controller device  160  is implemented using suitable software code for interacting with the user and using the wireless communication capabilities to conduct communications with IPG  150 . One or more user interface screens may be provided in software to allow the patient and/or the patient’s clinician to control operations of IPG  150  using controller device  160 . In some embodiments, commercially available devices such as APPLE IOS devices are adapted for use as controller device  160  by include one or more “apps” that communicate with IPG  150  using, for example, BLUETOOTH communication. 
     Controller device  160  preferably provides one or more user interfaces to allow the user to operate IPG  150  according to one or more stimulation programs to treat the patient’s disorder(s). Each stimulation program may include one or more sets of stimulation parameters including pulse amplitude, pulse width, pulse frequency or inter-pulse period, pulse repetition parameter (e.g., number of times for a given pulse to be repeated for respective stimset during execution of program), etc. 
     Controller device  160  may permit programming of IPG  150  to provide a number of different stimulation patterns or therapies to the patient as appropriate for a given patient and/or disorder. Examples of different stimulation therapies include conventional tonic stimulation (continuous train of stimulation pulses at a fixed rate), BurstDR stimulation (burst of pulses repeated at a high rate interspersed with quiescent periods with or without duty cycling), “high frequency” stimulation (e.g., a continuous train of stimulation pulses at 10,000 Hz), noise stimulation (series of stimulation pulses with randomized pulse characteristics such as pulse amplitude to achieve a desired frequency domain profile). Any suitable stimulation pattern or combination thereof can be provided by IPG  150  according to some embodiments. Controller device  160  communicates the stimulation parameters and/or a series of pulse characteristics defining the pulse series to be applied to the patient to IPG  150  to generate the desired stimulation therapy. 
     Examples of suitable therapies include tonic stimulation (in which a fixed frequency pulse train) is generated, burst stimulation (in which bursts of multiple high frequency pulses) are generated which in turn are separated by quiescent periods, “high frequency” stimulation, multi-frequency stimulation, noise stimulation. Examples of suitable therapies include tonic stimulation (in which a fixed frequency pulse train) is generated, burst stimulation (in which bursts of multiple high frequency pulses) are generated which in turn are separated by quiescent periods, “high frequency” stimulation, multi-frequency stimulation, and noise stimulation. Descriptions of respective neurostimulation therapies are provided in the following publications: (1) Schu S., Slotty P.J., Bara G., von Knop M., Edgar D., Vesper J. A Prospective, Randomised, Double-blind, Placebo-controlled Study to Examine the Effectiveness of Burst Spinal Cord Stimulation Patterns for the Treatment of Failed Back Surgery Syndrome. Neuromodulation 2014; 17: 443-450; (2) Al-Kaisy A1, Van Buyten JP, Smet I, Palmisani S, Pang D, Smith T. 2014. Sustained effectiveness of 10 kHz high-frequency spinal cord stimulation for patients with chronic, low back pain: 24-month results of a prospective multicenter study. Pain Med. 2014 Mar;15(3):347-54; and (3) Sweet, Badjatiya, Tan D1, Miller. Paresthesia-Free High-Density Spinal Cord Stimulation for Postlaminectomy Syndrome in a Prescreened Population: A Prospective Case Series. Neuromodulation. 2016 Apr;19(3):260-7. Noise stimulation is described in U.S. Pat. No. US8682441B2. Burst stimulation is described in U.S. Pat. No. 8,224,453 and U.S. Published Application No. 20060095088. A “coordinated reset” pulse pattern is applied to neuronal subpopulation/target sites to desynchronize neural activity in the subpopulations. Coordinated reset stimulation is described, for example, by Peter A. Tass et al in COORDINATED RESET HAS SUSTAINED AFTER EFFECTS IN PARKINSONIAN MONKEYS, Annals of Neurology, Volume 72, Issue 5, pages 816-820, November 2012, which is incorporated herein by reference. The electrical pulses in a coordinated reset pattern are generated in bursts of pulses with respective bursts being applied to tissue of the patient using different electrodes in a time-offset manner. The time-offset is selected such that the phase of the neural-subpopulations are reset in a substantially equidistant phase-offset manner. By resetting neuronal subpopulations in this manner, the population will transition to a desynchronized state by the interconnectivity between the neurons in the overall neuronal population. All of these references are incorporated herein by reference. 
