There we go. Thank you. Alright. We're gonna get started. My name is Ross Osborne. I'm the med tech and diagnostics analyst here at Cantor Fitzgerald. And this morning, we have Neuropace, and we have the company's CEO, Joel Becker, and newly appointed CFO, Patrick Williams. So with that, Joel, you can provide a brief background on yourself. I will. Thank you. And thank you, Ross, and thank you, Kenneth Fitzgerald, for having us here. So my name is Joel Becker. I work as the CEO here at Neuropace. I come from a background of a number of years in medical technology building and developing companies, implantable device companies primarily with a focus on therapeutic devices. I've been here at NeuroPace for a little bit over two years and have really just been thrilled to to find myself part of a company that says mission driven in meeting needs of patients the way we are and similarly thrilled here to have Patrick Williams have joined us as our CFO. Patrick similarly brings a broad and diverse background in med tech and in developing processes and systems and scaling businesses that are at a point where we are. We've got some good momentum and some significant opportunities in front of us, and we're looking forward to to all that is to to bring. For those who may not be quite as familiar, NeuroPace focuses on treating patients who suffer from debilitating seizures and for whom anti seizure medications don't work. So patients that are drug refractory to anti seizure medications and we have a unique and differentiated neuro implantation device that records, monitors and then can tailor and target neurostimulation on an individualized basis for what patients need. A unique technology in a significant and large unmet clinical need, and we're excited about everything do there. Great. Maybe going off of that, would you discuss the market size, how many patients suffer from VRE? You bet. So in The United States I'll I'll speak about The United States population specifically here. So in The US, there are about three point six million patients that are diagnosed with epilepsy. Of that group, about a third don't respond satisfactorily to anti seizure medications. So there are about one point two million drug resistant epilepsy patients in The United States. So a significant unmet need there for which neuromodulation, like RNS specifically, isn't can be indicated. And then there's an interesting dynamic of a smaller portion of those patients going through CECs versus historically, many of those patients were left untreated. That's why you guys have established product care. So maybe just level set the room there. You bet. So if we think about the segments of that 1,200,000 patients, there's a couple of important ways to think about who those patients are and where they're located. So as Ross mentioned, comprehensive epilepsy centers or CECs as we commonly refer to them are level four tertiary referral highest level care centers that offer an expansive set of diagnostic as well as patient management options. The majority of patients up until now or up until recently anyway that have been implanted with RNS devices are implanted in level four centers and they're the ones who do the vast majority of interventions for patients with drug resistant epilepsy. About seventy five thousand patients a year move their way through level four centers. And so while that's a significant number of patients, there are also still a significant number of patients that are out in the community setting. And so excuse me, pardon me. Up until not too long ago, RNS devices were limited to level four center implantation only. Through a regulatory approval, we've now gotten the ability to move it to level three in community settings as well. So that opens up a significant portion of the market for us. And that's important both to generate referrals for patients who should be treated in level four centers, but also patients who can be treated in a community setting now can be, which can be even more important as we work on a number of indication expansion efforts that we have underway. Great. And then sticking with level four centers Vocal ZRE, what other devices are on the market for patients that aren't able to be treated here? It's a great question. So again, back to maybe segmenting that one point two million epilepsy patients. About sixty percent of the drug resistant epilepsy population is diagnosed with what we call focal drug resistant epilepsy, which as it sounds, is their epilepsy starts in a very focused place in the brain and spreads from there. That's where we're currently indicated today. And direct brain stimulation or VNS as well as vagal nerve stimulation or VNS are also indicated in the focal patient population. The other forty percent of the drug resistant epilepsy population is what's known as generalized and we are currently working on today a clinical trial, our NAUTILIST trial, to gain an indication for the idiopathic generalized epilepsy population for which there are no indicated devices today. And we're similarly also working on an expansion into the pediatric segments of the market. So today, focalized adult therapy is the market that we're the patient population that we're focused on in the business that we have today with significant expansion opportunities, both from a site of service perspective for those focal patients as well as an indication expansion perspective. Great. And before we get to generalize and Nautilus, which we're obviously very excited about, maybe spend some more time on what RNS is and how that differs from other neuromodulation offerings. Great question, and one we like to talk about. So, RNS is the acronym for responsive neurostimulation. And what lies behind that is a unique technology that consists of an implantable device and leads that is unique in its ability to monitor a patient's seizure activity on an ongoing basis. It's also unique then in its ability to record that activity on an ongoing basis. And what that allows then is for patients to only receive stimulation when they need it and in the way that they need it. And so you end up delivering minutes of very individualized