Recent Advances in Vagus Nerve Stimulation for Stroke Rehabilitation

Abstract Purpose of Review This review synthesizes recent developments in vagus nerve stimulation (VNS) for stroke rehabilitation from 2021–2025, emphasizing the transition from experimental approaches to clinical implementation following FDA approval of implantable VNS. Recent Findings The 2021 FDA approval of the Vivistim Paired VNS System marked a watershed moment in stroke neuromodulation, providing the first regulatory-approved VNS therapy for upper extremity motor recovery. Long-term follow-up studies demonstrate sustained benefits at one year, with 66% of patients achieving clinically meaningful improvements. Concurrently, investigational transcutaneous approaches continue to evolve, though they remain limited by protocol heterogeneity and anatomical specificity concerns. Summary Implantable VNS paired with rehabilitation represents a paradigm shift in stroke care, offering evidence-based neuromodulation therapy for patients with chronic upper limb impairment. While transcutaneous approaches show promise in research settings, their clinical translation requires standardization and larger controlled trials. Current evidence strongly supports implantable VNS as a viable therapeutic option for carefully selected patients, while highlighting the importance of distinguishing proven treatments from investigational approaches in clinical practice.