Closed-Loop Stimulation

Closed-loop neurostimulation is a form of neuromodulation that provides therapeutic stimulation only when necessary. It has been explored for conditions such as Parkinson’s disease and chronic pain. (1, 2) An early application of closed loop neurostimulation is in the treatment of refractory epilepsy – when seizures cannot be adequately controlled by medication alone. Much like a pacemaker stops abnormal heart rhythms, a closed-loop device aims to halt epileptic seizures by delivering stimulation when it detects the beginnings of seizure activity. A programmable responsive neurostimulation (RNS) brain implant for the treatment of certain types of epilepsy received approval from the FDA in November 2013. (3) Since then, studies have demonstrated favorable outcomes, with 53% median seizure reduction after two years and 70% median seizure reduction after five years. (4)


  1. Parker, John & H Shariati, Nastaran & M Karantonis, Dean. (2018). Electrically evoked compound action potential recording in peripheral nerves. Bioelectronics in Medicine. 1. 71-83. 10.2217/bem-2017-0005.

  2. Russo, M., Cousins, M. J., Brooker, C., Taylor, N., Boesel, T., Sullivan, R., Poree, L., Shariati, N. H., Hanson, E. and Parker, J. (2018), Effective Relief of Pain and Associated Symptoms With Closed-Loop Spinal Cord Stimulation System: Preliminary Results of the Avalon Study. Neuromodulation: Technology at the Neural Interface, 21: 38–47. doi: 10.1111/ner.12684.

  3. Anon. FDA Grants Premarket Approval (PMA) for the NeuroPace RNS System to treat Medically Refractory Epilepsy. NeuroPace: News. Accessed March 5, 2018.

  4. Geller EB, Skarpaas TL, Gross RE, Goodman RR, Barkley GL, Bazil CW, Berg MJ, Bergey GK, Cash SS, Cole AJ, Duckrow RB, Edwards JC, Eisenschenk S, Fessler J, Fountain NB, Goldman AM, Gwinn RP, Heck C, Herekar A, Hirsch LJ, Jobst BC, King-Stephens D, Labar DR, Leiphart JW, Marsh WR, Meador KJ, Mizrahi EM, Murro AM, Nair DR, Noe KH, Park YD, Rutecki PA, Salanova V, Sheth RD, Shields DC, Skidmore C, Smith MC, Spencer DC, Srinivasan S, Tatum W, Van Ness PC, Vossler DG, Wharen RE Jr, Worrell GA, Yoshor D, Zimmerman RS, Cicora K, Sun FT, Morrell MJ. Brain-responsive neurostimulation in patients with medically intractable mesial temporal lobe epilepsy. Epilepsia. 2017 Jun;58(6):994-1004.

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. . . a closed-loop neuromodulation system only delivers stimulation when it detects the beginnings of seizure activity . . .

Reviewed Maarch 18, 2018
Chengyuan Wu, MD, MSBmE
Member, International Neuromodulation Society
Thomas Jefferson University Hospital, Department of Neurosurgery
Philadelphia, Pennsylvania, U.S.A.

Last Updated on Monday, November 22, 2021 11:04 AM