Programming Instructions
80
RNS
®
System User Manual
Recommended Modifications to Responsive Therapy Settings
Based on the clinical response, the physician may choose to modify stimulation. If the physician
chooses to modify stimulation, it is recommended that the current amplitude be increased in 0.5 mA
increments. It is recommended that stimulation settings be tested using the test stimulation function to
ensure that it is well tolerated by the patient and there are no undesired changes in the ECoG such
as afterdischarges.
•
Review device data such as lead impedance, battery voltage, number of detection and
stimulations, and stored ECoGs.
•
Adjust stimulation settings if the patient reports an acute worsening or increase in clinical
seizures that is not typical.
•
Consider making minor adjustments if the patient reports only a mild or no improvement in
clinical seizures.
•
Allow sufficient time between stimulation adjustments to assess the patient’s clinical seizure
response.
In the RNS
®
System Pivotal study very few subjects used any of the additional responsive stimulation
therapy options (see Table 1). These were: pattern specific therapy (each detector triggers a different
stimulation setting); adaptive therapy (the stimulation frequency adjusts with the ECoG frequency);
synchronized stimulation (stimulation is delivered into a specific part of the ECoG waveform); and
post episode monitoring/post episode monitoring interval (responsive therapies are disabled for a
specified period of time after detecting the end of the episode). Table 1 provides the number and
percentage of subjects who were treated with any of the additional stimulation therapy options.
Table 1: Additional responsive stimulation therapy options
Number and (%) of
Subjects Programmed
Pattern Specific Therapy
29 (15%)
Adaptive Therapy
4 (2%)
Synchronized Stimulation
3 (2%)
Post-Episode Monitoring Interval
4 (2%)
Programming the Newly Selected Settings
1. Select the
P
ROGRAM
S
ETTINGS
tab.
2. Select
R
EVIEW
C
HANGES
to view changes prior to programming.
3. Select the
P
ROGRAM
button.
The following can be configured under the
A
DVANCED
S
ETTINGS
button if an
A
DAPT
C
HANNEL
has been selected on the
R
ESPONSIVE
T
HERAPY
main tab.
Select
A
DAPTIVE
F
REQUENCY
ON to deliver adaptive therapy such that the pulse-to-pulse
interval (p-p interval = 1/Frequency) of the stimulation is a percentage (
A
DAPTIVE
%
) of the
sensed signal pulse-to-pulse interval (i.e., the delivered stimulation frequency is
proportional to the sensed ECoG signal frequency).
Example: If the Adaptive% = 100% and sensed signal frequency = 20 Hz (50 ms
period), the stimulation frequency is delivered at 20 Hz (50 ms p-p interval). If
