In scenarios where the epileptogenic zone cannot be safely resected, neuromodulation is a viable option. When considering responsive neurostimulation (RNS), deep brain stimulation (DBS), or vagal nerve stimulation (VNS), however, we must understand that these modalities provide significant seizure reduction, but rarely seizure freedom. Specifically, although RNS, DBS, and VNS, in general, have reported seizure reduction rates of 70%, 40%, and 44%, respectively, they are associated with seizure freedom rates of 15% (for 1 year), 6%, and less than 10%.54-56 In comparison to the potential for seizure freedom with surgical resection, neuromodulation is definitively inferior and as such should only be considered when resection cannot be performed.