Learning About Vagus Nerve Stimulation (VNS) After a Stroke

Vagus nerve stimulation (VNS) uses a device to send electric impulses to the vagus nerve. The vagus nerve is the longest nerve in the body. It carries signals between your brain, heart, and digestive system. There is one on each side of your body.

Doctors have been using VNS to treat people with epilepsy or severe depression. In 2021, the U.S. Food and Drug Administration (FDA) approved a device that can help people who have trouble using an arm or hand after a stroke.

When you have a stroke, the blood flow from your heart to a part of your brain is blocked. The lack of blood damages the cells in that part of your brain. This can cause one side of your body to become weak or paralyzed (unable to move). Sometimes that means you won’t be able to use the arm and hand on that side of your body at all or not as well as before.

Stimulating the vagus nerve, along with doing physical therapy, can help create new pathways in the brain. This can improve people's ability to use their arm or hand after a stroke. To stimulate the nerve, a device is implanted under the skin of your chest. A thin wire connects the device to the vagus nerve in your neck. When activated, the device sends an electrical impulse through the vagus nerve to your brain. This usually doesn’t hurt, but you might feel a tingling sensation in your neck when the device is on. You might also find that your voice gets hoarse.

You will get medicine to put you to sleep (general anesthesia). The doctor makes a small cut in your chest to implant the device. The doctor guides the wire under your skin to the vagus nerve in your neck. The doctor makes another small cut to the skin of your neck to connect the wire to the vagus nerve. Usually doctors choose the left side of the body to implant the device.

Most people go home the same day and can resume their normal activities after a few days.

Not everyone who has had a stroke can have a VNS device. To be considered for this device you must:

• Have had a stroke that was caused by a clot (ischemic stroke).
• Be able to move your arm and hand a little.
• Have had the stroke more than 9 months before you get the device.

You can start using your VNS device a few weeks after the surgery. This will give the skin where the cuts were made time to heal. Your doctor will tell you when it's safe to use your VNS device and explain how to use it.

To get the most benefit, it’s best to activate your device while you’re doing physical therapy or other exercise to improve function in your arm or hand. Stimulating the vagus nerve along with doing repetitive movements with your arm or hand helps the brain form new pathways. You or your physical therapist will use a magnet to activate the device for a set amount of time.

When the VNS device is activated, you may have:

• Coughing.
• Hoarseness or a change in your voice.
• Tingling or pain in your neck or throat.
• Shortness of breath.
• Trouble speaking or swallowing.
• Headaches.

Usually these side effects lessen over time. Your doctor may also be able to adjust the strength of the electrical impulses to help with side effects.

Like any surgery, implanting the device also has possible risks. They include:

• Infection.
• Bleeding.
• Pain and swelling where the cuts were made.
• Damage to your vagus nerve or vocal cords.