RNS® System Pivotal Study
Condition: Epilepsy
MeSH terms: Epilepsy
Study type: Interventional
Phase: Phase 3

Summary: 
      The RNS® System Pivotal study is designed to assess safety and demonstrate that the RNS®
      System is effective as an adjunctive (add-on) therapy in reducing the frequency of seizures
      in individuals 18 years of age or older with partial onset seizures from no more than two
      foci (two areas of the brain) that are refractory (drug-resistant or hard-to-treat) to two or
      more antiepileptic medications. Patients continue to receive their epilepsy medications while
      participating in the study.
    

Detailed description: 
      NeuroPace, Inc. is sponsoring an investigational device study of the RNS® System, the first
      closed loop responsive brain stimulator designed to treat refractory epilepsy. The RNS®
      System Pivotal study is a multi-center, randomized, double-blinded, sham-stimulation
      controlled investigation being conducted at 32 epilepsy centers throughout the United States.
      The study is designed to assess safety and demonstrate that the RNS® System is effective in
      reducing the frequency of medically uncontrolled and disabling partial onset seizures that
      start from one or two areas of the brain.

      The RNS® Neurostimulator (a pacemaker-like device) and NeuroPace® Leads (tiny wires with
      electrodes) are implanted in the head. The Neurostimulator is a battery powered,
      microprocessor controlled device that detects and stores records of electrographic patterns
      (such as epileptiform, or seizure-like, activity) from the Leads within the brain. When the
      device detects an electrographic pattern, it responds by sending electrical stimulation
      through the Leads to a small part of the patient's brain to interrupt the electrographic
      pattern. This type of treatment is called responsive stimulation, but it is not yet known if
      it will work for the treatment of epilepsy. Direct brain stimulation therapy has already
      received approval in the United States, Europe, Canada, and Australia for the treatment of
      Essential Tremor and Parkinson's disease. Direct brain stimulation is not approved for the
      treatment of epilepsy.

      Subjects participating in the RNS® System Pivotal study must met inclusion criteria,
      including localization of epileptogenic region(s), prior to enrolling in the study.
      Throughout the entire study, subjects or their caregivers must keep a seizure diary. Seizure
      frequency, seizure severity, and antiepileptic medications, as well as physical and emotional
      health will be monitored and recorded throughout the study.

      Upon demonstrating the required seizure frequency and stable antiepileptic medications over 3
      consecutive months of the Baseline (pre-implant) Period, subjects will qualify for RNS®
      System implantation. Antiepileptic medications should continue to remain stable until 6
      months post-implant. The surgical procedure will be performed within one month of
      qualification.

      The RNS® Neurostimulator is cranially implanted and connected to one or two NeuroPace® Leads
      implanted in the brain. The investigational team will determine the placement of the Leads
      based on prior localization of the epileptogenic region, according to standard localization
      procedures. Detection of epileptiform activity will be enabled for all subjects during the 1
      month Post-Operative Stabilization Period. Subjects will be randomized 1:1 to either the
      Treatment or Sham group prior to starting the 1 month Stimulation Optimization Period. During
      this period subjects are seen on a weekly basis by the Treatment Protocol investigator.
      Responsive stimulation will be enabled and optimized for subjects randomized to the Treatment
      group. Subjects randomized to the Sham group will be seen for simulated stimulation
      programming in order to maintain the treatment blind.

      The Blinded Evaluation Period is comprised of months 3, 4, and 5 post-implant. Subjects in
      the Treatment group will receive responsive stimulation and subjects in the Sham group will
      not. Subjects will not know whether responsive stimulation is being delivered or not. At the
      end of the 5th month, all subjects' transition into the Open Label Evaluation Period during
      which all subjects may receive responsive stimulation and antiepileptic medications may be
      adjusted as medically required.

      Subjects will be followed for 2 years post-implant. Throughout study participation, both
      effectiveness and safety data will be monitored continuously, and reviewed and documented by
      the study investigator at study appointments scheduled every month for the first year
      post-implant, then every 3 months.
    

Intervention name(s): RNS® System implantation; RNS® System responsive stimulation
Intervention type(s): Procedure; Device
Intervention description(s): Using standard neurosurgical techniques the surgical team implants the RNS® System, which includes the RNS® Neurostimulator and intracranial NeuroPace® Leads. Up to 4 Leads (Cortical Strips and/or Depth Leads) are placed in or near the epileptogenic focus/foci. The Neurostimulator is placed in the skull and connected to up to 2 Leads. At first the Neurostimulator is programmed to record brain activity (electrographic patterns). The neurologist or neurosurgeon reviews the recorded electrographic patterns and identifies abnormal (epileptiform, or seizure-like) activity. The Neurostimulator is then programmed to detect the abnormal activity.; The RNS® System is programmed to provide responsive stimulation (stimulation is ON or enabled). Upon detecting electrographic patterns, previously identified by the neurologist or neurosurgeon as abnormal (epileptiform, or seizure-like) activity, the Neurostimulator provides brief pulses of electrical stimulation through the Leads to interrupt those patterns. The typical patient is treated with a cumulative total of 5 minutes of stimulation a day.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Responsive Stimulation; Brain Stimulator; Epilepsy; Seizures