FAQ: NeuroPace Responsive Neurostimulation for Epilepsy

RNS for epilepsy treatmentNeuroPace for Epilepsy TreatmentAbout one-third of patients with epilepsy have seizures that are poorly controlled with medications alone. UCSF is one of the few centers in the nation offering a revolutionary technology for treating adults with medication-resistant epilepsy. In this new approach, a small, battery-powered device (called a Neurostimulator) is surgically implanted in the skull. Wires (called leads) that are connected to the Neurostimulator are placed on the surface and/or inside the brain. The Neurostimulator monitors the electrical activity of the brain and detects abnormal activity that could lead to a seizure. When abnormal activity is detected, the Neurostimulator delivers electrical stimulation to the brain through the leads to prevent seizures. The system is analogous to cardiac pacemakers that detect abnormal heart rhythms and respond by delivering electrical stimulation.

For certain patients, using an implanted Neurostimulator to treat seizures can be more effective than medications, and, because no brain tissue is removed, can involve less risk than other surgical options. Responsive neurostimulation (RNS) represents an exciting and much-needed therapeutic option for patients with seizures that arise from more than one brain region and/or from brain regions that cannot be removed surgically.

Who is a candidate for NeuroPace Responsive Neurostimulation?

In general, adult patients with medication-resistant epilepsy who have frequent disabling seizures that arise from one or two brain regions are candidates for responsive neurostimulation. A team of neurologists, neurosurgeons, and other providers with expertise in the diagnosis and management of epilepsy will determine an individual patient’s suitability for this treatment.

What are the advantages over other types of epilepsy surgery?

When seizures arise from more than one brain region, or from a single brain region that serves a critical function like speech or movement, surgical removal of the seizure-producing tissue may not be possible. RNS is advantageous in that leads can be placed in several different locations to detect and terminate seizures at multiple sites without removing any critical brain tissue. Unlike epilepsy surgery, RNS is reversible, and the implanted device can be removed at any time. The RNS device continuously monitors brain activity, and the information it records can be used by providers to optimize treatment.

What are the potential risks or side effects?

Although implantation of the neurostimulator and leads is less invasive than traditional epilepsy surgery, which requires larger surgical exposure, there are some risks. With any brain procedure, there is a chance of bleeding, infection, pain, and neurological impairment, though rates of these complications were low in clinical trials of RNS. There is a chance that RNS will not improve seizure severity or frequency. There is also a very small chance that electrical brain stimulation will cause side effects, though the vast majority of patients do not notice the stimulation. Currently, patients who have the RNS device implanted cannot have MRI scans due to safety considerations in strong magnetic fields.

How long will the treatment take?

The implantation procedure will take place in the operating room and will last about 3-4 hours. The majority of patients will spend one night in the hospital and will be discharged the following day.

How long will I be in the hospital?

The device is turned on in the operating room and initially programmed to record brain activity without delivering electrical stimulation. About 10-14 days after surgery, patients will have an outpatient clinic appointment to check wound healing and determine how many seizures have been recorded. The device will then be specifically programmed to detect those seizures and stimulation will be enabled. Subsequent appointments will be scheduled at 4-6 weeks after surgery and then about every three months thereafter to monitor the effect of treatment.

Will my seizures be cured?

The NeuroPace RNS system was approved by the FDA in 2013. In clinical trials, the efficacy of the device increased over time, and, after two years, more than half of patients had at least a 50% reduction in seizure frequency. In long-term clinical trials, patients treated with the RNS system experienced an average reduction in seizure frequency of over 70%, and UCSF outcomes have been comparable. 

Who should I contact for an evaluation?

For patients currently being treated at UCSF Epilepsy Center, please speak with your doctor to see if you may be a candidate for treatment with the RNS System. If you are not a current patient at UCSF Epilepsy Center but would like to find out if you might be eligible for treatment with the RNS System at UCSF, contact Patient Navigator, Erica Terry at (415) 353-2241 or at Erica.Terry@ucsf.edu. An epilepsy specialist may review your medical records to determine whether you are a candidate and if you need further evaluation.