Abstracts

Rationale: Brivaracetam is a new generation antiepileptic drug (AED), which has recent FDA approval for monotherapy or as an adjunct treatment for focal seizures in patients older than 4 years of age; however, clinical data, especially in the pediatric population is sparse. Its mechanism of action is not fully understood but it displays a high and selective affinity for the synaptic vesicle protein 2A (SV2A) in the brain. The most commonly reported adverse events include sedation, dizziness, fatigue, cerebellar ataxia and psychiatric disturbances. The objective of this study was to retrospectively assess efficacy and tolerability for brivaracetam in patients with refractory epilepsy followed in our Section of Neurology.   Methods: This is a retrospective chart review of patients with refractory epilepsy treated with brivaracetam from January 2016 to May 2018 and who had previously failed at least two different AEDs. Medical records were reviewed to obtain information about parental reports and physician assessments to evaluate the efficacy and safety of treatment. Primary outcome measurement was significant seizure reduction, which was defined as a decrease in seizure frequency greater than 50%.  Results: A total of 23 patients with refractory epilepsy on treatment with brivaracetam were identified; 3 were excluded due to insufficient data. Age range was 4-20 years (mean: 12.5 years). Fourteen patients (70%) were females. Epilepsy was focal in 11 patients (55%), generalized in 6 (30%) and mixed  in 3 (15%). The mean number of concurrent AEDs in use at the time brivaracetam was started was 2.2 (range 0-6). Doses ranged from 50 to 300 mg daily (mean 166.5 mg). The mean duration of treatment with brivaracetam was 8.2 months (range 1-16 months). Eight patients (40%) had greater than 50% decrease in seizure frequency. In the responder group, the mean number of AEDs concurrently in use besides brivaracetam was 1.75 (range 1-4). Almost all responders (7 out of 8, or 87.5%) had a diagnosis of focal epilepsy, except for 1 patient with refractory Lennox-Gastaut (12.5%). In terms of side effects, 2 patients (10%) experienced drowsiness, 3 (15%) had behavioral complaints; however, all had underlying behavioral disorders prior to initiation of brivaracetam. One patient (5%) experienced tingling of the extremities and dizziness. None of them had to discontinue the therapy due to side effects. The main cause for discontinuation of brivaracetam was lack of efficacy, which occurred in 5 (25%) cases. Conclusions: Brivaracetam is a new FDA-approved AED with limited clinical data, especially in the pediatric population. Based on our results we conclude that it is an effective adjunct therapy for refractory epilepsy, especially of focal origin in patients older than 4 years of age. The medication was well tolerated with no cases of discontinuation due to side effects. Further randomized studies are necessary to confirm these findings. Funding: None