Responsive neurostimulation (RNS) programming

Programming of RNS is an iterative process involving a logical progression of patient-specific electrocorticographic biomarker detections that inform stepwise progression of stimulation parameters. In this paper, we discuss the identification and detection of specific pro-ictal, pre-ictal, ictal onset, and seizure body biomarkers as they relate to optimal timing of neurostimulation. General principles underlying different stimulation paradigms are reviewed, and a practical progression of stimulation paradigms is presented with the goals of maximizing the acute seizure-disruptive effects of stimulation as well as the long term neuromodulatory effects, which translate to sustained improvement in seizure frequency and severity.