About 40 % of new-onset epilepsy is drug refractory. If epilepsy surgery is not an option or fails, vagal nerve stimulation (VNS) can be considered. VNS efficacy is reported as more than 50 % seizure frequency reduction in 50-56 % of patients. Features in the newer models offer additional treatment optimization possibilities. Side effects include hoarseness, cough, and dyspnoea. Caution is advised for patients with sleep apnoea or lung disease. VNS has specific limitations concerning MRI. This review presents an overview of VNS treatment in Denmark and discusses future challenges.