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Multiple devices are available with long\u2010term follow\u2010up and real\u2010world experience. The aim of this review is to give a practical summary of available neuromodulation techniques to guide the selection of modalities, focusing on patient selection for devices, common approaches and techniques for initiation of programming, and outpatient management issues. Vagus nerve stimulation (VNS), deep brain stimulation of the anterior nucleus of the thalamus (DBS\u2010ANT), and responsive neurostimulation (RNS) are all supported by randomized controlled trials that show safety and a significant impact on seizure reduction, as well as a suggestion of reduction in the risk of sudden unexplained death in epilepsy (SUDEP). Significant seizure reductions are observed after 3\u2009months for DBS, RNS, and VNS in randomized controlled trials, and efficacy appears to improve with time out to 7 to 10\u2009years of follow\u2010up for all modalities, albeit in uncontrolled follow\u2010up or retrospective studies. A significant number of patients experience seizure\u2010free intervals of 6\u00a0months or more with all three modalities. Number and location of epileptogenic foci are important factors affecting efficacy, and together with comorbidities such as severe mood or sleep disorders, may influence the choice of modality. Programming has evolved\u2014DBS is typically initiated at lower current\/voltage than used in the pivotal trial, whereas target charge density is lower with RNS, however generalizable optimal parameters are yet to be defined. Noninvasive brain stimulation is an emerging stimulation modality, although it is currently not used widely. In summary, clinical practice has evolved from those established in pivotal trials. Guidance is now available for clinicians who wish to expand their approach, and choice of neuromodulation technique may be tailored to individual patients based on their epilepsy characteristics, risk tolerance, and preferences.<\/jats:p>","DOI":"10.1111\/epi.17329","type":"journal-article","created":{"date-parts":[[2022,6,14]],"date-time":"2022-06-14T13:22:01Z","timestamp":1655212921000},"page":"2445-2460","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":118,"title":["Practical considerations in epilepsy neurostimulation"],"prefix":"10.1111","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8695-1904","authenticated-orcid":false,"given":"Hugh D.","family":"Simpson","sequence":"first","affiliation":[{"name":"Division of Epilepsy, Department of Neurology Mayo Clinic  Rochester Minnesota 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