Already on the leading edge of electronic stimulation for new applications like stroke recovery, UConn Health's Dr. Christopher Conner, who specializes in stereotactic and functional neurosurgery, is on the verge of another one! He joins Dr. Anthony Alessi to explain how Vivistim has been opening new doors to regaining function after stroke, who the best candidates are, and how a similar concept for autoimmune disorders may not be far behind.
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https://www.uconnhealth.org/providers/profiles/conner-christopher
UConn Health Department of Neurosurgery:
https://www.uconnhealth.org/neurosurgery
The Brain and Spine Institute at UConn Health:
https://www.uconnhealth.org/brain-spine
UConn Health Orthopedics and Sports Medicine:
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“UConn Health Neuromodulation Center of Excellence for Veterans” (UConn Today, June 17, 2025):
https://today.uconn.edu/2025/06/uconn-health-neuromodulation-center-of-excellence-for-veterans/
“Grateful Stroke Survivor Shares How New Technology Is Transforming His Recovery” (UConn Today, Nov. 25, 2024):
https://today.uconn.edu/2024/11/grateful-stroke-survivor-shares-how-new-technology-is-transforming-his-recovery/
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Transcript
Dr. Alessi: Welcome to the Healthy Rounds Podcast, where we provide you with up-to-date and timely medical information from national and international leaders in their fields. This podcast is brought to you by UConn Health, with support from the Department of Orthopaedic Surgery and a grant from Coverys. It is not designed to direct your personal healthcare, which should only be done by your physician.
I’m your host, Dr. Anthony Alessi, and it’s great to have as my guest today Dr. Christopher Conner. Dr. Conner is an assistant professor in the Department of Neurosurgery, and he specializes in stereotactic and functional neurosurgery. Chris, welcome to the show.
Dr. Conner: It’s fantastic being here, Dr. Alessi.
Dr. Alessi: Let’s talk. Can you explain to our listeners what is stereotactic and functional neurosurgery?
Dr. Conner: The simple answer is that I get paid money to put wires and batteries into people’s bodies, which is a really weird thing to do with your day-to-day work, but it is what it is. What it really means, though, is that a majority of what I’m doing is trying to improve people’s day-to-day lives.
That’s kind of the functional aspect of it, and that can encompass a lot of things. It can encompass chronic pain. It can encompass stroke recovery. It can also involve Parkinson’s disease or movement disorders, and even epilepsy. And so these are some diseases that you might sometimes think of as not something that surgery can, can treat, but this is kind of where someone like myself comes into play.
Dr. Alessi: That’s great. Now, let’s go back a little bit. I want to talk, you brought up several different topics, and I know we covered this about two years ago when you were on my radio show. So I want to touch base. Let’s go to Parkinson’s disease, doing deep brain stimulation. You were just starting that at the time here at UConn Health. Where are we with that program?
Dr. Conner: The program has really gotten its feet underneath it. We’ve done upwards of, I think, about 25 or 30 patients with deep brain stimulation, primarily for Parkinson’s disease, although we also treat patients with essential tremor and some other disorders with that here at UConn Health.
But at this point in time, we have a, a really full-fledged program. My movement disorder neurologists, like Dr. [Sarah] Mancone, Dr. [Bernardo] Rodrigues, Dr. [Chindhuri] Selvadurai, and I, we’re really proud of what we can accomplish here, and we can offer kind of a full-stack treatment for people who have advanced Parkinson’s disease. And again, that deep brain stimulation, when I use that term, stimulation, it generally means applying electricity somewhere in the body, and it’s been really gratifying seeing a lot of our patients now that are coming back in a year or two years who are having life-changing, remarkable improvements in their symptoms.
And so we’re finally kind of at that point where we’re getting to our long-term patient outcomes, and I’m really happy to report that we’re doing as well or really much better than what kind of the typical program’s able to achieve.
Dr. Alessi: Let me get back to the idea of putting batteries and wires in people How does that work? In other words, when you’re doing deep brain stimulation or, for years we talked about vagal nerve stimulation, right? People were, and still are, obsessed with the vagus nerve. But when you’re doing that, is it the depolarization? Is it the stim? What is actually taking effect when you’re doing something like that?
