Brain stimulation has become a major field of innovation in epilepsy therapy during the last five years. Both direct stimulation of the brain and stimulation of brain nerves have class I evidence for efficacy in focal epilepsy. Diverse mechanisms of action are involved in the antiepileptic action, depending on stimulation parameters and site. Ictal closed-loop stimulation of the epileptic focus provides the first on-demand treatment available for epileptic seizures.