and tailored therapy for what an individual patient needs versus with other technologies which we we think of as what we call a duty cycle. So you set it and then it stimulates for a period of time and it's off for a period of time without regard to the patient's epileptic status. As a result, you end up stimulating for hours a day without regard to whether the patient is seizing or needs stimulation or not versus minutes a day in a very individualized fashion with RNS. Where that all shows up is in the clinical data. So what we find with the data is best in category, medium seizure reduction rates for these patients and lowest in category adverse event rates. It may seem intuitive, when a patient needs their brain to be stimulated, you should. And you should do it in a way that's unique and tailored to what that patient needs. And when they don't need it, you shouldn't. Because when you do, that ends up with higher adverse event rates like mood, sleep disruption, other adverse events that are not good for patients. And so we have a unique device here that allows us to tailor therapy. And I guess the final thing I'd say is that it's also allowed us to learn. When we first introduced the device, we saw median seizure reduction rates in the fifty to sixty percent. The post approval study data that was presented in April at the American Academy of Neurology showed north of eighty percent median seizure reduction rates and that's improved over time. And one of the reasons that's improved over time is we've learned because we can monitor these patients how to best program and then we can tailor that for each individual patient over time as well. We we look to accentuate that and do more with that. And I hate to even mention the the two letters, but with AI, we now have I'm gonna go on here for a little bit. We we have a set of brain data, 22,000,000 individualized seizure records. It is a unique asset, and this will sound hyperbolic and it's not a unique asset to humankind. We have more data and know more about what goes on with the patient's brain when they're seizing from epilepsy than anyone. And we take that stewardship very seriously. And so we're really excited about what's going on with data science around us. And then what we can do to generate insights and algorithms that can help us treat more patients get better faster with individualized therapy. And so we think there's just a tremendous amount of runway ahead of us here because of the ability to uniquely monitor, record, and tailor therapy. And we see the data becoming an increasingly important part of what we do both in treating patients today as well as in our future. If I could just add real quick on that, Joel talked about it, but our our median reduction rate on seizures is north of 80, right, in our in our PAS. I think it's important that all of the stuff that Joel just talked about with our ability to monitor, stimulate, report, that's about two x what the other predicate devices that are out there doing today, whether that's a DBS device or a VNS, two x. And I think that's very important is that not only are we have a very unique system, but it's delivering the clinical benefit far above what what we'll call the competition or the alternate devices out there. Absolutely. And this is gonna be one of my last questions, but since you alluded to it, you know, can the RNS system and your database be helpful to therapeutic companies? It's a it's a great question. We've, so, we think there are a number of opportunities associated with the data. I mentioned one of them here about training the ways that we tailor and target algorithm development and therapy management for patients with the RNS system. We also see the data being helpful. It's really you can think of it as a the RNS system as a window into the brain. And so for patients who are, for example, in clinical trials for a pharma or biotechnology agent, what we can do now is give people a physiologic marker for what happens when they take that compound and then the indicators from an epileptic physiology perspective. Up until now in these trials, the best that people have had is things like patient diaries and very qualitative assessments of, I had a seizure and here's what I think happened when I was having that seizure. And as you might imagine, that can be less than specific from a scientific perspective and unreliable. You know, patients are going through a lot. And to try and then remember to write down and write down with enough specificity so that it's useful can be challenging to run a trial under those conditions. We have a relationship with a company by the name of Rapport Therapeutics, who's got an early stage agent that is under clinical evaluation that is now being evaluated in patients who have an RNS device. And we're able to show them what happens from a physiology perspective when they take that compound. As you might imagine, that has the potential to be very valuable and highly efficient for people who are doing trials like this. We've also recently announced a similar type of relationship with UCB, a large pharmaceutical company in the epilepsy space, and the potential for more to come. So we think the monitoring and reporting capability of the RNS system provide that window into the physiology of what's happening, both within epilepsy today, as well as potentially in other alternative applications going forward, is a way that we can further utilize data and data science to more quantitatively evaluate brain physiology. Great. And switching back to your core business, how's Project Care going? Care is going well. For those who might not be quite as familiar with it, Project Care is the effort that we launched, as I mentioned, subsequent to the regulatory approval that allows us to move outside of level four centers to move into the community. So level three epilepsy centers as well as community oriented centers, both for the identification and implant of patients who can be appropriately treated in the community as well as then to identify additional patients who, for whatever reason, either couldn't have been or wouldn't have been identified in