Responsive Neurostimulation (RNS)

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If your seizures cannot be controlled with medications or safely and effectively treated by surgically removing the area that causes seizures, responsive neurostimulation (RNS) may be an option for you. RNS, a type of neuromodulation, can significantly improve seizure control and quality of life. Duke epileptologists, neurosurgeons, and other epilepsy specialists determine whether RNS is right for you and ensure you experience the best-possible outcome. 

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About Responsive Neurostimulation

RNS constantly monitors your brain activity; when it identifies abnormal brain waves that are associated with a seizure, it sends brief electrical signals to reset the brain’s normal activity. The device is made up of two parts: a generator and electrodes. The RNS generator is placed in a small window in the skull and connects to electrodes placed on or in the brain. 

RNS is more effective over time, reducing seizures by about 60% to 80% after one to three years.1 RNS is FDA-approved for people ages 18 years and older. However, in certain circumstances, RNS can be used in younger children with epilepsy.

Learn how responsive neurostimulation works.

Duke University Hospital

RNS surgery is performed at Duke University Hospital. Evaluation, pre- and post-op visits, and other appointments may take place at other clinics.

RNS Placement Procedure

Before the surgery to place your RNS device, you will undergo a thorough epilepsy evaluation to pinpoint the area in your brain where seizures begin. 

First, a neurosurgeon makes tiny holes in the skull to implant up to four threadlike electrodes on the brain’s surface or deeper within the brain. The electrodes are strategically placed where your seizures originate. Then the surgeon creates a larger opening in the skull and embeds the RNS generator. The surgeon attaches the generator to the electrodes through tiny wires called leads and closes the incision. The procedure takes about three to four hours. You’ll likely stay in the hospital for one night following the surgery. Full recovery takes six to eight weeks. After your incision heals, there are no water-related restrictions. You can shower and swim normally.

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RNS Programming and Activation

The RNS device begins monitoring brain activity as soon as the surgery is completed. For the first few weeks to months after the surgery, you will hold a magnet over the device when you have a seizure. This teaches your RNS to recognize seizures. Your neurologist will program your device to deliver electrical stimulation when it detects the beginning of a seizure.

Doctors usually recommend continuing epilepsy medications after placement of an RNS, though this surgery may enable you to reduce your medications.

Level 4 Epilepsy Center - Adult

As a Level 4 Epilepsy Center, Duke Health provides the highest level of diagnosis, medical, and surgical treatments for people with epilepsy. It is one of the reasons why Duke University Hospital’s neurology and neurosurgery program is nationally ranked, and the highest-ranked program in North Carolina, according to U.S. News & World Report in 2023-2024.

Battery Change Procedures

RNS batteries need to be changed about every 8 to 10 years. This requires an outpatient surgical procedure.

This page was medically reviewed on 08/17/2023 by