This document discusses a medical device for coupling to a plurality of implantable electrodes. The medical device includes a therapy circuit, a biomarker sensing circuit, and a control circuit operatively coupled to the therapy circuit and biomarker sensing circuit. The therapy circuit delivers electrical neurostimulation energy to the plurality of implantable electrodes. The biomarker sensing circuit generates a sensed biomarker signal representative of a physiological biomarker of a subject. The control circuit initiates delivery of bursts of pulses of the electrical neurostimulation energy to the plurality of the implantable electrodes according to a first therapy regimen and monitor efficacy of the delivered electrical neurostimulation energy using the sensed biomarker signal； and changes the electrical neurostimulation to a second therapy regimen upon detecting a reduction in the efficacy of the first therapy regimen using the sensed biomarker signal.
