Vagus nerve stimulation is an alternative to antiepileptic medications that has specific benefits for many patients. It was approved for general clinical use in Europe in 1994 and in the United States in 1997, and there now have been 60,000 patients implanted and more than 200,000 patient-years of experience. Along with growing clinical use, research has continued, with much of the focus on vagus nerve stimulation’s optimal use and breadth of indications. In a broad review, Dr. John Stern of UCLA discusses mechanistic insights, current use, and future directions for vagus nerve stimulation. The treatment of epilepsy continues to evolve to commonly include non-pharmacologic treatments, and vagus nerve stimulation is an important, conventional treatment option.