Deep brain stimulation (DBS) was FDA-approved in 2018 as adjunctive therapy for refractory epilepsy. DBS is different from RNS and similar to VNS in that treatment is designed to reduce the frequency of seizures over time, rather than target specific seizures at the time of their occurrence. DBS therapy can be a valuable addition to treatment options available for patients who continue to experience seizures despite optimum drug treatment, though full benefits may take months or years to accrue. As with all complex patients, patients who may benefit from DBS are first vetted at our multidisciplinary patient management conference for their suitability. Following a consensus decision to proceed with DBS, the patient is counseled and scheduled for the procedure. The insertion of the DBS itself involves surgery under general anesthesia, where the stimulation wires are inserted into the anterior nucleus of the thalamus of the brain, and the stimulator pack is situated under the skin on the upper chest. At the University of Florida, we have pioneered these surgeries for other types of neurological patients (those with movement disorders such as Parkinson’s disease) and our surgeons have extensive experience of the practical aspects of the surgical procedure. Patients usually go home a day or two after the procedure, and subsequently attend the clinic for follow up where the settings of stimulation are gradually adjusted. The benefits of DBS for epilepsy takes time to build up – at least several months, and sometimes a few years.