the community and then referred into Level four centers. We've been pleased with the progress we've made there. What we said in our last earnings call was that we continue to see highs in terms of both the referrals and total implants that we're seeing come from that. And we're really pleased with both what that's doing for increasing access to RNS, which is our overall mission, but also then generating increased awareness out in the community, so that people know that know what they know what RNS is and they know how they can get to it. And then with regards to the centers that are doing implants, what do those centers look like? Do they have an existing neuromodulation offering there? Or where are you getting traction? It's a great question. It's we've learned a lot going into the community here with this effort. What we find is that there are really what I would call three segments in the community. One is centers who today have the epileptologist functional neurosurgeons technology and patient populations to turn into an implanted center. And it's really an education and training effort. And so I mean, in many cases, the clinicians that are there were familiar with harness through their training and are able to quickly pick it up and begin implanting. Other centers because they haven't had access to it. And then the second segment is they're they're going to turn into implanting centers, but they may need to go through technology acquisition or get some increased amount of functional neurosurgery time for this type of a procedure. And so in the interim, they've identified patients and are referring patients in the local support centers and then getting them back and programming and managing the centers on a the patients on an ongoing basis. The third kind of profile of a center it's been interesting to see is they have the neurology and epilepsy capability. They have the patient populations. They want to manage those patients with RNS, but they're happy to refer them to level four centers for implant. And so we're also seeing emerge what we what we think of as programming centers out in the community that then obviously make it easier for patients to be managed on an ongoing basis from a travel and and access to the therapy perspective. And are there any challenges in terms of monitoring those patients if they're visiting multiple centers? So what we're able to do is the patient patients are able to remotely download the data from the device. They have a wand that they use through then RF telemetry to remotely download the data. And physicians and and allied health personnel can monitor that data remotely. And so they're able to then over patients, if there's some kind of update that's needed, they can they can travel into the clinic and and have the device programmed. We're working now as part of our product development pipeline on also remote programming. So over time, patients will need to travel to the clinic to have the device tailored and targeted. And so, that that's that's well underway and is, one of the things in the product pipeline. But it eve even today, we can can remotely download managed data. Great. And then lastly on product care, how can you guys influence more patients to get to the bottom half? It's a it's a great question. I think that as we have worked to begin to move outside of level four centers, again, we've we've learned a lot. One of the things that we've learned is that there is a need, but an appetite for awareness for other options for these patients. And when we when we we talk a lot about access to RNS, and we think that's important across a number of different aspects. One of which is general education and awareness of the community, epileptology, and neurology segments. So just making sure they understand and are aware of the data and the indications for for the technology. There's a lot of good work that we are doing and can do with in terms of basic education and awareness there. Secondly, a direct education, education and awareness process that we have underway as well that we've been doing for some time but are now starting to scale. Those are both things that generate awareness and interest for appropriate patients. Finally, indication expansion. So today, it's really a adult patient population with focal disease. Tomorrow, we're working on indication expansion to generalized adult and pediatric patients as well as focal pediatric patients. And so as we do, then that opens up additional populations for us to educate both on the patient side as well as from a referral perspective. So we're trying to work 360 degrees here both with health care professionals as well as patients. RNS is continuing to grow and expand, and so we want to make sure that we continue to grow and expand, how people are aware and get educated upon it. Perfect. And that's a great segue to Nautilus. I'll through the structure of that trial and the latest update there. Great. So Nautilus is our FDA pivotal trial for the use of the RNS system in the idiopathic generalized epilepsy population, the IgE population you'll hear us refer to as. Today in The United States, there are no devices that are indicated for use in the idiopathic generalized population. And so we undertook this trial over the past several years to evaluate and develop FDA highest level randomized sham gold evidence for the treatment of these patients that suffer from another acronym for you, IgE patients that suffer suffer from GTC or generalized tonic clonic seizures. These are the seizures that are most dangerous to patients. These are the seizures where they fall, most likely to be injured, most likely to further the parade of acronyms here, experience. SUDEP, it's one of the acronyms that I was sad to learn. Sudden unexpected death in epilepsy patients. So when you suffer from poorly controlled, uncontrolled, generalized tonic tonic seizures, bad things happen. The jury's and death happens in epilepsy patients. And so these GTC patients from this generalized population is the group that that we're evaluating in the DAWNESS trial. We've excuse me. We've announced the one year data from that trial and are