     For implementation of the components within IPG  150 , a processor and associated charge control circuitry for an implantable pulse generator is described in U.S. Pat. No. 7,571,007, entitled “SYSTEMS AND METHODS FOR USE IN PULSE GENERATION,” which is incorporated herein by reference. Circuitry for recharging a rechargeable battery of an implantable pulse generator using inductive coupling and external charging circuits are described in U.S. Pat. No. 7,212,110, entitled “IMPLANTABLE DEVICE AND SYSTEM FOR WIRELESS COMMUNICATION” which is incorporated herein by reference. 
     IPG  150  modifies its internal parameters in response to the control signals from controller device  160  to vary the stimulation characteristics of stimulation pulses transmitted through stimulation lead  110  to the tissue of the patient. Neurostimulation systems, stimsets, and multi-stimset programs are discussed in PCT Publication No. WO 2001/093953, entitled “NEUROMODULATION THERAPY SYSTEM,” and U.S. Pat. No. 7,228,179, entitled “METHOD AND APPARATUS FOR PROVIDING COMPLEX TISSUE STIMULATION PATTERNS,” which are incorporated herein by reference. 
     External charger device  165  may be provided to recharge battery  153  of IPG  150  according to some embodiments when IPG  150  includes a rechargeable battery. External charger device  165  comprises a power source and electrical circuitry (not shown) to drive current through coil  166 . The patient places the primary coil  166  against the patient’s body immediately above the secondary coil (not shown), i.e., the coil of the implantable medical device. Preferably, the primary coil  166  and the secondary coil are aligned in a coaxial manner by the patient for efficiency of the coupling between the primary and secondary coils. In operation during a charging session, external charger device  165  generates an AC-signal to drive current through coil  166  at a suitable frequency. Assuming that primary coil  166  and secondary coil are suitably positioned relative to each other, the secondary coil is disposed within the magnetic field generated by the current driven through primary coil  166 . Current is then induced by a magnetic field in the secondary coil. The current induced in the coil of the implantable pulse generator is rectified and regulated to recharge the battery of IPG  150 . IPG  150  may also communicate status messages to external charging device  165  during charging operations to control charging operations. For example, IPG  150  may communicate the coupling status, charging status, charge completion status, etc. 
     System  100  may include external wearable device  180  such as a smartwatch or health monitor device. Wearable device may be implemented using commercially available devices such as FITBIT VERSA SMARTWATCH™, SAMSUNG GALAXY SMARTWATCH™, and APPLE WATCH™ devices with one or more apps or appropriate software to interact with IPG  150  and/or controller device  160 . In some embodiments, wearable device  180 , controller device  160 , and IPG  150  conduct communications using BLUETOOTH communications. 
     Wearable device  180  monitors activities of the patient and/or senses physiological signals. Wearable device  180  may track physical activity and/or patient movement through accelerometers. Wearable device  180  may monitory body temperature, heart rate, electrocardiogram activity, blood oxygen saturation, and/or the like. Wearable device  180  may monitor sleep quality or any other relevant health related activity. 
     Wearable device  180  may provide one or more user interface screens to permit the patient to control or otherwise interact with IPG  150 . For example, the patient may increase or decrease stimulation amplitude, change stimulation programs, turn stimulation on or off, and/or the like using wearable device  180 . Also, the patient may check the battery status of other implant status information using wearable device  180 . 
     Wearable device  180  may include one or more interface screens to receive patient input. In some embodiments, wearable device  180  and/or controller device  160  are implemented (individually or in combination) to provide an electronic patient diary function. The patient diary function permits the patient to record on an ongoing basis the health status of the patient and the effectiveness of the therapy for the patient. In some embodiments as discussed herein, wearable device  180  and/or controller device  160  enable the user to indicate the current activity of the patient, the beginning of an activity, the completion of an activity, the ease or quality of patient’s experience with a specific activity, the patient’s experience of pain, the patient’s experience of relief from pain by the stimulation, or any other relevant indication of patient health by the patient. 