Dr. Conner: So every one of these applications we have works in a different way, and the uncomfortable but honest answer that I have for you is that a vast majority of the time, we don’t understand how the electricity is really working on a pretty fundamental level. And that’s true of deep brain stimulation, of vagus nerve stimulation, of spinal cord stimulation. Every one of those is a different kind of wire. Every one of those is a different kind of thing we’re stimulating, and a lot of the time we don’t completely understand it. We might have a good idea about it, but it’s still more than a little bit of a mystery.
Dr. Alessi: And I want to clarify, because I was talking to a patient about it today, and they said, “Oh, is that like ECT?” And this is very different from electroconvulsive therapy which we know how that works.
Dr. Conner: Yeah. We have a better idea, kind of generally, of how electroconvulsive therapy works. The difference is that electroconvulsive therapy is, I think it’s fair to say that it’s a less targeted therapy. So when we’re talking about these wires, we’re talking about trying to deliver electricity to something that’s the, you know, maybe two or three millimeters in size.
That’s a really small area. It’s really targeted that we’re trying to deliver therapy to. Electroconvulsive therapy is more of a whole-brain kind of style of therapy. And so the difference really is magnitude and targeting when we’re talking about the difference between those different approaches.
Dr. Alessi: Let’s go to the vagus nerve, vagal nerve stimulation, I remember, I mean, we’ve been doing this for decades for epilepsy. How effective is it for epilepsy?
Dr. Conner: Yeah. So it’s been around and FDA approved for several decades for both epilepsy and then also for depression. Epilepsy is a seizure disorder. Once you’ve had several seizures, you have a diagnosis of epilepsy, and in some people, we can’t really figure out exactly what area of the brain it’s coming from. It’s called generalized epilepsy. And in those patients, sometimes medications work, and in a shockingly large chunk of people, medications don’t work.
And then, kind of one of the best therapies we had for a long time was stimulating the vagus nerve, which is a nerve in the neck, and the general kind of way I counsel patients is that in 50% of patients it’ll drop your seizures by 50%. So it’s kind of a 50/50 rule, which, in some people, that’s enough to have them be happy with the outcome and to think that the surgery was worthwhile. But it still wasn’t maybe the best that we could do. Fortunately, now there are some deep brain stimulation, wires inside of the brain, there are some ways that we can do that in order to treat epilepsy as well now.
Dr. Alessi: I’ve seen several people using or purchasing these external vagal nerve stimulators. Do they work? Is it garbage? What is it?
Dr. Conner: I mean, that’s a really great question. To my knowledge, no one’s ever really validated whether or not external vagus nerve stimulation works. The vagus nerve is not right at the surface. There’s a big muscle in your neck. If you turn your head, there’s a big muscle coming from the back of your skull all the way down to your collar or clavicle, and that muscle, it’s called the sternocleidomastoid, it’s a big, thick muscle, and it’s sitting right over the vagus nerve.
I just don’t—it’s tough for me to see how electrical stimulations can get through that muscle and into the nerve and not cause that muscle to painfully contract. So I don’t know if it works or not. I think there’s a lot of people out there selling it to you, and it’s up to them to really tell you whether or not it’s effective and do that study. I don’t think it’s been done, though.
Dr. Alessi: Well, it’s interesting because I had a patient who had a concussion, and he was a professional athlete, so he had unlimited means. And someone told him to buy one of these vagal stimulators.
Now, professional athletes don’t buy anything, so he had somebody buy it for him, OK? I’m sure that they wanted an endorsement. He used it once and said it was so uncomfortable and painful, he would never touch it again. So I think that’s the idea of trying to get the stim through the sternocleidomastoid and probably made it very uncomfortable. And I’ve not known it to work at all for a concussion.
Let’s move on, when we talk about the vagus nerve, and I really wanted to get to Vivistim. Because Vivistim is something we talked about back in February of 2024 when you were on my radio program, and you were really just starting that program. Can you tell people really what is Vivistim, and what are you using it for?
Dr. Conner: Awesome question, something I love talking about. So Vivistim is the commercial name for a vagus nerve stimulator. It’s a totally new one, even though it’s very similar to the old one that we had. Again, it’s a small wire that wraps around a nerve in your neck, and it runs electricity into that nerve. We are using it right now for stroke recovery.
A lot of people who have strokes, they don’t get back to where they want to be at in terms of their functional ability, that’s the word functional again, and they kind of plateau between six and twelve months after the stroke. What we have found is that if you stimulate that nerve in a certain way, you can actually boost someone’s recovery quite significantly, even years after they’ve had their stroke.
