The anterior nucleus of the thalamus (ANT) plays a critical role in epilepsy, particularly in the propagation and generalization of seizures through its connections with the limbic system and cortico-thalamo-cortical circuits. As a target for deep brain stimulation (DBS), the ANT has emerged as a promising treatment for patients with drug-resistant epilepsy not amenable to conventional therapies. Early studies on thalamic lesioning in epilepsy paved the way for investigating ANT-specific interventions. Preclinical and clinical studies demonstrated that high-frequency ANT stimulation reduces seizure frequency and severity, particularly in generalized tonic-clonic and focal impaired-awareness seizures, while maintaining a favorable safety profile. Advances in DBS technology facilitated fully implantable systems, leading to further studies and clinical trials, including the landmark SANTE trial. This multicenter study confirmed the efficacy of ANT DBS, particularly in patients with temporal lobe epilepsy (TLE), with seizure reductions sustained over long-term follow-ups. While adverse events were reported, they were largely device-related and comparable to other DBS applications. Variability in outcomes highlights the need for further research into stimulation parameters, seizure origin, and mechanisms of action.