NeuroPace Cuts 2026 Revenue Outlook After RNS Growth Collapses

The Tip Desk · November 13, 2026 · 3 min read

Third-quarter revenue was $23.1 million as RNS System sales rose just 1.4% year over year, and the company now sees full-year revenue of $91 million to $92 million.

NeuroPace, Inc. (NPCE), a medical device company selling the RNS System for drug-resistant epilepsy, reported third-quarter revenue of $23.1 million and cut its full-year 2026 outlook after RNS System growth collapsed from the pace of the first half.

RNS System revenue was $22.9 million, up 1.4% from a year earlier. That followed 21.3% growth in the second quarter and 19.5% growth in the first quarter. Total revenue declined 1.1% from $23.4 million in the third quarter of 2025.

President and Chief Executive Officer Joel Becker said third-quarter revenue was below the company’s expectations and that the shortfall was concentrated in several of the largest accounts, reflecting isolated account-level issues and changes to the field organization that created more disruption than anticipated. He said the company is addressing those factors and that fourth-quarter scheduled cases have begun to recover.

NeuroPace revised full-year 2026 revenue guidance to $91 million to $92 million, representing underlying RNS growth of 10% to 11%. That compared with previously issued guidance of $99.5 million to $101.5 million, which had assumed 21% to 23% growth in core RNS revenue. The new range continues to reflect expected service revenue of about $1 million.

GAAP net loss from continuing operations narrowed to $3.3 million, or $0.10 a share, from $4.9 million, or $0.15 a share, a year earlier. Adjusted EBITDA was $0.4 million, compared with a $1.3 million loss. Non-GAAP income from operations was $0.4 million, versus a $1.4 million loss.

Non-GAAP gross margin expanded to 84.8% from 82.8% a year earlier. The company said the slight year-over-year growth was driven by improved labor absorption. GAAP gross margin from continuing operations was 84.3%.

Non-GAAP operating expenses were $19.2 million, down from $20.7 million a year earlier. Sales and marketing expense was $10.5 million, research and development $5.5 million, and general and administrative $3.2 million. GAAP operating expenses were $21.6 million. The company said the sales-and-marketing decline was largely due to lower personnel-related expenses, including sales commissions, partially offset by an increase in headcount.

Cash, cash equivalents, short-term investments and restricted cash were $49.5 million as of September 30, 2026, compared with $51.9 million at the end of the prior quarter. Long-term borrowings totaled $59.2 million.

For the full year, NeuroPace raised non-GAAP gross margin guidance to 83.0% to 83.5% from 82.0% to 83.0%. It revised non-GAAP operating expenses down to $85 million to $86 million from $90 million to $92 million, a range that continues to exclude about $10 million in stock-based compensation. Adjusted EBITDA guidance worsened to a loss of $8.5 million to $9.5 million from a loss of $7.5 million to $8.5 million.

Becker said the company is focused on improving commercial execution and returning the business to historical growth rates, citing ongoing demand for RNS therapy and the opportunity within the current indication.

The company completed a Submission Issue Request meeting with the FDA in October on its PMA supplement for idiopathic generalized epilepsy and said it is incorporating the agency’s feedback into an amendment it expects to submit around year-end. It submitted a PMA supplement for Remote Care, designed to let physicians program the RNS System through telehealth, with a planned 180-day review cycle. It also initiated enrollment in AURORA, a real-world evidence study intended to support expansion of the RNS System’s indication to adolescents aged 12 to 17 with drug-resistant focal epilepsy; data collection is expected to be completed in early 2027.