Responsive Neurostimulation (NeuroPace)

Responsive neurostimulation (RNS or “NeuroPace”) is used to treat patients with seizures (epilepsy) that cannot be controlled with medications. It has been likened to a pacemaker for the brain. RNS is a medical implant inserted into the brain that constantly monitors for seizures and then delivers painless electrical pulses to prevent or interrupt them.

The RNS implant consists of two parts: (1) one or two wires inserted into the brain, and (2) a microprocessor embedded in the skull. The entire system is inside the body and is not visible from the outside.

Additional information or RNS is outlined below. Click here to read my patient guide for the procedure.

3D view of a responsive neurostimulation (RNS or NeuroPace) implant in a patient with bilateral temporal lobe epilepsy; the electrodes are inserted into the hippocampus

CT scan of a patient with an RNS implant in the temporal lobes.

What can RNS do for patients with epilepsy?

  • Fewer seizures

  • Lower risk of death from seizures

  • DATA TO GUIDE MEDICATION REDUCTION

  • Improved thinking and memory

  • Better quality of life

 

RNS is for patients with seizures that have not been controlled with medications or with previous surgeries. I use RNS when a patient is found to have more than one area in the brain causing their seizures or when the risks of treating epileptic brain tissue with a craniotomy or laser ablation are not acceptable. RNS is also an option for patients with primary generalized epilepsy.

I implant RNS with the help of an advanced surgical robot. Most patients stay in the hospital one or two nights after the procedure. The device is then turned on several weeks later in your neurologist’s office. Click here to review my patient guide that provides more specifics about what to expect from surgery.

One of the valuable features of RNS is that it provides ongoing feedback to your neurologist about your epilepsy. The device keeps a precise tally of seizure activity. Over time, the device "learns" about your epilepsy, allowing your neurologist to customize your therapy and improve your seizure control.

 
Illustration of RNS device, courtesy of NeuroPace
 

Because of ongoing feedback from the RNS device, seizure control tends to improve the longer the device has been implanted. Don't rush to judgement on whether (and how much) the device is helping you right away - it takes time for it to learn about your brain.

You will be provided a tablet that allows you to upload seizure data to a secure server that your neurologist and surgeon can access. It is a good habit to upload regularly; the more data the system has about your seizures, the better your neurologist is able to tailor your therapy.

Long-term, the average patient sees over an 80% reduction in seizures. Some patients may even have long periods of seizure-freedom. Clinical studies have documented other benefits, too: improved cognition/memory and quality of life, reduced medication doses, and a lower risk of sudden death from seizures.

I am passionate about expanding access to surgeries for epilepsy like RNS, and I am the director of epilepsy surgery at Swedish Medical Center. If you or a family member lives near Denver and has seizures that are not controlled with medications, please consider meeting me or one of my epilepsy neurology colleagues in consultation.

 
Responsive neurostimulation (RNS) implant (also known as NeuroPace) inserted into the centromedian nucleus of the thalamus to treat a patient with primary generalized epilepsy.