Responsive Neuro Stimulation (RNS) is a well-known tool for focal epilepsy, and it has been proved useful to control and decrease frequency of seizures. 

There are few data available in the literature regarding use of RNS in drug-resistant generalized epilepsy. 

We present two cases of drug-resistant idiopathic generalized epilepsy who responded effectively to RNS. 

Case 1: 22-year-old male with a history of autism and generalized epilepsy since age of 12. Family reported very long history of intractable generalized tonic-clonic seizures (GTC), absence seizures, and myoclonic jerks, few times per week. MRI brain epilepsy protocol displayed no abnormalities. Generalized 3Hz acute spikes and waves were seen on the EEG, supporting the diagnosis of generalized epilepsy. He had tried several anti-epileptic drugs (AEDs), with no avail. Patient underwent RNS surgery with direct stimulation of the centromedian thalamic nucleus.  After turning the device on, the number of spells decreased significantly. He remains taking the same anti-epileptic medications after RNS implantation. The patient has been seizure-free for three months.

Case 2: 28-year-old female with seizures since 13 years-old. The patient frequently suffered from myoclonic jerks that progressed to GTC seizures. Despite taking several AEDs, the patient continued to experience seizures daily. MRI brain seizure protocol was unremarkable. EEG displayed generalized discharges. Patient underwent RNS placement with direct stimulation of the centromedian thalamic nucleus. Following RNS implantation, the patient continued taking the same AEDs. The patient experienced an isolated episode of GTC seizure after two months of follow-up.

Closed-loop stimulation of the centromedian thalamic region may significantly enhance seizure control and quality of life in patients with drug-resistant generalized epilepsy.

Further studies are needed to determine the ideal location and settings for detection and stimulation of epileptogenic source.