tVNS for epilepsy

The short version

If your seizures have not responded to medication, you may already have been told about vagus nerve stimulation. For most people that conversation is about the implant: an operation under general anaesthetic, a wire around the nerve in the neck, a generator under the skin of the chest. Many people hear that and hesitate. Some are not suitable for it. Some are on a waiting list.

tVNS is the same idea without the operation. A small electrode worn in the ear delivers gentle electrical pulses to a branch of the same nerve, for a few hours a day, at home, alongside your usual anti-seizure medicines. It is a certified medical device, manufactured in Germany and distributed in the UK by Anatomical Concepts UK, and in controlled trials it has reduced seizures for some people. It has never been tested head to head against the implant, so nobody can yet say how the two compare. It can be stopped at any time.

It is not quick, and it does not work for everyone. This page says what it does, how long it takes to know, and how we support you through those weeks.

Who this is for

Around one in a hundred people in the UK live with epilepsy. For about two-thirds, medication brings seizures under reasonable control. For the rest, roughly 35,000 adults in the UK, the drugs do not work well enough, and clinicians call this drug-resistant epilepsy. If you are in that group you already know what it costs: driving, work, confidence, sleep, relationships, and the wear of never quite knowing.

tVNS is for adults in that group. It fits best if:

you have a confirmed diagnosis and a named neurologist or epilepsy nurse
your medication has been stable for a couple of months
you have been offered an implant and did not want it, are not suitable for it, or want to try a non-surgical route first
you have been referred for assessment for epilepsy surgery, or your team has already decided surgery is not right for you
you can commit to daily use for twenty weeks before judging

It is used alongside your medicines, never instead of them.

How it works, in plain English

The vagus nerve runs from the base of the brain, through the neck, and out to the heart, lungs and gut. One small branch of it surfaces in the outer ear, on a ridge called the cymba conchae. The implanted stimulator reaches the nerve in the neck; tVNS reaches the same nerve at the ear.

The device clips into the ear and touches that ridge. When you switch it on, it sends tiny, rhythmic pulses into the branch. Those pulses travel to the brainstem and on to the regions involved in seizures. Over weeks, this appears to make seizures less likely to happen and, when they do, often less severe.

You do not feel anything dramatic. Most people describe a gentle tingling in the ear. You wear the device for a few hours a day while you do something else.

What the evidence shows

tVNS is not a cure for epilepsy. Nothing is, for most people. The research on it as an add-on treatment for drug-resistant epilepsy is encouraging but mixed, and the overall quality of evidence is still rated low. Trials show fewer seizures on average, but the pooled results for the number of people who halve their seizures have not yet reached statistical significance.

In the largest controlled trial of auricular tVNS to date, published in 2023, just under 45% of the people who completed it achieved at least a 50% reduction in seizures, compared with around 17% in a low-dose control group. That trial used a different manufacturer's ear device, made in China, not this one.
In a real-world study in China with no control group, 99 people started and 65 were followed up for one to two years. Of those 65, just over 60% achieved at least a 50% reduction; counting the people lost to follow-up as not helped, the figure is about 40%. The device used was not named.
The largest European trial, run with the predecessor of this device and published in 2016, did not meet its main goal.
The benefit builds. In the controlled trial the effect only became clear at twenty weeks, with the difference growing but not yet certain at the earlier checks. This is why the decision point is week twenty, not week two.
Most side effects are mild and local: tingling, itching or redness where the electrode sits, and sometimes headache, dizziness or ear or neck discomfort. As with any vagus nerve therapy, a few people notice a temporary increase in seizures early on. The Instructions for Use list the full range, and anything that concerns you is a reason to call, not to wait.

An independent, triple-blind trial of this device in drug-resistant epilepsy, commissioned in Germany with 164 adults, is under way, with results expected in 2028. We say so because a good neurologist will find it, and because it is the kind of evidence the field needs.

Not everyone responds. People with fewer seizures to begin with tend to do better, and focal seizures may respond slightly better than some other types. Your neurologist is the best person to say whether you are a good candidate, and we will ask you about that on the first call.

The full evidence, for clinicians

The twenty weeks: what happens

This is the part that a device in a box cannot give you. tVNS reveals itself at week twelve to twenty, so we sell it as a supported programme with a decision at week twenty, and we walk alongside you until then.

