Precise control of tibial nerve stimulation for bladder regulation via evoked compound action potential feedback mechanisms

Young-Soo Lim, Ji Hong Kim, Junho Kim, MinhDuc Hoang, Wonok Kang, Mattew Koh, Won Hyuk Choi, Steve Park, Unyong Jeong, Do Hwan Kim () and Sung-Min Park ()
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Young-Soo Lim: Pohang University of Science and Technology (POSTECH)
Ji Hong Kim: Hanyang University
Junho Kim: Pohang University of Science and Technology (POSTECH)
MinhDuc Hoang: Pohang University of Science and Technology (POSTECH)
Wonok Kang: Pohang University of Science and Technology (POSTECH)
Mattew Koh: Pohang University of Science and Technology (POSTECH)
Won Hyuk Choi: Hanyang University
Steve Park: Korea Advanced Institute of Science and Technology (KAIST)
Unyong Jeong: Pohang University of Science and Technology (POSTECH)
Do Hwan Kim: Hanyang University
Sung-Min Park: Pohang University of Science and Technology (POSTECH)

Nature Communications, 2025, vol. 16, issue 1, 1-12

Abstract: Abstract Optimizing stimulation protocols for peripheral neuromodulation often depends on patient feedback, which can result in inconsistent clinical outcomes. Here we present a closed-loop control system for peripheral nerve stimulation (PNS) that utilizes evoked compound action potential (ECAP) feedback to regulate stimulation parameters, addressing the limitations of traditional methods. Unlike established closed-loop control techniques in the central nervous system, such as local field potential and spike analysis, a comparable approach for the peripheral nervous system remains underdeveloped. ECAPs can be consistently observed across peripheral nerves, providing a reliable measure of nerve activation. We developed a fully implantable device and neural interface for tibial nerve stimulation (TNS) that incorporates the proposed closed-loop system. This TNS system shows promise as a PNS treatment for alleviating overactive bladder symptoms. In a rat model, the system demonstrated longer micturition intervals and greater effectiveness compared to conventional motor response-based control.

Date: 2025
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DOI: 10.1038/s41467-025-59436-4

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