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Responsive neurostimulation (RNS) is designed for patients with drug-resistant focal epilepsy in whom seizures arise from one or more identifiable networks but conventional resection is not appropriate or would carry unacceptable risk. This review describes the RNS system as a closed-loop platform that detects abnormal electrical activity and delivers stimulation in response, rather than providing continuous open-loop stimulation. Long-term clinical experience has shown progressive seizure reduction with continued use, while chronic recording from the implanted leads also provides an opportunity to understand individual seizure networks and treatment response. The appeal is therefore both therapeutic and diagnostic. For HCPs, RNS is best considered within a comprehensive epilepsy-surgery pathway, including video-EEG monitoring and structural and functional imaging to identify the seizure network. Implantation requires neurosurgical expertise and careful programming, and patients need realistic expectations because seizure freedom is not guaranteed. The approach is particularly relevant to patients with eloquent-cortex seizure onset or multiple seizure foci where a conventional resection is unsuitable. The review highlights the broader shift toward personalised neuromodulation in epilepsy.
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Responsive neurostimulation (RNS) is designed for patients with drug-resistant focal epilepsy in whom seizures arise from one or more identifiable networks but conventional resection is not appropriate or would carry unacceptable risk. This review describes the RNS system as a closed-loop platform that detects abnormal electrical activity and delivers stimulation in response, rather than providing continuous open-loop stimulation. Long-term clinical experience has shown progressive seizure reduction with continued use, while chronic recording from the implanted leads also provides an opportunity to understand individual seizure networks and treatment response. The appeal is therefore both therapeutic and diagnostic. For HCPs, RNS is best considered within a comprehensive epilepsy-surgery pathway, including video-EEG monitoring and structural and functional imaging to identify the seizure network. Implantation requires neurosurgical expertise and careful programming, and patients need realistic expectations because seizure freedom is not guaranteed. The approach is particularly relevant to patients with eloquent-cortex seizure onset or multiple seizure foci where a conventional resection is unsuitable. The review highlights the broader shift toward personalised neuromodulation in epilepsy.
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