Responsive neurostimulation may be considered medically necessary for individuals with focal epilepsy who meet ALL of the following criteria:
· Are 18 years or older;
· Have a diagnosis of focal seizures with 1 or 2 well-localized seizure foci identified;
· Have an average of 3 or more disabling seizures (eg, motor focal seizures, complex focal seizures, or secondary generalized seizures) per month over the prior 3 months;
· Are refractory to medical therapy (have failed ≥2 appropriate antiepileptic medications at therapeutic doses);
· Are not candidates for focal resective epilepsy surgery (eg, have an epileptic focus near the eloquent cerebral cortex; have bilateral temporal epilepsy); and
· Do not have contraindications for responsive neurostimulation device placement (see Policy Guidelines section).
Responsive neurostimulation is considered investigational for all other indications.
