What Conditions Do We Treat with Responsive Neurostimulation?
Because the electrical pulses target distinct areas of the brain, the FDA approves RNS mostly for focal- or multifocal-onset epilepsy. This is when the seizure starts in one or two places in the brain.
Doctors can use RNS for other types of epilepsy in certain cases.
RNS involves brain surgery, which carries slight risks. Doctors only use it when medications or other options don't work well to control seizures.
Removing part of the brain may be another option for controlling your child's seizures. But sometimes, this is too risky since it could cause physical or mental shortfalls.
What to Expect Before, During, and After Responsive Neurostimulation Surgery
At UPMC Children's Hospital of Pittsburgh, we offer the most advanced treatments for all types of epilepsy, including RNS.
Our pediatric neurosurgeons are some of the most skilled with RNS implantation in the U.S. They use advanced techniques to reduce risk and speed up your child's recovery.
Before your child's RNS
You and your child will meet a neurosurgeon, neurologist, nurse, and maybe others from our epilepsy surgery clinic.
The team will explain:
- Why they suggest RNS for your child over other epilepsy treatments.
- The RNS process in detail and answer any questions you may have.
- The likelihood for RNS success based on your child's symptoms and the type of epilepsy they have.
Because your child will be under anesthesia, they can't eat for eight hours before RNS. Your child should stop drinking clear liquids like water or juice two hours before the surgery.
During your child's RNS
RNS takes about two to four hours, depending on where the doctor implants the electrodes. Your child will be under general anesthesia, so they'll be asleep for the entire procedure.
During RNS surgery, your child's neurosurgeon will:
- Uses special equipment to make tiny holes to place the electrodes on the brain's surface or deeper in the brain. The exact location depends on where the abnormal brain activity is occurring.
- Attach the electrodes to the detector device.
- Places the detector in a metal tray that replaces a small part of the skull.
After RNS, the surgeon will turn on the detector to detect electrical activity in the brain.
They won't program the device to send electrical pulses until two to six weeks after the surgery. In other words, the device will gather data right away. But it won't start disrupting your child's seizures until the surgeon programs it a few weeks after the implant.
After your child's RNS surgery
There's a small risk of bleeding or infection during or shortly after the surgery.
In a major study on RNS for focal epilepsy, 4% of patients got a skin infection — but not brain infections. Doctors watch closely for these adverse effects so they can treat them right away.
Most children stay in the hospital one night after RNS. The doctor will provide pain medicine if your child needs it.
Before your child goes home, the team will give you details on:
- How the detector works and how to use the RNS equipment.
- What symptoms to look out for.
- How to care for the surgical wound.
A follow-up visit to program the RNS device
Two weeks after surgery, your child will visit the clinic so we can make sure the wound is healing well.
The doctor will also download the data on your child's electrical signature for seizures saved on the detector.
The team will use this data to program the device to:
- Know the abnormal brain activity your child has during a seizure.
- Send an electrical pulse to the seizure.
The neurologist will test the stimulation make sure it doesn't cause twitching, tingling, or other side effects.
If this happens, they can adjust the settings before you leave the clinic.
Responsive Neurostimulation Recovery
The neurologist will meet with you and your child many times post-op to see how the device is working. It is crucial that patients and families are able to attend follow-up visits for programming about every 3 months.
Sometimes they need to slightly adjust the electrical pulses of the detector to improve seizure control. They can make any programming changes to the RNS equipment in the clinic — there's no surgery involved.
After your child recovers from RNS surgery, they can get back to their day-to-day life. Be sure to ask your child's doctor when they can play sports again.
If your child is taking drugs to reduce seizures, the doctor may be able to lower the dose. Or your child may be able to stop taking them altogether.
Your child's neurologist will guide you through this process.
About every 10 years, your UPMC Children's neurology team will replace the detector's battery through a simple surgery.
Patient and Family Involvement With RNS
Patients with RNS devices, and their families, play an important role in functions of the device. Each patient is given a magnet, which can be swiped over the device during or after a seizure in order to store a picture of the electrical activity at that time.
Each patient is also given a remote monitor system to download the information from the device every day, which takes only a few minutes. About once per week they are asked to send the date from the remote monitor to a secure RNS database, through their home internet router, so that the data can be reviewed.
Contact Us
If you have questions about whether Responsive Neurostimulation may be a good treatment option for your child, contact us at 412-692-6928 or email epilepsysurgery@chp.edu.
