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Closed-Loop Neurostimulation for Biomarker-Driven, Personalized Treatment of Major Depressive Disorder

Closed-Loop Neurostimulation for Biomarker-Driven, Personalized Treatment of Major Depressive Disorder

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Stereo-electroencephalography-guided responsive neuromodulation: A propensity-matched cohort study.

David Botros¹, Julian Brown², John D Rolston³

¹Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.

|July 14, 2026

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Preoperative stereo-electroencephalography (sEEG) did not improve seizure reduction in patients receiving responsive neurostimulation (RNS) for drug-resistant epilepsy. These findings suggest sEEG may not be essential for optimizing RNS surgical planning.

Area of Science:

Neurosurgery
Epileptology
Neuromodulation

Background:

Responsive neurostimulation (RNS) is an option for drug-resistant focal epilepsy.
Optimal pre-implantation evaluation and surgical targeting for RNS remain debated.
The role of stereo-electroencephalography (sEEG) in preoperative testing for RNS is undefined.

Purpose of the Study:

To determine if sEEG-guided targeting for RNS implantation improves seizure reduction compared to RNS implantation without sEEG.
To evaluate the efficacy of RNS in patients with drug-resistant focal epilepsy.

Main Methods:

Retrospective review of 99 patients who underwent RNS implantation (2015-2024).
Propensity score matching to create balanced groups with and without prior sEEG.

Keywords:

closed‐loop stimulation drug‐resistant epilepsy patient‐reported outcomes seizure severity

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Primary outcome: seizure reduction percentage from baseline via linear regression.

Main Results:

79% of patients had prior sEEG monitoring.
Mean seizure reduction was 72.4% at a median follow-up of 45.3 months.
Preoperative sEEG was not associated with greater seizure reduction in original or matched cohorts (p > 0.8).
Female sex, older age, thalamic stimulation, and longer follow-up were associated with greater seizure reduction in the unmatched cohort.
No significant differences in seizure reduction were found across epilepsy subtypes.

Conclusions:

Responsive neurostimulation (RNS) efficacy did not differ with or without prior sEEG monitoring.
Findings may assist in patient selection and surgical planning for RNS.
Prospective data are needed to further investigate the benefit of preoperative sEEG.