Neuromodulation alters neuronal activity with electrical impulses delivered to the targeted neurologic sites. The various neuromodulation options available today for epilepsy management have proven efficacy primarily in adult trials. These include open-loop stimulation with invasive vagus nerve stimulation and deep brain stimulation, as well as closed-loop responsive neurostimulation. The use of neurostimulation therapy to treat intractable epilepsy in children is growing. This article reviews the literature, historical background, and current principles in pediatric patients.