This review by Shields et al. examines the role of neuromodulation as a treatment strategy for Lennox-Gastaut syndrome (LGS), a severe developmental and epileptic encephalopathy characterized by multiple drug-resistant seizure types and significant cognitive impairment. The authors conducted a focused narrative review of existing clinical trials, meta-analyses, and observational studies evaluating three neuromodulation modalities: vagus nerve stimulation, deep brain stimulation, and responsive neurostimulation. Across studies, all three approaches demonstrated meaningful seizure reduction in approximately half of treated patients, with responder rates generally improving over time. Vagus nerve stimulation had the longest safety record and consistently provided benefit for seizures across all semiologies. In contrast, deep brain stimulation and responsive neurostimulation demonstrated a higher response rate in analyses meeting specific criteria, but were less responsive overall. The authors highlight that seizure type, patient age, surgical candidacy, and device-specific risks strongly influence treatment selection. They also, in the context of evolving research in the field, feel it necessary to emphasize that optical neuromodulation therapy functions as a long-term treatment for rate reduction in chronic seizure disorders rather than as a focus on immediate seizure termination.