Experience With Brivaracetam in the Acute Care Setting at a Large Tertiary Care Center
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background/Purpose: Data analyzing usage patterns, efficacy, tolerability, and long-term continuation of brivaracetam (BRV) when initiated in the acute, inpatient setting is lacking. Methods: Retrospective chart review of adult patients who initiated BRV in the emergency or inpatient setting at Yale New Haven Hospital over 5-year span. Results: Of 133 patients, BRV was used for status epilepticus (SE) in 37% (n = 49), seizures in 38% (n = 51), and rhythmic/periodic patterns (RPP) in 21% (n = 28). Eighty-six (65%) were in an ICU and 33 (25%) were in a non-ICU setting. BRV was the first anti-seizure medication (ASM) tried in 9 (7%), while 124 (93%) tried other ASMs first (mean ASMs = 2; SD = 1). Initial dosing ranged from 50-400 mg (median = 200 mg, IQR = 200-300 mg), then median maintenance dosing of 200 mg/day (IQR = 200-300 mg/day). Of patients with RPP, seizures, or SE on EEG (n = 115, 86%), 46% (n = 53) had electrographic and/or clinical improvement, including 23 (20%) with complete resolution. In patients with clinical seizures (n = 10) or SE (n = 2) not on EEG, BRV was effective in 10 patients. BRV was discontinued in 49 (36%) patients, typically for inefficacy. Of 88 survivors to discharge, 86 (98%) were discharged on ASMs, including 62% (n = 54) discharged on BRV. Follow-up data were available for 53 (60%) patients - 51 (96%) remained on ASMs, with 33 (65%) remaining on BRV (median follow-up = 30 d, IQR = 18-65 d). Conclusions: BRV appears safe, well-tolerated, and efficacious for acute, inpatient management of RPP, seizures, and SE. Prospective studies validating these findings and directly comparing BRV with other ASMs are warranted.
Source: The Neurohospitalist
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7127449158