Brivaracetam add-on treatment in pediatric patients with severe drug-resistant epilepsy: Italian real-world evidence.

Abstract

PURPOSE:

To report the efficacy and tolerability of brivaracetam (BRV) in add-on therapy in pediatric patients with severe drug-resistant epilepsy. Prognostic factors of clinical outcome were also analyzed.

METHODS:

This Italian multicenter retrospective observational study was conducted on 45 pediatric patients with severe drug-resistant epilepsy, treated with BRV for at least 1 month and with a follow-up >6 months. Demographic, clinical, and treatment variables were assessed at T0 (baseline, BRV introduction) and T1 (6 months after BRV introduction). The response was defined as ≥50% seizure frequency reduction; responders and non-responders were then compared to assess potential prognostic factors.

RESULTS:

Forty-five patients (M = 28, mean age 12.4+/-4.4 years) were enrolled (focal epilepsy=14; generalized epilepsy=2; epileptic encephalopathy=29). At T1, 19/45 patients (42.2%) were responders (≥50% seizure frequency reduction), with 4 patients (8.9%) achieving a ≥ 75% seizure reduction and 2 patients (4.4%) becoming seizure free. Epilepsy onset at >12 months of age (p = 0.001), disease duration ≤6 years (p = 0.036), and lower seizure frequency at baseline (p = 0.008) were the prognostic factors significantly associated with a better prognosis. No significant difference emerged for demographics, epilepsy types/etiology, intellectual disability, or therapy variables. At T1, 21 patients (46.6%) discontinued BRV, mainly due to lack of efficacy (13 subjects; 28.9%) and adverse events in 8 patients (17.8%).

CONCLUSION:

Brivaracetam was an effective and tolerated treatment in pediatric patients with severe drug-resistant epilepsy, especially when the seizure onset was at >12 months of age, the epilepsy duration ≤6 years, and the seizure frequency before BRV treatment was low. Further and controlled studies are needed.

• Authors: Angelo Russo, Jacopo Pruccoli, Carlo Alberto Cesaroni, Laura Maria Beatrice Belotti, Corrado Zenesini, Paolo Bonanni, Antonella Boni, Elisabetta Cesaroni, Giangennaro Coppola, Duccio Maria Cordelli, Alberto Danieli, Maria Margherita Mancardi, Francesca Marchese, Sara Matricardi, Tullio Messana, Giovanna Martina Nocera, Francesca Felicia Operto, Giuditta Pellino, Federica Reina, Francesca Vanadia, Alberto Verrotti, Pasquale Striano
• Journal: Seizure (Seizure) Vol. 102 Pg. 120-124 (Nov 2022) ISSN: 1532-2688 [Electronic] England
• PMID: 36223675 (Publication Type: Observational Study, Multicenter Study, Journal Article)
• Copyright: Copyright © 2022. Published by Elsevier Ltd.

Chemical References

• brivaracetam
• Anticonvulsants
• Pyrrolidinones

Topics

• Humans
• Child
• Adolescent
• Anticonvulsants (adverse effects)
• Treatment Outcome
• Drug Therapy, Combination
• Pyrrolidinones (adverse effects)
• Drug Resistant Epilepsy (drug therapy)
• Epilepsy, Generalized (drug therapy)
• Epilepsy (drug therapy)
• Seizures (drug therapy)