Individualizing Programming of Responsive Neurostimulation and Deep Brain Stimulation Therapies in Epilepsy

Area of Science:

• Neurology
• Biomedical Engineering
• Neurosurgery

Background:

• Responsive neurostimulation (RNS) and deep brain stimulation (DBS) are established intracranial neuromodulation therapies for drug-resistant epilepsy.
• Surgical resection is not always an option for patients with drug-resistant epilepsy.
• Programming these neuromodulation devices for epilepsy presents significant clinical challenges.

Purpose of the Study:

• To review current evidence on standard and individualized programming approaches for RNS and DBS in epilepsy.
• To highlight practical strategies, clinical outcomes, and insights from recent studies on device programming.
• To synthesize existing clinical literature shaping current programming practices.

Main Methods:

• Review of current clinical literature on RNS and DBS programming for epilepsy.
• Synthesis of evidence on standard and individualized programming strategies.
• Focus on practical aspects, clinical outcomes, and recent study insights.

Main Results:

• Standard programming faces challenges due to lack of immediate feedback and limited clinical time.
• Individualized programming, using nonstandard parameters and target-specific strategies, shows promise.
• Emerging research explores closed-loop biomarkers and predictive modeling for improved seizure control and reduced adverse effects.

Conclusions:

• Individualized programming approaches are crucial for optimizing RNS and DBS therapy in epilepsy.
• Careful programming is needed to balance seizure control with avoiding unintended interference with critical functions.
• While advanced tools are emerging, current clinical literature guides today's programming practices.