Work

The efficacy of switching intravenous to oral brivaracetam following status epilepticus: A real-world, multicenter Sicilian study

Year: 2025

Type: article

Abstract: BACKGROUND: Brivaracetam (BRV) is a third-generation antiseizure medication (ASM) that acts as a high-affinity ligand for synaptic vesicle protein 2A (SV2A), sharing a similar mechanism of action with levetiracetam (LEV). Nevertheless, BRV exhibits higher binding affinity and selectivity for SV2A and a more favorable safety profile. We aim to study the efficacy of switching intravenous to oral BRV following status epilepticus (SE) and cluster seizures. METHODS: We conducted a multicenter, retrospective, observational study performed at seven Sicilian epilepsy centers in the context of real-world clinical practice. Recruited patients received intravenous BRV as a second-line treatment for SE and subsequently switched to oral administration. Outcome measures were responder rate (≥ 50 % seizure reduction), sustained seizure freedom and the occurrence of adverse events. were defined as the occurrence, number, and type of adverse events (AEs). RESULTS: 75 patients were included in the study whereas seven were excluded because of death before six months of follow-up and five were because lost at follow-up. Sixty-two patients (mean age 69.63 ± 12.99) were included in the present analyses. The mean dosage of BRV was 165 mg (SD 50,04) mg/day at 8.7 months. The retention rate of BRV was 93.7 %. At follow-up, 30 (47.6 %) patients showed sustained seizure freedom, in 22 (34.9 %) seizure frequency decreased ≥ 50 % and 10 (16,1%) experienced a clinical worsening. Adverse events (AEs) were observed in two out of 62 participants (3.2 %). We didn't find any correlation between sex, age, dosage of BRV and the sustained seizure freedom or the reduction in the number of seizures ≥ 50 % (p = 0.57; p = 0.26; p = 0.57, respectively). Patients with vascular aetiology had a likelihood of resolution or a reduction ≥ 50 % approximately three times higher (odds ratio 3.13(IC 95 %: 1.01-9.77), p = 0.05) than others. CONCLUSIONS: The switch of BRV from intravenous to oral administration has demonstrated a good effectiveness and safety profile in long-term treatment of epilepsy following a prior SE particularly in patients with vascular diseases.

Source: Epilepsy & Behavior

DOI: 10.1016/j.yebeh.2025.110744