Brivaracetam in the treatment of focal and idiopathic generalized epilepsies and of status epilepticus

ABSTRACT

Brivaracetam is the latest approved antiepileptic drug in focal epilepsy and exhibits high affinity as SV2A-ligand. More than two thousand patients have received brivaracetam within randomized placebo-controlled trials. Significant median seizure reduction rates of 30.5% to 53.1% for 50 mg/d, 32.5% to 37.2% for 100 mg/d and 35.6% for 200 mg/d were reported. Likewise, 50% responder rates were 32.7% to 55.8% for 50 mg/d, 36% to 38.9% for 100 mg/d and 37.8% for 200 mg/d. Overall, brivaracetam is well tolerated. The main adverse events are fatigue, dizziness, and somnolence. Immediate switch from levetiracetam to brivaracetam at a conversion ratio between 10:1 to 15:1 is feasible, and might alleviate the behavioral side effects associated with levetiracetam. Brivaracetam has the potential to perform as an important, possibly broad-spectrum AED, initially in patients with drug-refractory epilepsies. Its intravenous formulation may be a new and desirable alternative for status epilepticus, but there is so far no experience in these patients.

KEYWORDS:

• Brivaracetam
• epilepsy
• myoclonus
• seizure

Financial and competing interests disclosure

A Strzelczyk reports personal fees and grants from Bayer HealthCare, Boehringer Ingelheim, Desitin Arzneimittel, Eisai, Pfizer, Sage Therapeutics, and UCB Pharma, outside the submitted work. KM Klein reports personal fees from UCB Pharma, Novartis Pharma AG and Eisai as well as grants from the Deutsche Forschungsgemeinschaft and The University of Melbourne outside of the submitted work. LM Willems reports travel support from Eisai, outside the submitted work. F Rosenow reports personal fees from Eisai, grants and personal fees from UCB, grants and personal fees from Desitin Arzneimittel, personal fees and other from Novartis, personal fees from Medtronic, personal fees from Cerbomed, personal fees from ViroPharma and Shire, grants from the European Union, and grants from Deutsche Forschungsgemeinschaft, outside the submitted work. The authors have no other 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 apart from those disclosed.