The real-world effectiveness of intravenous brivaracetam as a second-line treatment in status epilepticus

Chiara Martellino; Angelina Laganà; Giorgia Atanasio; Fabio Lamanna; Silvia Attardo; Simona Cascino; Marcella De Luca; Orazio Pardeo; Giuseppa Giacobbe; Giovanni Tripepi; Roberta Roberti; Francesca Granata; Carmela Morace; Emilio Russo; Angelo Labate

doi:10.1016/j.yebeh.2023.109464

The real-world effectiveness of intravenous brivaracetam as a second-line treatment in status epilepticus

Epilepsy Behav. 2023 Nov:148:109464. doi: 10.1016/j.yebeh.2023.109464. Epub 2023 Oct 13.

Authors

Affiliations

¹ Neurophysiopatology and Movement Disorders Clinic, University of Messina, Messina, Italy.
² Neurophysiopatology and Movement Disorders Clinic, University of Messina, Messina, Italy; Regional Epilepsy Center, University of Messina, Messina, Italy.
³ National Research Council (CNR), Institute of Clinical Physiology (IFC), Clinical Epidemiology of Renal Diseases and Hypertension, Ospedali Riuniti, Reggio Calabria, Italy.
⁴ Science of Health Department, University Magna Grecia of Catanzaro, Catanzaro, Italy.
⁵ Neuroradiology Unit, University of Messina, Messina, Italy.
⁶ Internal Medicine Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
⁷ Neurophysiopatology and Movement Disorders Clinic, University of Messina, Messina, Italy; Regional Epilepsy Center, University of Messina, Messina, Italy. Electronic address: alabate@unime.it.

PMID: 37839249
DOI: 10.1016/j.yebeh.2023.109464

Abstract

Purpose: Status epilepticus (SE) is defined by abnormally prolonged seizures that may lead to brain damage and death. Our aim was to evaluate the efficacy and tolerability (effectiveness) of intravenous brivaracetam (BRV) as a second-line treatment.

Methods: Twenty-one patients (median age 68 years ± 17.28) were prospectively recruited between June 2019 and December 2022. Patients were treated with BRV (50-200 mg) as a second-line add-on therapy for SE. We evaluated the response of SE to the administration of BRV in terms of SE termination and recurrence of epileptic seizures at 6, 12, and 24 h, also monitoring safety. The first-line therapy was represented by intravenous benzodiazepines (mainly diazepam).

Results: Almost a quarter of patients had generalized seizures, whereas the vast majority (76.2%) presented focal seizures. In 52.4% of patients, the underlying cause was cerebrovascular. Fourteen (66.7%) patients displayed a good early response in the subsequent 6 h. At 12 and 24 h, 8 (38%) and 11 (52.4%) patients, respectively, did not present seizures.

Conclusion: The present study highlights the potential of BRV when used as an early add-on therapy in SE, further confirming its good safety profile.

Keywords: Brivaracetam; Early add-on; Efficacy; Safety; Second line; Treatment.

MeSH terms

Aged
Anticonvulsants* / adverse effects
Drug Therapy, Combination
Humans
Pyrrolidinones / adverse effects
Seizures / drug therapy
Status Epilepticus* / chemically induced
Status Epilepticus* / drug therapy
Treatment Outcome

Substances

brivaracetam
Anticonvulsants
Pyrrolidinones