PMID- 31493736
OWN - NLM
STAT- MEDLINE
DCOM- 20200803
LR  - 20200803
IS  - 1525-5069 (Electronic)
IS  - 1525-5050 (Linking)
VI  - 99
DP  - 2019 Oct
TI  - Adjunctive brivaracetam in focal and generalized epilepsies: A single-center 
      open-label prospective study in patients with psychiatric comorbidities and 
      intellectual disability.
PG  - 106505
LID - S1525-5050(19)30394-4 [pii]
LID - 10.1016/j.yebeh.2019.106505 [doi]
AB  - Clinical studies suggest that the antiepileptic drug (AED) brivaracetam (BRV) is 
      associated with fewer behavioral and psychiatric adverse events (AEs) compared 
      with levetiracetam (LEV) in treating epilepsy. There are, however, few 
      comparative studies of treatment-emergent AEs between patients on BRV with 
      preexisting psychiatric or behavioral comorbidities to those without. Our study 
      compared longer-term tolerability over a 26-month period between these patient 
      groups and assessed the overall efficacy of BRV as add-on therapy. Patients with 
      intellectual disabilities in whom the prevalence of epilepsy is higher, are often 
      excluded from randomized controlled trials, and our study further assessed 
      comparative effectiveness between this patient group and those with normal range 
      intellect. We collected prospective data on 134 patients prescribed add-on BRV 
      for epilepsy at a tertiary UK center over a 26-month period. All patients had 
      previously received LEV. Sixty-three patients were on LEV at the start of the 
      data collection period. Levetiracetam was withdrawn and switched to BRV in 39 
      patients because of inefficacy and 24 patients because of behavioral or 
      psychiatric side effects. Seventy-three patients (54%) had a preexisting 
      psychiatric or behavioral disorder compared with 64 patients (46%) without. The 
      retention rate at last follow-up [mean: 11 months (0.5-26 months)] was 60% in the 
      psychiatric/behavioral disorders group versus 67% in those without (p = 0.68). 
      Forty-one patients had diagnosed intellectual disabilities. The retention rate 
      was 66% in this group versus 62% in patients without intellectual disabilities 
      (p = 0.36). The commonest treatment-emergent AEs were somnolence (26%), 
      aggression (23%), and depression (9%). There were similar frequencies reported 
      for these specific events across the groups. The proportion with a 50% responder 
      rate was 29% in patients with focal epilepsy and 47% in patients with generalized 
      and combined focal and generalized epilepsies. However, fifteen patients (11%) 
      reported increased seizure activity leading to withdrawal of treatment. This 
      study showed evidence that BRV may be an effective adjunctive therapy in patients 
      with drug-resistant focal or generalized epilepsies whose seizures have 
      previously not responded or tolerated LEV therapy. We demonstrated a higher 
      incidence of treatment-emergent AEs leading to lower retention rates compared 
      with previous studies across all patient groups. There were, however, no 
      significant differences in tolerability between patients with preexisting 
      psychiatric or behavioral comorbidities, or intellectual disability to those 
      without.
CI  - Crown Copyright (c) 2019. Published by Elsevier Inc. All rights reserved.
FAU - Foo, Eng Chuan
AU  - Foo EC
AD  - Department of Neurology, Leeds Teaching Hospitals, Leeds, United Kingdom. 
      Electronic address: engchuan.foo@nhs.net.
FAU - Geldard, Jo
AU  - Geldard J
AD  - Department of Neurology, Leeds Teaching Hospitals, Leeds, United Kingdom.
FAU - Peacey, Caroline
AU  - Peacey C
AD  - Department of Neurology, Leeds Teaching Hospitals, Leeds, United Kingdom.
FAU - Wright, Elizabeth
AU  - Wright E
AD  - Department of Neurology, Leeds Teaching Hospitals, Leeds, United Kingdom.
FAU - Eltayeb, Khalid
AU  - Eltayeb K
AD  - Department of Neurology, Leeds Teaching Hospitals, Leeds, United Kingdom.
FAU - Maguire, Melissa
AU  - Maguire M
AD  - Department of Neurology, Leeds Teaching Hospitals, Leeds, United Kingdom.
LA  - eng
PT  - Journal Article
PT  - Observational Study
DEP - 20190904
PL  - United States
TA  - Epilepsy Behav
JT  - Epilepsy & behavior : E&B
JID - 100892858
RN  - 0 (Anticonvulsants)
RN  - 0 (Pyrrolidinones)
RN  - 44YRR34555 (Levetiracetam)
RN  - U863JGG2IA (brivaracetam)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Anticonvulsants/administration & dosage/adverse effects/*pharmacology
MH  - *Behavioral Symptoms/chemically induced/epidemiology
MH  - Comorbidity
MH  - Drug Therapy, Combination
MH  - Epilepsies, Partial/*drug therapy/epidemiology
MH  - Epilepsy, Generalized/*drug therapy/epidemiology
MH  - Female
MH  - Humans
MH  - *Intellectual Disability/epidemiology
MH  - Levetiracetam/administration & dosage/adverse effects/*pharmacology
MH  - Male
MH  - *Mental Disorders/chemically induced/epidemiology
MH  - Middle Aged
MH  - Prospective Studies
MH  - Pyrrolidinones/administration & dosage/adverse effects/*pharmacology
MH  - Treatment Outcome
MH  - Young Adult
OTO - NOTNLM
OT  - Brivaracetam
OT  - Epilepsy
OT  - Intellectual disability
OT  - Levetiracetam
OT  - Psychiatric adverse event
OT  - Treatment-emergent adverse events
EDAT- 2019/09/08 06:00
MHDA- 2020/08/04 06:00
CRDT- 2019/09/08 06:00
PHST- 2019/04/22 00:00 [received]
PHST- 2019/08/03 00:00 [revised]
PHST- 2019/08/14 00:00 [accepted]
PHST- 2019/09/08 06:00 [pubmed]
PHST- 2020/08/04 06:00 [medline]
PHST- 2019/09/08 06:00 [entrez]
AID - S1525-5050(19)30394-4 [pii]
AID - 10.1016/j.yebeh.2019.106505 [doi]
PST - ppublish
SO  - Epilepsy Behav. 2019 Oct;99:106505. doi: 10.1016/j.yebeh.2019.106505. Epub 2019 
      Sep 4.