Vagal nerve stimulation (VNS) was FDA-approved in 1997 as an adjunctive therapy for refractory epilepsy. The University of Florida was part of the early trials for VNS, and we have a large population of patients with VNS currently under our care. While the detailed mechanisms of VNS’s efficacy remain under investigation, it is clear that the therapy can be a valuable addition to treatment options available for patients who continue to experience seizures despite optimum drug treatment. All patients who may benefit from VNS are first vetted at our multidisciplinary patient management conference for their suitability. Following a consensus decision to proceed with VNS, the patient is counseled and scheduled for the procedure. The insertion of the VNS itself is a short surgery under general anesthesia, where the battery pack is inserted into the upper chest, and the stimulation wire attached to the vagus nerve in the neck. Patients usually go home the day following their procedure, and subsequently attend the clinic for follow up where the settings of stimulation are gradually adjusted. Benefit from VNS can take several months to become evident.