in the process of engaging with FDA on it now. What we've announced is that we met the primary safety endpoint. We did not meet the primary efficacy endpoint. We did meet the prespecified secondary endpoints, which are the clinically most meaningful endpoints, median percent reduction of generalized tonic clonic seizures, which is nearly eighty percent reduction at one year. The number of responders and the days of response as well. So in addition to the seizure reduction data that we see, which is, as you might imagine, if somebody experienced yearly immediate percent reduction in those types of generalized tonic clonic seizures and somebody's going from ten to 15 to 10 than that, that can really change somebody's life. We also see where forty five percent of patients in the trial experienced prolonged period of seizure. Going from having those types of seizures and the fear and risk of injury that that goes along with that to having a significant period of time where they did not experience GTCs at all. So the net net is we really like the data from a political leadership perspective. It is inconvenient to have not hit the primary efficacy endpoint, but that primary efficacy endpoint we really think is an artifact of the trial design. The trial design was the time from the first to second generalized tonic clonic seizure. Not as clinically relevant, but it's so to just emphasize that a little bit, a clinician, when they sit down with the patient, doesn't spend time talking with them about maybe this therapy can help you delay the time from when you have your first to your second generalized tonic clonic seizure. That's not the conversation that happens. The conversation that happens is, well, maybe we can help you reduce those seizures, maybe we can help give you some periods of time where you don't have those seizures at all. And these are the clinically meaningful things we're trying to impact. And we think on the clinically meaningful side, we really like the data. So we're excited about talking to the agency about it. We've submitted our pre submission documents. So from a logistics perspective, we've submitted those pre submission documents. We're in the process of going to meet with them. In the next few weeks here, we'll be we'll be meeting with FDA for a sprint meeting discussion with them, and and we're really pleased with the collaborative and engaged nature of the agency. Our our our team and and the team at the FDA are working have been working closely on Nautilus and continue. Great. I think maybe one more point that's helpful on the structure of the trial. Why was your primary efficacy endpoint reduction? Next episode. It is a really good point and one that I should emphasize. The trial was designed the way that it was because we knew that in order to enroll the trial and to have patients treated ethically, we didn't want to subject patients to a long sham period where therapy was withheld. And so the time to a second generalized tonic clonic seizure then allows them to cross over into the treatment group. And so patients that are suffering from these types of seizures don't have to go through a prolonged period of time where they can't have access to the therapy. So unfortunately, if you have somebody who has a high seizure frequency, you can take them from 10 to two or 15 to four. So they have a significant reduction in the number of seizures which is clinically meaningful, but they still may have a seizure earlier And so then that comes through as a failure in the primary endpoint. So what the the trial's design was effective for its intention. We were able to enroll the trial. We were able to enroll the trial ahead of schedule. And we were able to enroll the trial and treat patients again with what we think are very clinically meaningful outcomes. Unfortunately, because of the time to event endpoint that allowed us to enroll patients in the trial with that kind of a treatment crossover, you run the risk of having that early failure rate impact the primary efficacy endpoint. Makes sense. And then thinking about the probability of approval, expanded indication, thinking about what's on the market, if it's not a device that's approved, what else is there? So when, you know, we again, we are engaged with the agency and and we'll have to see how those discussions pan out, but we really like the clinical meaningfulness of the data. Again, there isn't anything else indicated from a device perspective. Surgery? So surgery for a generalized patient population is not an option. So if you're a focal patient, you might imagine that there would be some regions of the brain that could be resected and then the bad actor area, is no longer there because it was a focal part of the brain that was causing the problem. With a generalized seizure where the seizure propagates through the network of the brain and happens everywhere all at once, resection isn't an option. And so these patients have failed anti seizure medications, resection isn't an option, nothing else is approved, and they're at the highest risk for injury and death. And so that's the clinical scenario that we're presented with here and the one that we're working hard to try and provide patients options for. Yep. And maybe in the last couple of seconds here, I think one of the great things is with our current indication, we have a ton of conviction that over the next, whatever, two or three years that we can continue to grow at twenty percent as a minimum, we'll call it. We think there's upside to that number under adult epilepsy. We've got very strong gross margins. We'll start approaching eighty percent plus as we move into 2026. Cash flow breakeven should be coming in 2027 as we move forward. And everything we just talked about related to expanded indications will just add to that. And so that's where I think we've got a lot of excitement about what the next couple of years up is for us. The foundational business is strong. We've got good momentum. The pipeline is as strong as we've seen it, and we're excited about everything else that we're working on that will be added in. Perfect. Thanks for the time, Dan. Thank you.