| Sumario: | Over the recent years, electrical stimulation therapy has rapidly evolved as a commonly used neuromodulation therapy for epilepsy. Although open - loop stimulation [such as vagus nerve stimulation (VNS) and anterior nucleus of the thalamus deep brain stimulation (ANT-DBS)] has achieved certain success in treating drug -resistant epilepsy, its fixed -parameters, continuous stimulation paradigm suffers from limitations such as a mismatch between timing and dosage, poor individual adaptability, and more. In contrast, closed - loop stimulation [exemplified by responsive neurostimulator system (RNS)] significantly enhances treatment precision and energy efficiency by monitoring brain activity in real time and delivering responsive stimulation before or during seizures. It also leverages long-term data to optimize stimulation parameters and promote brain network remodeling. This review outlines the development, mechanisms, and recent advances in drug-resistant epilepsy neuromodulation from open-loop stimulation to closed-loop stimulation, and discusses future prospects for more predictive, adaptive, and network-oriented approaches, providing a theoretical foundation for personalized and precise epilepsy treatment.
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