Clinical Use of the RNS
®
System
31
RNS
®
System User Manual
example, channel 1 should be programmed to sense the difference between electrode 1 on lead 1
and electrode 2 on lead 1.
The recommended initial detection settings are the default settings in the programmer. These settings
detect changes in frequency and power of the ECoG (line Length detector with a 75% threshold).
The neurostimulator is programmed to store segments of the ECoG when specific events occur. The
physician selects which types of events trigger ECoG storage – these are called ECoG triggers.
There are three recommended ECoG triggers to be programmed at implant. The first is a magnet
swipe by the patient, which could indicate that a clinical seizure has occurred. The others are
saturation (high amplitude ECoG) and long episode (sustained changes in the ECoG), both of which
could indicate an electrographic seizure.
Instructions for setting up the initial detection and ECoG storage parameters are provided in the
sections titled
and
After implantation, the patient should be instructed to interrogate their neurostimulator daily using the
remote monitor and to transfer that data to the PDMS at least weekly so that sufficient data are stored
for the physician’s review. The patient should be seen approximately 2 weeks after implant so that the
physician can review the detections using the stored ECoGs.
Recommended Initial Responsive Therapy Settings
Responsive stimulation therapy should be enabled once the physician has determined the
electrographic activity of interest is being detected.
Recommended initial responsive therapy settings are a frequency of 200 Hz, pulse width of 160 µsec
and burst duration of 100 ms. Current amplitude should be initially programmed at 1.0 mA. In general,
stimulation should be delivered to the leads and electrodes from which electrographic patterns of
interest are observed. For example, if electrographic activity of interest is observed on all channels,
then the stimulation pathway should be configured to stimulate across all electrodes. However, if
electrographic activity of interest is observed on only 2 channels, then the stimulation pathway should
be configured such that current is delivered through only those electrodes with electrographic activity
of interest.
Recommended Initial Responsive Therapy Settings
Frequency
200 Hz
Pulse Width
160 µs
Burst Duration
100 ms
Current
1.0 mA and adjusted as necessary
Electrodes
Those from which patterns of interest are observed
Stimulation should be tested while the patient is in the physician’s office by using the therapy testing
function. This ensures that the patient tolerates the stimulation settings and that there are no
undesired changes in the ECoG. If the patient cannot tolerate the stimulation settings or there are
changes of concern in the ECoG, the current amplitude should be reduced.
Instructions for setting up the initial stimulation parameters are provided in the section titled
