OBJECTIVE To describe the mechanism and first results of vagus nerve stimulation at the Medisch Spectrum Twenty, the Netherlands, for the treatment of patients with drug-resistant epilepsy. METHODS Descriptive retrospective. METHODS Fifteen patients, 8 male and 7 female, aged 18-45 years with drug-resistant epilepsy, who were not eligible for surgical resection of an epileptic focus, received a vagus nerve stimulator implant in the period April 1999-December 2000. Whilst the vagus nerve stimulator was being adjusted, the medication remained unchanged. RESULTS Due to vagus nerve stimulation the mean seizure frequency decreased by 32% (range: +20% to -100%). In 6 patients there was a strong reduction in seizure frequency, in 3 there was a mild reduction, and in 6 patients there was no apparent effect. The most common adverse events during stimulation were a mild prickly cough and a change of voice during stimulation. In one patient a temporary left vocal cord paralysis was observed, which may possibly have been a result of the procedure. CONCLUSIONS Vagus nerve stimulation is an effective means of treatment for drug-resistant epilepsy and is therefore a treatment option that deserves more attention in the Netherlands.