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Fedor Panov, Sara Ganaha, Jennifer Haskell, Madeline Fields, Maite La Vega-Talbott, Steven Wolf, Patricia McGoldrick, Lara Marcuse, and Saadi Ghatan

, minimally invasive alternative to traditional resection with comparable clinical efficacy. 7–9 Neither resection nor ablation is recommended in cases of multiple seizure foci, a focus in an eloquent area, or poor delineation of the network, a frequent occurrence in pediatric epilepsy. 10–12 These limitations have led to the development of neuromodulatory treatments, such as vagus nerve stimulation (VNS) and deep brain stimulation (DBS). 13 In 2013, the FDA approved the closed-loop responsive neurostimulation (RNS) system (NeuroPace Inc.) as an adjunctive therapy for

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Malgosia A. Kokoszka, Fedor Panov, Maite La Vega-Talbott, Patricia E. McGoldrick, Steven M. Wolf, and Saadi Ghatan

T he responsive neurostimulation (RNS) system (NeuroPace), an FDA-approved adjunctive treatment for adults with medically intractable partial-onset seizures arising from 1 or 2 foci, 10 , 17 is not yet approved for children with medically refractory epilepsy (MRE). The device consists of a surgically implanted cranial neurostimulator that is connected to 2 cortical and/or depth leads containing 4 electrodes each that are placed at the putative seizure focus (foci). The neurostimulator continuously senses electrographic activity and is programmed to deliver