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Our goal was to assess VNS efficacy and identify potential predictors of favorable outcome.<\/jats:p><jats:p><jats:bold><jats:italic>Methods<\/jats:italic><\/jats:bold>: This was a retrospective study. Inclusion criteria were: \u226418 years at the time of VNS implantation and at least one year of follow\u2010up. All patients were non\u2010candidates for excisional procedures. Favorable clinical outcome and effective VNS therapy were defined as seizure reduction &gt;50%. Outcome data were reviewed at one, two, three and five years after VNS implantation. Fisher's exact test, Kaplan\u2010Meier and multiple logistic regression analysis were employed.<\/jats:p><jats:p><jats:bold><jats:italic>Results<\/jats:italic><\/jats:bold>: Twenty\u2010seven patients met inclusion criteria. Responder rate (seizure frequency reduction \u2265 50%) at one\u2010year follow\u2010up was 25.9%, and 15.3% at last follow\u2010up visit. The only variable significantly predicting favorable outcome was time to VNS implantation, with the best outcome achieved when VNS implantation was performed within five years of seizure onset (overall response rate of 83.3% at one year of follow\u2010up and 100% at five years). In total, 63% of patients evidenced improved QOL at last follow\u2010up visit. Only one patient exited the study due to an adverse event at two years from implantation.<\/jats:p><jats:p><jats:bold><jats:italic>Significance<\/jats:italic><\/jats:bold>: Early VNS implantation within five years of seizure onset was the only predictor of favorable clinical outcome in pediatric patients with epileptic encephalopathy. Improved QOL and a very low incidence of adverse events were observed.<\/jats:p>","DOI":"10.1684\/epd.2021.1299","type":"journal-article","created":{"date-parts":[[2021,7,29]],"date-time":"2021-07-29T13:02:14Z","timestamp":1627563734000},"page":"563-571","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Early vagus nerve stimulator implantation as a main predictor of positive outcome in pediatric patients with epileptic encephalopathy"],"prefix":"10.1002","volume":"23","author":[{"given":"Angelo","family":"Russo","sequence":"first","affiliation":[{"name":"IRCCS Istituto delle Scienze Neurologiche di Bologna UOC Neuropsichiatria dell'et\u00e0 pediatrica Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann","family":"Hyslop","sequence":"additional","affiliation":[{"name":"Department of Neurology and Comprehensive Epilepsy Program, Brain Institute Nicklaus Children's Hospital Miami Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Gentile","sequence":"additional","affiliation":[{"name":"IRCCS Istituto delle Scienze Neurologiche di Bologna UOC Neuropsichiatria dell'et\u00e0 pediatrica Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonella","family":"Boni","sequence":"additional","affiliation":[{"name":"IRCCS Istituto delle Scienze Neurologiche di Bologna UOC Neuropsichiatria dell'et\u00e0 pediatrica Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian","family":"Miller","sequence":"additional","affiliation":[{"name":"Department of Neurology and Comprehensive Epilepsy Program, Brain Institute Nicklaus Children's Hospital Miami Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Chiarello","sequence":"additional","affiliation":[{"name":"Child Neurology and Psychiatric Unit, Departement of Medical and Surgical Science (DIMEC), S. 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