       FIG.  2    is a block diagram of one embodiment of a computing device  200  that may be used to according to some embodiments. Computing device  200  may be used to implement external controller device  160 , wearable device  180 , remote care management servers, or other computing system according to some embodiments. 
     Computing device  200  includes at least one memory device  210  and a processor  215  that is coupled to memory device  210  for executing instructions. In some embodiments, executable instructions are stored in memory device  210 . In some embodiments, computing device  200  performs one or more operations described herein by programming processor  215 . For example, processor  215  may be programmed by encoding an operation as one or more executable instructions and by providing the executable instructions in memory device  210 . 
     Processor  215  may include one or more processing units (e.g., in a multicore configuration). Further, processor  215  may be implemented using one or more heterogeneous processor systems in which a main processor is present with secondary processors on a single chip. In another illustrative example, processor  215  may be a symmetric multi-processor system containing multiple processors of the same type. Further, processor  215  may be implemented using any suitable programmable circuit including one or more systems and microcontrollers, microprocessors, reduced instruction set circuits (RISC), application specific integrated circuits (ASIC), programmable logic circuits, field programmable gate arrays (FPGA), and any other circuit capable of executing the functions described herein. 
     In the illustrated embodiment, memory device  210  is one or more devices that enable information such as executable instructions and/or other data to be stored and retrieved. Memory device  210  may include one or more computer readable media, such as, without limitation, dynamic random access memory (DRAM), read-only memory (ROM), electrically erasable programmable read-only memory (EEPROM), static random access memory (SRAM), a solid state disk, and/or a hard disk. Memory device  210  may be configured to store, without limitation, application source code, application object code, source code portions of interest, object code portions of interest, configuration data, execution events and/or any other type of data. 
     Computing device  200 , in the illustrated embodiment, includes a communication interface  240  coupled to processor  215 . Communication interface  240  communicates with one or more remote devices, such as a clinician or patient programmer. To communicate with remote devices, communication interface  240  may include, for example, a wired network adapter, a wireless network adapter, a radiofrequency (RF) adapter, and/or a mobile telecommunications adapter. 
       FIG.  3    depicts a network environment  300  for remote management of patient care. One or more embodiments of a remote care therapy application or service may be implemented in network environment  300 , as described herein. In general, “remote care therapy” may involve any care, biomedical monitoring, or therapy that may be provided by a clinician, a medical professional or a healthcare provider, and/or their respective authorized agents (including digital/virtual assistants), with respect to a patient over a communications network while the patient and the clinician/provider are not in close proximity to each other (e.g., not engaged in an in-person office visit or consultation). Accordingly, in some embodiments, a remote care therapy application may form a telemedicine or a telehealth application or service that not only allows healthcare professionals to use electronic communications to evaluate, diagnose and treat patients remotely, thereby facilitating efficiency as well as scalability, but also provides patients with relatively quick and convenient access to diversified medical expertise that may be geographically distributed over large areas or regions, via secure communications channels as described herein. 
     Network environment  300  may include any combination or sub-combination of a public packet-switched network infrastructure (e.g., the Internet or worldwide web, also sometimes referred to as the “cloud”), private packet-switched network infrastructures such as Intranets and enterprise networks, health service provider network infrastructures, and the like, any of which may span or involve a variety of access networks, backhaul and core networks in an end-to-end network architecture arrangement between one or more patients, e.g., patient(s)  302 , and one or more authorized clinicians, healthcare professionals, or agents thereof, e.g., generally represented as caregiver(s) or clinician(s)  338 . 
     Example patient(s)  302 , each having a suitable implantable device  303 , may be provided with a variety of corresponding external devices for controlling, programming, otherwise (re)configuring the functionality of respective implantable medical device(s)  303 , as is known in the art. Such external devices associated with patient(s)  302  are referred to herein as patient devices  304  and may include a variety of user equipment (UE) devices, tethered or untethered, that may be configured to engage in remote care therapy sessions. By way of example, patient devices  304  may include smartphones, tablets or phablets, laptops/desktops, handheld/palmtop computers, wearable devices such as smart glasses and smart watches, personal digital assistant (PDA) devices, smart digital assistant devices, etc., any of which may operate in association with one or more virtual assistants, smart home/office appliances, smart TVs, virtual reality (VR), mixed reality (MR) or augmented reality (AR) devices, and the like, which are generally exemplified by wearable device(s)  306 , smartphone(s)  308 , tablet(s)/phablet(s)  310  and computer(s)  312 . As such, patient devices  304  may include various types of communications circuitry or interfaces to effectuate wired or wireless communications, short-range and long-range radio frequency (RF) communications, magnetic field communications, Bluetooth communications, etc., using any combination of technologies, protocols, and the like, with external networked elements and/or respective implantable medical devices  303  corresponding to patient(s)  302 . 
