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Responsive neurostimulation (RNS) programming.

Philip M McCarthy¹, David E Burdette¹

¹Corewell Health Medical System Department of Neurosciences, USA; Michigan State University College of Human Medicine, USA.

Neurotherapeutics : the Journal of the American Society for Experimental Neurotherapeutics

|June 16, 2026

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Responsive neurostimulation (RNS) programming uses electrocorticographic biomarkers to guide stimulation parameter adjustments. This approach aims to reduce seizure frequency and severity through optimized neurostimulation timing and paradigms.

Area of Science:

Neurology
Neuroscience
Biomedical Engineering

Background:

Responsive neurostimulation (RNS) is an adaptive neuromodulation therapy for epilepsy.
Programming RNS involves optimizing stimulation parameters based on detected brain activity.

Purpose of the Study:

To detail the process of identifying and detecting electrocorticographic biomarkers for RNS programming.
To present a practical framework for advancing stimulation paradigms to maximize seizure control.

Main Methods:

Review of general principles for different neurostimulation paradigms.
Identification and detection of specific seizure phase biomarkers (pro-ictal, pre-ictal, ictal onset, seizure body).
Stepwise progression of stimulation parameters informed by biomarker detection.

Keywords:

Epilepsy RNS targets Responsive neurostimulation (RNS)Seizure biomarkers Seizure detection

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Main Results:

Established a logical progression for RNS programming based on biomarker detection.
Demonstrated how biomarker detection informs optimal neurostimulation timing.
Presented a practical approach to RNS programming for improved seizure management.

Conclusions:

RNS programming is an iterative, biomarker-driven process.
Optimized neurostimulation timing and paradigms enhance acute seizure disruption and long-term neuromodulation.
This approach aims for sustained improvements in seizure frequency and severity.