Now, the vagus nerve doesn’t control your arms or legs, so we don’t know how it works. But what we do find is that if we stimulate it while you’re getting occupational therapy, while you’re trying to use whatever arm or leg is affected — and technically only the arm’s FDA approved — your therapy is much more effective at getting you back to where you want to be.
Now, at this point in time, I’m really happy to let everyone know we’ve done over 25 patients. We’ve just had our first paper on our first 20 patients accepted, and I can report that in our first 21 patients, everyone saw a functional gain with this vagus nerve stimulation, and our results were about 2X, about twice what they saw in the initial trial.
And so it does work. And I see patients back in my clinic all the time who’ve had this done, and it’s incredibly gratifying to see how much benefit they can get from it. It’s been remarkable. And I have physicians text me, physiatrists, I have neurologists text me, or come and find me to talk to me, like, “I’ve never seen this kind of recovery in stroke before,” and it’s really changing how we’re treating things.
Dr. Alessi: So I guess I have to ask you, why only 25 patients in two years? So how do you select your patients? Is it just people who had a hemorrhagic stroke? Is it just ischemic stroke? Is it lacunar stroke? I mean, how are you picking it? Because obviously there’ve been a lot more patients here for stroke.
Dr. Conner: I think... Well, to get to the primary question, which is how do we, what is patient selection? Right now the only strokes that are on label are what are called ischemic strokes. You have to be several months out from the stroke, so we’re usually saying six to 12 months out from the stroke. You still have to have a deficit, i.e., weakness or some kind of functional issue with one of your arms. But there’s a Goldilocks zone for that. If you have a stroke and you get no recovery at all, you can’t move your arm at all, Vivistim’s not going to work for you. If you have a stroke and you get all the way back to where you were before the stroke, you have a complete recovery, we wouldn’t do surgery, OK?
So there’s a Goldilocks zone in there, and that’s measured by an occupational therapist, and that window can sometimes be a little bit tricky because it seems pretty wide, but sometimes patients don’t quite qualify on that. I’d say that’s the most common reason that patients don’t qualify.
And then we’re doing a lot of work trying to get the message out. This is one of the reasons that I’m here today, that I’m really excited to talk about Vivistim because I do think that we need to do a better job kind of advertising this and kind of talking to people about this as an option. So I spend a lot of time doing that, going out and talking to occupational therapists, physiatrists, patient support groups. We’re doing a lot of outreach, and I think outreach is kind of one of the ways that we’re going to get more in.
Twenty-five, though, for a program of our size, in our state is... I’m really proud of that. We actually have had a faster adoption than just about anywhere else, and the company’s told me that. I did three of them on Monday. So we’re picking up a lot of speed. We have money from the Connecticut legislature to do a whole program just focusing on veterans. So we really are kind of like ramping this up, but this is where I need people like Dr. Tony Alessi to help out.
Dr. Alessi: Do you you expect that Goldilocks range to increase to some degree? I mean, well, let me go back. What are the risks of the surgery?
Dr. Conner: So I mean, every surgery has a risk of bleeding, infection, all that kind of stuff. The main risks of this surgery, when we’re putting one of these implants in, the infection risk is 3%. It’s kind of generally what’s accepted. So it’s not trivial. You can damage any structure that we’re operating around. We talked about the muscle that it’s underneath, but there’s a big artery in your neck you can feel, your carotid artery. That big pumping artery is actually how I find the nerve. Now, knock on wood, I’ve never actually injured that during a surgery, but that’s there.
There are other small nerves there, the jugular veins, so there’s a lot of things there. So the risks are low, though. The main one is infection, and I’ve seen... I generally quote people there’s a 1% to 3% risk of having a major complication. It’s pretty safe. It’s outpatient. You go home the same day.
Dr. Alessi: Why does it not work if you have complete paralysis of the limb?
Dr. Conner: So your brain needs to have some connection to the arm. Some information needs to be getting through. And we have to have something to kind of build on. If that hasn’t happened at all, my thought is that it’s telling us that the stroke was too extensive for us to really build on it. So something has to be getting through. Some activity or activation has to be making it through, and if that’s not occurring by six to 12 months, I think it’s unlikely for that to occur.
Dr. Alessi: Is that why the six-to-12-month period to see how much recovery was going to occur on its own?
Dr. Conner: That’s just how they designed the study. Should we be doing it earlier and super charging—
Dr. Alessi: Yeah! Well, I’m thinking of myself, OK? If it was my stroke, I’d want to get on this deal.
