Patent ID: 8126559

Claim:
An implantable medical device, comprising: a pulse generator to generate a neural stimulation signal for a neural stimulation therapy, the neural stimulation signal having at least one adjustable parameter, wherein the pulse generator is configured to generate the neural stimulation signal for the neural stimulation therapy as a programmed series of intermittent bursts of neural stimulation pulses, and wherein the programmed series of intermittent bursts includes successive stimulation on periods separated by a stimulation off period; a first monitor adapted to monitor at least one physiological response that is not desired to be affected by the neural stimulation therapy to detect an undesired side effect of the neural stimulation signal, wherein the first monitor is adapted to: detect capture of muscle as the undesired side effect of the neural stimulation signal; or detect neural activity in a nerve not targeted by the neural stimulation therapy as the undesired side effect of the neural stimulation signal; a second monitor adapted to monitor at least one physiological response that is desired to be affected by the neural stimulation therapy to detect a desired physiological response to the neural stimulation therapy, wherein the second monitor includes a sensor configured to sense a feedback parameter indicative of the desired physiological response to the neural stimulation therapy; and a controller configured to: respond to the first monitor and automatically adjust the at least one adjustable parameter of the neural stimulation signal to avoid the undesired side effect of the neural stimulation therapy; and implement a programmed routine a plurality of times during the neural stimulation therapy to maintain efficacy of the neural stimulation therapy, wherein for each time the controller implements the routine the controller is configured to: sense the feedback parameter during the stimulation off period and during the stimulation on period to determine a detected feedback parameter change between the stimulation off and stimulation on periods within the programmed series of intermittent neural stimulation bursts; compare the detected feedback parameter change between the stimulation off and stimulation on periods to a desired feedback parameter change between the stimulation off and stimulation on periods; and automatically adjust the at least one adjustable parameter of the neural stimulation signal, in response to the feedback parameter sensed by the sensor of the second monitor, to achieve the desired physiological response to the neural stimulation therapy, including adjust the at least one adjustable parameter of the neural stimulation signal such that the detected feedback parameter change corresponds with the desired feedback parameter change between the stimulation off and stimulation on periods to maintain efficacy of the neural stimulation therapy.