A conversation first. Ask us for a call and we phone you within three working days for 20 to 30 minutes. We check the four things the device must not be used with, ask who your neurologist is, and talk honestly about what to expect. If we think tVNS is unlikely to help you, we say so. Nobody asks for money on that call.
A baseline. Before the device arrives you keep a seizure diary for eight weeks. We post you a printed one, laid out the way epilepsy nurses are used to; if you already keep a diary, carry on with it and we copy the totals across. Without a baseline, nobody can tell whether the treatment is working.
Your consultant informed. We write to your neurologist or epilepsy nurse when you start: what the device is, the protocol, the review schedule, and our details. If they want to talk to us, we talk to them.
A fitting call. By video, we make sure the electrode sits in the right place and the intensity is comfortable, and we agree a slot in your day that the sessions will live in. Four hours a day sounds like a prescription. In practice it is the evening film and the drive to work.
Scheduled calls. Week 2, to reset the intensity as your skin gets used to it. Week 4, which we call the wobble week, because that is when routines slip. Week 8 and week 12, to look at the diary together without judging it yet. Each time, a named person who knows your file.
Summary sheets for your appointments. At weeks 8, 12 and 20 we give you a one-page summary to take to your neurologist: adherence, diary totals, side effects, questions to ask.
The decision at week twenty. You, your consultant and we look at the diary and name the outcome plainly: a clear response, a partial response worth continuing, or no response. If it has not helped, we say so and help you stop. We are finalising a supported evaluation period around that decision, and the terms will be published here when they are settled.

Each stage in more detail, and what it usually feels like: Twenty weeks, week by week.

One safety note, said once. Epilepsy charities recommend that everyone with epilepsy goes through the SUDEP and Seizure Safety Checklist with their clinical team. tVNS does not change that advice. Any adverse event can be reported to us and to the MHRA's Yellow Card scheme.

Who it is not for

tVNS is intended for adults aged 18 and over. Do not use it if you:

are pregnant
have an active implant, such as a cochlear implant, an implanted vagus nerve stimulator, or a cardiac pacemaker
have a cerebral shunt (for example, for hydrocephalus)
have sore or broken skin where the electrode would sit

If you have a heart rhythm problem, talk to your doctor before using tVNS. We ask all four questions on the first call, and tVNS should be used under medical supervision throughout.

Common questions

Is tVNS the same as the implanted vagus nerve stimulator? Same nerve, same principle, different route in. The implant is placed surgically in the neck and chest and has the longer and stronger evidence record. The two have never been compared in the same trial, so nobody can say how their results compare, and a response or non-response to tVNS does not tell you how you would do with an implant. tVNS reaches the nerve through the ear, needs no operation, and can be stopped at any time. It does not replace an assessment for epilepsy surgery: NICE advises that everyone with drug-resistant epilepsy is referred for one, because for suitable people surgery is the treatment most likely to stop seizures altogether.

Does it hurt? Most people describe a mild tingling in the ear. It should not be painful. The intensity is set so that you feel it clearly but never uncomfortably, and we reset it at week two as your skin acclimatises.

Four hours a day sounds a lot. It is more than it sounds. The sessions can be split, and most people attach them to things they already do: the evening in front of the television, the commute, the hour after breakfast. On the fitting call we work out where they fit in your day.

Can I still drive? Driving depends on your seizure control, not on the device. DVLA rules apply to you in the usual way. Your consultant is the right person to advise you on driving.

Can I use it with other treatments? Yes. tVNS is designed to be used alongside your existing medication, and your medication should stay stable through the twenty weeks so that any change can be read clearly. Always talk to your consultant first.

How much does it cost? The device is £3,046.76 including VAT, which includes the starter consumables. That is considerably less than an implant, and there are no surgical or hospital costs. The price is not the whole story: it comes with the calls, the letters and the decision at week twenty described above. The how to access page has the detail and will carry the evaluation terms once they are settled.

What to do next

Ask us for a call. The form takes two minutes. We phone you within three working days, and nobody asks for money on that call.
Tell your neurologist. Or let us. Ask whether they are open to neuromodulation as an add-on to your current treatment; if they want the evidence, the clinician page below has it.
Start a seizure diary now, if you do not keep one. It is useful whatever you decide.

Request a call

For clinicians: the full evidence page

How to access tVNS

This page is for information only. It is not medical advice. Any decision about tVNS should be made with your clinician, who knows your full medical history.

tVNS is a Class IIa medical device manufactured by tVNS Technologies GmbH, Germany. Distributed in the UK by Anatomical Concepts UK Ltd.