PMID- 34131547
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20210617
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 13
IP  - 5
DP  - 2021 May 13
TI  - Clinical and Electroencephalography Assessment of the Effects of Brivaracetam in 
      the Treatment of Drug-Resistant Focal Epilepsy.
PG  - e15012
LID - 10.7759/cureus.15012 [doi]
LID - e15012
AB  - INTRODUCTION: Our aim was to evaluate the clinical and electroencephalographic 
      effects of brivaracetam (BRV) in patients with drug-resistant focal epilepsy. 
      BRV is a new antiepileptic drug (AED) with a high affinity for vesicle protein 2A 
      (SV2A) and recently approved as adjunctive therapy for focal onset seizures. 
      METHODS: In this observational study of six-month duration, BRV (50-200 mg) was 
      administered to 76 patients with drug-resistant focal epilepsy, who 
      were >/=16-year-old and who suffered from daily, weekly, monthly and yearly 
      recurrent seizures. At baseline and after six months of follow-up, we performed a 
      neurological visit, neuropsychological tests: Quality of life in epilepsy-31 
      (QOLIE31), Epworth Sleepiness Scale (ESS), Intrapersonal Emotional Quotient (IEQ) 
      and an electroencephalogram (EEG; inspective and quantitative analysis). 
      Twenty-four patients underwent an overnight switch from levetiracetam (LEV) to 
      BRV. RESULTS: Seizure frequency of the 54 patients remaining at six months was 
      reduced >50% in 29.6% of cases (responders), <50% in 31.5% (non-responders 1), 
      while it remained unchanged in 38.8% (non-responders 2). Twenty-nine percent of 
      patients early discontinued BRV because of lack of efficacy or minor adverse 
      effects (AEs) like irritability, asthenia or headache. Neuropsychological tests 
      in 28 patients demonstrated a significant improvement in I-EPI scores (p=0.04). 
      Comparable results have been found in the subgroup of patients who switched from 
      LEV to BRV. The EEG quantitative analysis showed a significant reduction of alpha 
      absolute power at six months (p=0.03). Theta band power resulted significantly 
      superior in non-responders than in responders (p=0.03). Furthermore, the delta+theta/alpha+beta 
      index resulted more elevated in patients with AEs than in patients without. 
      CONCLUSIONS: BRV showed discrete results in terms of efficacy, safety and 
      tolerability, with a good behavioural profile. BRV reduces the power of the alpha 
      band, in correlation with its sedative effects but not with its minor efficacy. 
      Furthermore, the increase in theta band power can be considered as a predictor of 
      scarce response to treatment, while an increase in the delta+theta/alpha+beta index could be a 
      possible predictor of AEs occurrence.
CI  - Copyright (c) 2021, Savastano et al.
FAU - Savastano, Ersilia
AU  - Savastano E
AD  - UOC Neurologia, Ospedale Santo Bono-Pausilipon, Napoli, ITA.
AD  - UOC Neurofisiopatologia, Policlinico Umberto I, Rome, ITA.
FAU - Pulitano, Patrizia
AU  - Pulitano P
AD  - Department of Human Neuroscience, Neurophysiopathology Unit, Policlinico Umberto 
      I, Rome, ITA.
FAU - Faedda, Maria Teresa
AU  - Faedda MT
AD  - Department of Human Neuroscience, Neurophysiopathology Unit, Policlinico Umberto 
      I, Rome, ITA.
FAU - Davi, Leonardo
AU  - Davi L
AD  - Department of Human Neuroscience, Neurophysiopathology Unit, Policlinico Umberto 
      I, Rome, ITA.
FAU - Vanacore, Nicola
AU  - Vanacore N
AD  - CNAPS Department (Promotion and Evaluation of Chronic Disease Prevention 
      Policies), Istituto Superiore di Sanita (ISS), Rome, ITA.
FAU - Mecarelli, Oriano
AU  - Mecarelli O
AD  - Department of Human Neuroscience, Neurophysiopathology Unit, Policlinico Umberto 
      I, University of Rome "Sapienza", Rome, ITA.
LA  - eng
PT  - Journal Article
DEP - 20210513
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC8197576
OTO - NOTNLM
OT  - brivaracetam
OT  - focal drug resistant epilepsy
OT  - levetiracetam
OT  - neurocognitive tests
OT  - pharmaco-eeg
OT  - quantitative eeg
COIS- The authors have declared that no competing interests exist.
EDAT- 2021/06/17 06:00
MHDA- 2021/06/17 06:01
PMCR- 2021/05/13
CRDT- 2021/06/16 06:48
PHST- 2021/06/16 06:48 [entrez]
PHST- 2021/06/17 06:00 [pubmed]
PHST- 2021/06/17 06:01 [medline]
PHST- 2021/05/13 00:00 [pmc-release]
AID - 10.7759/cureus.15012 [doi]
PST - epublish
SO  - Cureus. 2021 May 13;13(5):e15012. doi: 10.7759/cureus.15012.