     With respect to networked communications, patient devices  304  may be configured, independently or in association with one or more digital/virtual assistants, smart home/premises appliances and/or home networks, to effectuate mobile communications using technologies such as Global System for Mobile Communications (GSM) radio access network (GRAN) technology, Enhanced Data Rates for Global System for Mobile Communications (GSM) Evolution (EDGE) network (GERAN) technology, 4G Long Term Evolution (LTE) technology, Fixed Wireless technology, 5th Generation Partnership Project (5GPP or 5G) technology, Integrated Digital Enhanced Network (IDEN) technology, WiMAX technology, various flavors of Code Division Multiple Access (CDMA) technology, heterogeneous access network technology, Universal Mobile Telecommunications System (UMTS) technology, Universal Terrestrial Radio Access Network (UTRAN) technology, All-IP Next Generation Network (NGN) technology, as well as technologies based on various flavors of IEEE 802.11 protocols (e.g., WiFi), and other access point (AP)-based technologies and microcell-based technologies such as femtocells, picocells, etc. Further, some embodiments of patient devices  104  may also include interface circuitry for effectuating network connectivity via satellite communications. Where tethered UE devices are provided as patient devices  304 , networked communications may also involve broadband edge network infrastructures based on various flavors of Digital Subscriber Line (DSL) architectures and/or Data Over Cable Service Interface Specification (DOCSIS)-compliant Cable Modem Termination System (CMTS) network architectures (e.g., involving hybrid fiber-coaxial (HFC) physical connectivity). Accordingly, by way of illustration, an edge/access network portion  119 A is exemplified with elements such as WiFi/AP node(s)  316 - 1 , macro/microcell node(s)  116 - 2  and  116 - 3  (e.g., including micro remote radio units or RRUs, base stations, eNB nodes, etc.) and DSL/CMTS node(s)  316 - 4 . 
     Similarly, clinicians  338  may be provided with a variety of external devices for controlling, programming, otherwise (re)configuring or providing therapy operations with respect to one or more patients  302  mediated via respective implantable medical device(s)  303 , in a local therapy session and/or remote therapy session, depending on implementation and use case scenarios. External devices associated with clinicians  338 , referred to herein as clinician devices  330 , may include a variety of UE devices, tethered or untethered, similar to patient devices  304 , which may be configured to engage in remote care therapy sessions as will be set forth in detail further below. Clinician devices  330  may therefore also include devices (which may operate in association with one or more virtual assistants, smart home/office appliances, VRAR virtual reality (VR) or augmented reality (AR) devices, and the like), generally exemplified by wearable device(s)  331 , smartphone(s)  332 , tablet(s)/phablet(s)  334  and computer(s)  336 . Further, example clinician devices  330  may also include various types of network communications circuitry or interfaces similar to that of patient device  304 , which may be configured to operate with a broad range of technologies as set forth above. Accordingly, an edge/access network portion  319 B is exemplified as having elements such as WiFi/AP node(s)  328 - 1 , macro/microcell node(s)  328 - 2  and  328 - 3  (e.g., including micro remote radio units or RRUs, base stations, eNB nodes, etc.) and DSL/CMTS node(s)  328 - 4 . It should therefore be appreciated that edge/access network portions  319 A,  319 B may include all or any subset of wireless communication means, technologies and protocols for effectuating data communications with respect to an example embodiment of the systems and methods described herein. 
