I don't know that I have any answers for you. I was thinking about the VNS comment. I can't remember which mom wrote on the old forum (and I can see her son's face) saying that it would never be turned back on, but she was glad they tried it. You are seeing some good from the VNS, just not as good as you hoped. I don't hear anything in your words about even considering turning it off.

Success versus failure is always a relative thing. For someone having several seizures per day dropping to one per day, that's a success. For someone having one every two weeks, increasing to one per day is a failure. Even that isn't black and white. Having several myoclonics per day and dropping to one tonic-clonic per day is a tough call. One tonic-clonic every two weeks increasing to daily myoclonics, well... you get the picture.

I'm not sure how well you've documented the before and after changes to decide be able to judge the success versus failure of the VNS. I keep thinking you said writing her name has gotten worse? Regression is rarely a good sign. On the other hand, if you hadn't tried the VNS, would things be worse? (Didn't you say you had a crystal ball hidden somewhere? It might be helpful.)

There's always the old paper chart method, with pros in one column and cons in the other. You can list out anything you think of: frequency, severity ("strength" of the seizure), length of time, post-ictal, daily behavior (happy or angry or ???), side effects, and ???

(((Hugs))) Sorry you feel the need to ask the questions. Hope someone else comes along with better insight.