Vagus nerve stimulation and magnet use: Optimizing benefits

More than 10 years ago, the vagus nerve stimulator became the first device approved by the Food and Drug Administration for use in persons with epilepsy. The vagus nerve stimulator has subsequently served to spearhead the concept of neurostimulation for seizures. Chronic intermittent electrical stimulation of the left vagus nerve is the foundation for vagus nerve stimulation, yet little is known about its capability to deliver acute, on-demand, activation of stimulation through use of a magnet. Thus far, clinical use of magnet-induced vagus nerve stimulation has not been elucidated. In an effort to help guide management, we highlight current and potential uses of acute abortive therapy with vagus nerve stimulation. We review the current evidence that is available for vagus nerve stimulator magnet use, discuss potential clinical applications that exist, offer a protocol for magnet application within the institutional setting, provide our approach to titrating the magnet parameters, and make recommendations for magnet use that support an evolving standard of care.