At the “Second International Workshop on Seizure Prediction” held recently in Washington, DC, under the co-sponsorship of NIH/NINDS and the AES, the importance of prospectively comparing the therapeutic efficacy of “closed-” vs. “open-loop” brain electrical stimulation was identified as an important research aim, and the meaning of these terms was briefly debated. Therapies that utilize any type of feedback, including patient seizure diaries, are “closed-loop”. The term “open-loop” was adopted for description of clinical trials with devices lacking automated means for (a) detecting seizures, quantifying their severity, and logging these data; and (b) triggering delivery of therapy based on seizure detections. As currently used, the term “open loop” may create confusion since the therapies to which it is applied rely on patient diary-feedback. The following clarification may be useful: Closed-loop therapy: Any therapy that uses a feedback loop. The feedback may be real-time or delayed (off-line); for both these options, the feedback may be automated or manual, objective or subjective, and may be used to trigger therapy delivery or to adjust parameters or dose. Open-loop therapy: Any therapy that operates without any feedback loop. Recent trials that use automated seizure detection to trigger electrical stimulation directly to the brain (Osorio et al., 2005; Bergey et al., 2006) are examples of automated real-time closed-loop. One of these trials (Osorio et al., 2005) provides real-time automated therapy delivery and objective quantitative assessment of response, while the other (Bergey et al., 2006) provides only automated therapy (as assessment is based on seizure diaries). Vagus nerve stimulation with the neurocybernetic prosthesis (Cyberonics, Houston, TX, U.S.A.), exemplifies two closed-loop modalities: (1) real-time manual closed loop, when the magnet is used to activate the generator in response to an “aura”; and (2) delayed closed loop, when device parameter changes are based upon subjective feedback in the form of seizure diaries. With these definitions in place, the incorrectly stated and irrelevant/futile aim of comparing “open-loop” vs. “closed-loop” therapies should be re-framed. With respect to brain stimulation studies, we offer the following formulation: The aim is to compare efficacy (and adverse events) of therapies that use either continuous, periodic, or random brain electrical stimulation to that of therapies based on contingent stimulation (i.e., in response to) seizure detections. This would be a worthwhile endeavor that should be pursued using objective and quantifiable assessment means such as seizure detection algorithms, instead of patient seizure diaries; diaries are inherently and grossly inaccurate (Blum et al., 1996), provide information only about seizures with clinical manifestations (a small fraction of all recorded seizures) (Osorio et al., 2002), and do not quantify intensity, duration, and extent of spread.