Dr. Conner: I have no problem with that. My hands are... I’m a little bit handcuffed by like the guidelines and all that kind of stuff. It’s hard for me to even begin to tell you how much work it takes to get a patient into my clinic all the way through insurance authorization. I have a meeting every month with my whole team to talk about, “Where are all of our patients at?” We have a list of everyone. Where’s everyone at in insurance authorization?
If you guys and your listeners think insurance is a pain for them, on the physician side, it’s just as annoying because I see people who I know qualify, and then I have people who it takes over a year, and I have to go and talk with judges and make write letters all the time, and it’s a huge outlay, but I believe in it, and it works, so I’m willing to do it.
But I would love to do it earlier. Maybe we should do it at three months. Why not?
Dr. Alessi: What’s it cost?
Dr. Conner: That’s always a tricky question. Probably, I think all in, it’s, I don’t know, the device costs, I think 20, 25-thousand bucks. I’m pretty cheap. I’m a pretty cheap date, actually, timewise.
Dr. Alessi: Well, it’s UConn.
Dr. Conner: It’s UConn, right? We’re a state institution. We’re trying to have deals for people. So it’s not, it’s really not bad, and if someone wanted to pay out of pocket, we’d find a way to do that, but that would be what we’d have to do in order to do the surgery earlier.
Dr. Alessi: Let me move on a little bit, and since we’re coming to the end of the podcast, I always find it exciting to talk to you, and I certainly did the last time. What’s the next big step? I mean, what are we looking for in functional neurosurgery?
Dr. Conner: OK, so I’m, we’re going to stay on the topic of vagus nerve stimulation because we’re already there. So we are this close — and I’m holding my pinky and thumb really close together, or my index finger really close together — really close to launching a program and another stimulator called SetPoint. SetPoint — this is where things get totally weird. You can put a stimulator on the vagus nerve, and you can stimulate it to help people with autoimmune disorders get significant relief from their autoimmune disorders.
Now, number one on that list is rheumatoid arthritis, and this is a brand-new device. They are just launching it. We’re going to be one of the first centers anywhere to get it. I just talked with one of the reps today, like our lawyers are finishing up the agreement, but set point’s the next thing, and we’re going to do it for rheumatoid arthritis, but I know they’re looking into other indications for it as well.
And how does the vagus nerve affect your autoimmune system? The argument is that there’s an organ in your abdomen called the spleen. It’s really involved in your immune system, and there is some innervation, that’s nerves, from the vagus nerve going to the spleen, and that’s the thought.
Dr. Alessi: And it’s a different device.
Dr. Conner: It’s a totally different stimulator.
Dr. Alessi: So it’s not like one of those things where you put it in somebody who had a stroke, and they also had rheumatoid arthritis, and their arthritis got better.
Dr. Conner: I do have someone who’s had a stroke who has RA, and I was like, “Man, should we actually, like, follow and see what happens here?” Here’s the thing: They stimulate in different ways to get the electricity to do something different. So it’s actually a very different device, but that’s the thing I’m really excited about. We’re going to have that soon. We’re going to be the only place in Connecticut, to my knowledge, that’s going to have it. We’re really excited about it because those patients can be really disabled. And the reports, the literature, what it says out there is pretty remarkable.
Dr. Alessi: You know, I thought you were getting to the point where you were going to say, “And we’re this close, and this new device is going to result in weight loss.”
Dr. Conner: Ugh. There was a guy, his name is Casey Halpern. He’s now in Pennsylvania. He’d done a tremendous amount of work on deep brain stimulation for weight loss. Unbelievable science.
Dr. Alessi: Did he really?
Dr. Conner: Unbelievable. It was really, I mean, he was really doing it right. And then Ozempic came out, and I haven’t heard him talk about weight loss ais much. It was a little depressing ’cause it’s like, man, he did all the basic science. He did everything, and he had—
Dr. Alessi: He got it all.
Dr. Conner: and he got his lunch eaten.
Dr. Alessi: Chris, thank you. Thank you for your time today. Thank you for everything you do for our patients here at UConn Health.
Dr. Alessi: If you have any questions or ideas for future programs, you could reach out to me at [email protected]. Jennifer Walker is executive producer for the Healthy Rounds Podcast. Chris DeFrancesco is our studio producer. Until next time, this is Dr. Anthony Alessi. Please stay healthy.
