Nonpharmacological treatment can reinforce pharmacological treatment. Nonpharmacological treatment is the last method of treatment for extremely refractory persistent epilepsy, and common methods include subcryotherapy, electroconvulsive shock, repetitive transcranial magnetic stimulation, surgery, and vagus nerve stimulation. 1 , Cryotherapy Animal studies of persistent epilepsy found that hypothermia reduced the intensity of seizures and epileptic discharges, brain edema, and apoptosis, however, clinical studies in refractory persistent epilepsy are limited, and mild hypothermia (31C36°C) induced by midazolam, ketamine, and thiopental sodium use for one to several days has been reported to control refractory persistent epilepsy, but re-temperature is followed by relapse. Corry et al. reported that epilepsy was controlled by hypothermia in four patients who had failed to respond to intravenous antiepileptic drugs, but two of these patients died from other causes. Paralytic intestinal obstruction in patients with persistent epilepsy is a challenging complication, especially when combined with barbiturates. 2. Electroconvulsive shock Highly refractory persistent epilepsy can be treated with electroconvulsive shock, but its mechanism of action is not clear. Kamel et al. reported three cases of RSE treated with electroconvulsive shock, all of whom were switched to electroconvulsive therapy because of failure of intravenous antiepileptic drugs; two patients were treated with electroconvulsive shock on day 30 of drug therapy and one on day 70 of drug therapy. Two patients were treated with electroconvulsive therapy on day 30 of drug therapy and the other on day 70 of drug therapy. The mechanism of action of repetitive transcranial magnetic stimulation is unknown. In patients with simple partial-onset epilepsy, low-frequency transcranial magnetic stimulation can control seizures in the short term, but its effectiveness decreases after the start of treatment and therefore needs to be repeated. Surgery is known to improve seizures in some patients with intractable epilepsy, but the surgical approach varies depending on the cause. Common operable conditions include focal cortical dysplasia, hypothalamic malformations, cerebral spongiform vascular malformations, and Rasmussen’s encephalitis. Surgical options include focal resection, lobectomy, multiple submural dissection, hemispheric and corpus callosum ganglionectomy. Treatment of vagally refractory persistent seizures by stimulation of the vagus nerve. Complications such as transient bradycardia or cardiac arrest can occur with this approach that requires an operating room. There is a report of a 13-year-old boy diagnosed with refractory persistent epilepsy who had seizures stopped after placement of a left vagus nerve stimulator, with improved outcome and control lasting more than 1.5 years. There have also been recent reports of stimulation of the deep thalamic core adhesion granules bilaterally for refractory persistent epilepsy.