19-05-2025
Post-stroke, a Pittsburgh-area musician regains the ability to play with a new treatment
On Scott Pavlot's 65th birthday, he unwrapped a beautiful, custom-made Ibanez electric bass.
Just two days later, a stroke left the Pine Township man wondering if he'd ever be able to play it.
But thanks to the implantation of a vagus nerve stimulation device - described by Pavlot's neurosurgeon as a kind of defibrillator for the nervous system - music is starting to flow from his fingers again.
Pavlot, now 66, was the first person in the Pittsburgh area to be implanted with a technology called the MicroTransponder Vivistim Paired VNS System, or Vivistim for short, said Alexander Whiting, the neurosurgeon who implanted the device about seven months after Pavlot's stroke in February 2024. Whiting is also the director of epilepsy surgery for Allegheny Health Network's Neuroscience Institute.
The Food and Drug Administration approved the device in 2021 to "treat moderate to severe upper extremity motor deficits associated with chronic ischemic stroke" by using vagus nerve stimulation.
Nearly 800,000 people in the U.S. experience a stroke annually, according to the Centers for Disease Control and Prevention. Every 40 seconds, someone has a stroke; every 3 minutes, 11 seconds, someone dies of one.
The Vivistim is similar to the vagus nerve stimulation that has been used since 1988 - and FDA approved since 1997 - as an implanted therapy tool to treat epileptic focal or partial seizures that do not respond to seizure medications, according to the Epilepsy Foundation.
Since Pavlot underwent the implantation, two additional stroke patients at Allegheny General Hospital on the North Side have received the device and several others are awaiting insurance approval to undergo the procedure, Whiting said.
Right after the stroke, Pavlot could not walk or use his left hand - he's a lefty - for much of anything. His nerves could not deliver the correct impulses to the muscles to coordinate any sort of dexterity or strength. He also experienced spasticity, where muscles involuntarily contract and stiffen, often causing pain and limiting movement, per the American Stroke Association.
After experiencing a stroke like Pavlot's, doctors typically prescribe physical therapy to help patients try to regain control of the nerves that were damaged, Whiting explained. At some point the progress tends to plateau.
"Most people after a stroke, after about six months, most of what they are going to recover has happened. People can still make recoveries, but it certainly slows down at six months," Whiting said. "Before this device, it was really just therapy. That's all we had. This is kind of the first tool - the first surgical tool we've had - that can jumpstart that recovery process. Part of what's happening with the device is, Scott is retraining his brain."
Pavlot, an active grandfather of two and the founder of the West View Hub community center where he spends most of his days, did not hesitate when Whiting, at their first meeting, suggested becoming the first to undergo the Vivistim implantation at AGH.
During a chat last month, Pavlot reminded the surgeon that they had met for the first time about 25 years earlier. Pavlot was deejaying a middle school dance in the Pine-Richland School District, where Whiting was a classmate of Pavlot's son. "You should have seen him do the 'Macarena,'" Pavlot said, laughing and gesturing to his doctor.
"It takes a special person to want to be the first person to have something done," Whiting said.
"(O)ne of the benefits of Scott being first is that he doesn't see these things as insurmountable. I think he sees them all as challenges, which is a special thing, and so that makes him an inspiring person. But also, I think it's why he's done so well."
The system is implanted in the chest, similar to a pacemaker. "We run a wire up to your neck, wrap it around your vagus nerve a bunch of times. It's the exact same idea as the devices we use for epilepsy. That's actually why I was the one that did it," said Whiting, who has implanted numerous such devices in patients with epilepsy.
To activate the device, a handheld magnet is swiped across the skin above where it's implanted. Then, the device will deliver an electrical impulse to the vagus nerve once every seven seconds for 30 minutes, Pavlot said.
Pavlot then performs physical therapy exercises in order to retrain his damaged nerves to resume their normal function. Sometimes, when nerves are severed during the stroke, other nerves can be taught how to take over new functions, picking up the slack of the dead nerves.
Using electrical impulses, the device operates similarly to a transcutaneous electrical nerve stimulation (TENS) unit that is often used in physical therapy settings. A TENS unit delivers mild electrical impulses through the skin to help manage pain by blocking pain signals or stimulating the body to release natural pain-relieving chemicals and promote healing.
"Electrical current with a TENS unit is basically just waking up your muscles and saying, 'Pay attention to me!'" Whiting said. "Same thing is happening here. It's sending all this electrical stimulation" to the vagus nerve, which has connections throughout the brain.
"So when we stimulate it, we think we're basically waking up the whole brain saying, 'Hey, pay attention! Look what we're doing down here. We're moving our fingers. Pay attention! Make some connections!' I think that's why it supercharges it," Whiting said.
Candidates for the implant, Whiting said, must meet two conditions: The patient has experienced an ischemic stroke and six months have passed.
The Mayo Clinic defines an ischemic stroke as one caused by a blood vessel blockage whereas a hemorrhagic stroke is caused by bleeding in the brain due to a ruptured blood vessel. Most strokes - about 87% - are ischemic strokes, in which blood flow to the brain is blocked, per the CDC.
Down the road
While originally intended to be used only for a set amount of time, Whiting said that patients are reporting that they're continuing to progress in their recovery far beyond what was expected.
"I don't think we really know where the road eventually leads yet. The idea originally was you would put it in, and people like Scott would get what they need out of it, then you would take it out," Whiting said.
But with patients reporting continued improvements, "I don't think we really know where the off-ramp is yet. So far, everybody's done well, continuing to use it even past the period of time we thought they would need it for."
In theory, the device could remain for the rest of the patient's life, although battery replacement would be needed at some point, probably after seven to 10 years.
Pavlot said he'll keep activating his device and doing his therapy exercises for as long as it takes to regain what he lost.
He remembers well the first time he was able to brush his own teeth, feed himself at a restaurant and walk without a cane.
And he's looking forward to breaking in that new bass guitar soon: He and his band have some concert dates set for the summer.
The day after his stroke, he received a get-well message from an online acquaintance: musician Bootsy Collins, who played with James Brown in the early 1970s before joining the Parliament-Funkadelic collective and later forming his own side project, Bootsy's Rubber Band.
"The day after my stroke, (Collins) sent me a video. He's like, 'Scott, you got to keep that bass in everybody's face,'" said Pavlot, as he strummed his bass ukulele in Whiting's office in April. "Keep that funk alive."
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