     In one arrangement, a plurality of network elements or nodes may be provided for facilitating a remote care therapy service involving one or more clinicians  338  and one or more patients  302 , wherein such elements are hosted or otherwise operated by various stakeholders in a service deployment scenario depending on implementation (e.g., including one or more public clouds, private clouds, or any combination thereof). In one embodiment, a remote care session management node  320  is provided, and may be disposed as a cloud-based element coupled to network  318 , that is operative in association with a secure communications credentials management node  322  and a device management node  324 , to effectuate a trust-based communications overlay/tunneled infrastructure in network environment  300  whereby a clinician may advantageously engage in a remote care therapy session with a patient. 
     In the embodiments described herein, implantable medical device  303  may be any suitable medical device. For example, implantable medical device may be a neurostimulation device that generates electrical pulses and delivers the pulses to nervous tissue of a patient to treat a variety of disorders. 
     In some embodiments, the neurostimulation system is adapted to provided neural activity inhibiting or blocking stimulation as discussed herein. 
     In many applications of neurostimulation, the pulses applied to neural tissue of the patient evoke compound action potentials (ECAPs) (also referred to a neuronal activation). For example, traditional spinal cord stimulation (SCS) with tonic stimulation waveform activates the dorsal column fibers. The activated dorsal column fibers in turn activate the inhibitory interneurons and the activated inhibitory interneurons inhibit the dorsal horn projection of the spinal cord. 
     The electrical current of pulses causes depolarization of the stimulated neural cells. ECAPs represent the synchronous firing of a population of electrically stimulated nerve fibers. Measurement of ECAPs has been utilized as a means of directly assessing the level of fiber recruitment in the dorsal columns of the spinal cord for neurostimulation. ECAP sensing may also be applied for other neural targets in a similar manner. ECAPs are signals elicited by electrical stimulation and recorded near a bundle of fibers. In particular, ECAPs usually arrive less than one millisecond (&lt;1 ms) after a corresponding stimulation pulse and last in the range of approximately one half to one millisecond (0.5-1 ms). ECAPs may be measured and analyzed, for example, to evaluate and/or control the comfort and efficacy of a SCS treatment regimen (see e.g., U.S. Pat. Publication No. 2020/0282208 A1 entitled “Neural Stimulation Dosing”; 2011/018448 A1 entitled “Spinal Cord Stimulation to Treat Pain”; and 2020/0391031 A1 entitled “System and Method to Managing Stimulation of Select A-Beta Fiber Components”; the disclosures of which are incorporated herein by reference). 
     However, direct inhibition of neurons may be useful in different neuromodulation applications as opposed to direct activation of neural tissue. For example, maladaptation of voltage gated calcium channels (VGCC) is believed to be related with neuropathic pain and VGCC blockers has been shown to be effective in mitigating chronic pain. The VGCC is normally closed at resting potential. It opens when cells are depolarized. Therefore, maintaining the cells in a resting state or hyperpolarized state would keep the VGCC closed and prevent cascading effect of calcium influx. Anodic direct current (DC) stimulation can keep the cells hyperpolarized. However, DC stimulation cannot be used for implantable electrodes due to safety concerns. 
     Some embodiments provide a novel stimulation waveform that hyperpolarize neurons which can be used to mitigate pain by directly suppressing the nociceptive projection neurons in the superficial lamina of spinal dorsal horn. Embodiments of the inhibiting stimulation waveform keep a neuron population hyperpolarized to reduce the neuronal excitability. In some embodiments, the stimulation waveform is composed of a sequence of subthreshold anodic pulses with gradual increase of the stimulation amplitude and/or pulse width followed by cathodic discharge phase with intermittent time allocated for discharge to prevent cell activation during discharge. 
     Utilizing the knowledge of the time constants of different voltage gated ion channels, a stimulation waveform may be constructed that avoids action potential generation but induces subthreshold transmembrane potential change to make the neurons less excitable. 
     In some embodiments, inhibiting waveform  400  (shown in  FIG.  4   ) includes the following elements in a sequential order: 1) a charge injection phase; 2) an optional time delay; and 3) a passive discharge phase. 
     In some embodiments, the charge injection phase  401  may consist of a sequence of anodic pulses with gradually increasing pulse amplitude and/or pulse width with a gap between the pulses. The stimulation amplitude of each pulse is set to below the threshold amplitude to avoid generating action potentials. A sequence of the subthreshold anodic pulses  401  hyperpolarizes a cell. In another implementation, there can be optional active/passive discharge between the pulses during the inter-pulse interval of the charge injection phase  401 . 
