Real-life experience with brivaracetam in 101 patients with difficult-to-treat epilepsy-A monocenter survey.

Abstract

PURPOSE:

To assess the efficiency of brivaracetam under real-world conditions in a tertiary referral epilepsy center.

METHODS:

We consecutively collected patients treated at our center with brivaracetam (BRV). After a minimum observation period of six months we retrospectively analyzed the efficiency of BRV.

RESULTS:

Data of 101 patients (mean age 42 years, range 18-81 years, 54 females,) were analyzed. The median number of antiepileptic drugs (AEDs) used prior to BRV was 10 (range 2-18). The initial dose of BRV was at least 50mg per day, the mean maintenance dose at cut-off was 168.6mg (median 200mg, range 50-400mg). Efficacy data were assessed for the last three months or at the time of the last observation carried forward if BRV had been discontinued prematurely. Responder rate was 27.8% (n=28) with 7% seizure-free patients. Adverse events (AEs) occurred in 37 patients (37%). Most frequent AEs were dizziness (16%) and somnolence (11%). Psychiatric adverse events comprised irritability, aggression, depression and psychosis in single cases. Retention rate after six months was 51.5%. Main reason for discontinuation was a lack of efficacy. In 43 cases LEV and BRV were switched. The switch was performed abruptly without complications. In 26 cases (60%) BRV was discontinued and re-switched to LEV within weeks, mainly due to a lack of better efficacy. After the switch from LEV to BRV we even saw an aggravation both of seizure frequency and severity in 5 cases. Retention rate in patients who had not been on LEV was 57%.

CONCLUSION:

In our hands BRV appeared to be well tolerated and easy to handle. The retention rate was influenced by patients who were switched from LEV and re-switched because BRV was not more efficient. Switching from and re-switching to LEV was easy.

• Authors: Bernhard J Steinhoff, Matthias Bacher, Iancu Bucurenciu, Barbara Hillenbrand, Tassanai Intravooth, Reinhold Kornmeier, Christoph Kurth, Jakob Stockinger, Anke M Staack
• Journal: Seizure (Seizure) Vol. 48 Pg. 11-14 (May 2017) ISSN: 1532-2688 [Electronic] England
• PMID: 28364655 (Publication Type: Journal Article)
• Copyright: Copyright © 2017 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

Chemical References

• Anticonvulsants
• Pyrrolidinones
• Levetiracetam
• brivaracetam
• Piracetam

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Anticonvulsants (therapeutic use)
• Drug Substitution
• Epilepsy (drug therapy)
• Female
• Humans
• Levetiracetam
• Male
• Middle Aged
• Piracetam (analogs & derivatives, therapeutic use)
• Pyrrolidinones (therapeutic use)
• Treatment Failure
• Treatment Outcome
• Young Adult