Three neuromodulation therapies have been appropriately tested and approved in refractory focal epilepsies: vagus nerve stimulation (VNS), deep brain stimulation of the anterior nucleus of the thalamus (ANT-DBS), and closed-loop responsive neurostimulation of the epileptogenic zone or zones. These therapies are primarily palliative. Only a few individuals have achieved complete freedom from seizures for more than 12 months with these therapies, whereas more than half have benefited from long-term reduction in seizure frequency of more than 50%. Implantation-related adverse events primarily include infection and pain at the implant site. Intracranial haemorrhage is a frequent adverse event for ANT-DBS and responsive neurostimulation. Other stimulation-specific side-effects are observed with VNS and ANT-DBS. Biomarkers to predict response to neuromodulation therapies are not available, and high-level evidence to aid decision making about when and for whom these therapies should be preferred over other antiepileptic treatments is scant. Future studies are thus needed to address these shortfalls in knowledge, approve other forms of neuromodulation, and develop personalised closed-loop therapies with embedded machine learning. Until then, neuromodulation could be considered for individuals with intractable seizures, ideally after the possibility of curative surgical treatment has been carefully assessed and ruled out or judged less appropriate.

三种神经调节疗法已在难治性局灶性癫痫中进行了适当的测试和批准：迷走神经刺激 (VNS)、丘脑前核深部脑刺激 (ANT-DBS) 和致癫痫区的闭环响应性神经刺激。这些疗法主要是姑息性的。只有少数人通过这些疗法在超过 12 个月的时间内完全摆脱了癫痫发作，而超过一半的人从癫痫发作频率长期降低 50% 以上中受益。植入相关的不良事件主要包括植入部位的感染和疼痛。颅内出血是 ANT-DBS 和反应性神经刺激的常见不良事件。用 VNS 和 ANT-DBS 观察到其他刺激特异性副作用。无法获得预测对神经调节疗法的反应的生物标志物，并且缺乏高水平的证据来帮助决定何时以及哪些人应该优先选择这些疗法而不是其他抗癫痫治疗。因此，未来的研究需要解决这些知识不足，批准其他形式的神经调节，并开发具有嵌入式机器学习的个性化闭环疗法。在那之前，可以考虑对患有顽固性癫痫发作的个体进行神经调节，理想情况下是在对治愈性手术治疗的可能性进行仔细评估并排除或判断为不太合适之后。因此，未来的研究需要解决这些知识不足，批准其他形式的神经调节，并开发具有嵌入式机器学习的个性化闭环疗法。在那之前，可以考虑对患有顽固性癫痫发作的个体进行神经调节，理想情况下是在对治愈性手术治疗的可能性进行仔细评估并排除或判断为不太合适之后。因此，未来的研究需要解决这些知识不足，批准其他形式的神经调节，并开发具有嵌入式机器学习的个性化闭环疗法。在那之前，可以考虑对患有顽固性癫痫发作的个体进行神经调节，理想情况下是在对治愈性手术治疗的可能性进行仔细评估并排除或判断为不太合适之后。