     In some embodiments, after charge injection and before discharge there can be optional gap  402  to extend the hyperpolarized membrane status. 
     In some embodiments, discharge phase  403  is provided. During discharge phase  403 , passive discharge is used to recover the electric charge stored in a DC blocking capacitor and double layer capacitance. In order to prevent action potential (AP) generation from anodic breaking, the discharge occurs gradually with increased time allocated for discharge. The amplitude and pulse width of cathodic pulses occurring during the discharge phase are not high enough to generate AP. 
     In some embodiments, in order to minimize electrode corrosion or tissue damage due to irreversible Faradaic reaction at the electrode-tissue interface, the stimulation amplitude may be maintained at a low level (e.g. 100 uC/cm2 for total anodic pulses in spinal cord stimulation application). 
     In some embodiments, IPGs (such as IPG  150 ) are adapted to provide the inhibiting waveform to neural tissue of a patient. Additionally, external patient and/or clinician devices (such as device  160 ) are adapted to program and/or control IPG  150  to apply the inhibiting waveform as directed by the patient and/or clinician. In operation, IPG  150  repeatedly generate inhibiting waveform  400  in succession and applies waveform  400  to tissue of the patient using one or more electrodes of an implantable lead. In some embodiments, the one or more electrodes are implanted within the epidural space of the patient to inhibit dorsal fibers of the spinal cord. This inhibition may mitigate pain by directly suppressing nociceptive neurons in the superficial lamina of the spinal dorsal horn. 
     In some embodiments, stimulation waveform parameters are selected to optimize waveform  400  for a patient. For example, the pulse amplitude, pulse width, pulse gaps/delays are selected to inhibit neural activity of the patient. A clinician may manually program one or more of the respective stimulation parameters according to some embodiments. Additionally or alternative, IPG  150  may conduct sensing operations while stimulation is provided according to a range of stimulation parameters and, in response thereto, select suitable parameters for waveform  400  for the patient. 
       FIG.  5    depicts defining a neurostimulation therapy for a patient according to some embodiments. In  501 , a programming session is conducted with the patient IPG. The programming session may be an in-person programming session in a conventional clinic setting or may be a remote programming session. In  502 , trial stimulation is provided to the patient. The trial stimulation provides the inhibiting waveform to the patient across a range of stimulation parameters to identify optimal stimulation parameters for the patient. 
     In  503 , patient feedback and/or sensing data is obtained. In  503 , the feedback and/or sensing data may confirm that the inhibiting waveform is sub-threshold and is not generating action potentials. In some embodiments, stimulation pulses according to the inhibiting waveform may be provided on a first electrode or set of electrodes and sensing may be conducted on a second electrode or set of electrodes. The sensing on the second electrode(s) may verify that the inhibiting waveform is inhibiting neural activity in an expected manner. For example, initial sensing may occur before stimulation is provided to establish a baseline signal for comparison. Thereafter, while the inhibiting waveform is applied, ECAP or other suitable sensing may be conducted to compare against the baseline signal to verify that the inhibiting waveform has reduced and/or eliminated neural activity. 
     Based on the patient feedback and/or sensed data, the stimulation parameters are adjusted ( 504 ) for the inhibiting waveform to define the patient’s therapy. In  505 , the patient IPG/system is programmed to operate according to the defined patient therapy. 
     Also, in some embodiments, the sensing operations may be applied by the IPG to adjust therapy parameters in a closed-loop manner. 
     Although the aspects of the present disclosure and their advantages have been described in detail, it should be understood that various changes, substitutions and alterations can be made herein without departing from the spirit of the disclosure as defined by the appended claims. Moreover, the scope of the present application is not intended to be limited to the particular implementations of the process, machine, manufacture, composition of matter, means, methods and processes described in the specification. As one of ordinary skill in the art will readily appreciate from the present disclosure, processes, machines, manufacture, compositions of matter, means, methods, or operations, presently existing or later to be developed that perform substantially the same function or achieve substantially the same result as the corresponding aspects described herein may be utilized according to the present disclosure. Accordingly, the appended claims are intended to include within their scope such processes, machines, manufacture, compositions of matter, means, methods, or operations.