An update on brivaracetam for the treatment of pediatric partial epilepsy

ABSTRACT

Introduction: Brivaracetam (BRV) is an antiseizure medication (ASM), which has been approved as an adjunctive treatment in adults and pediatric patients aged four years and older with focal onset seizures. It is a second-generation levetiracetam (LEV) derivative, sharing the same mechanism of action, binding synaptic vesicles 2A (SV2A). BRV shows higher binding affinity and selectivity and higher brain permeability than LEV.

Areas covered: This article reviews randomized controlled trials, retrospective and prospective studies published up to December 2020, searched in electronic databases MEDLINE, EMBASE and the Clinical Trial Database and provide an overview of efficacy, safety and tolerability of BRV in pediatric patients with partial epilepsy. Furthermore, the authors provide their expert opinion on the drug and give their future perspectives.

Expert opinion: The analysis of the literature data has demonstrated the safety and efficacy of BRV in pediatric patients, with more evidence in children aged 4 to 16 years with an onset of focal seizures. However, a positive response was also achieved in patients affected by some encephalopathic epilepsies. Comparative efficacy studies between BRV and other ASMs, in addition to well-designed RCTs that include larger pediatric populations are needed to better define the role and potentiality of this ASM.

KEYWORDS:

• Antiseizure medication
• brivaracetam
• focal seizures
• partial epilepsy
• pediatric epilepsy

Article highlights

• Brivaracetam is a new antiseizure medication with high affinity for the synaptic vesicles 2A.

• Brivaracetam is useful in various types of adult epilepsy.

• The drug has been approved as adjunctive therapy of partial epilepsy with or without secondary generalization in children from four years of age.

• Brivaracetam can be useful also in some peculiar epileptic syndromes (e.g. Lennox-Gastaut syndrome, Jeavons syndrome).

• Brivaracetam has a quite safe profile.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.