Authors :
Presenting Author: Elena Fonseca, MD, PhD – Vall d'Hebron University Hospital
Carlos Lázaro, MD – Neurology Department – Vall d'Hebron University Hospital; Laura Melgarejo, MD – Neurology Department – Vall d'Hebron University Hospital; Sofía Lallana, MD – Epilepsy Unit, Neurology department – Vall d'Hebron University Hospital; Ariadna Gifreu, MD – Epilepsy Unit, Neurology department – Vall d'Hebron University Hospital; Manuel Quintana, MSc, PhD – Epilepsy Unit, Neurology department – Vall d'Hebron University Hospital; Daniel Campos, MD – Epilepsy Unit, Neurology department – Vall d'Hebron University Hospital; Laura Abraira, MD, PhD – Epilepsy Unit, Neurology department – Vall d'Hebron University Hospital; Samuel López, MD – Epilepsy Unit, Neurology department – Vall d'Hebron University Hospital; Estevo Santamarina, MD, PhD – Epilepsy Unit, Neurology department – Vall d'Hebron University Hospital; Manuel Toledo, MD, PhD – Epilepsy Unit, Neurology department – Vall d'Hebron University Hospital
Rationale: Brivaracetam (BRV) is an effective treatment for focal-onset seizures, and its pharmacokinetic profile makes it a suitable option for rapid loading in acute seizures. We aimed to describe the safety of an intravenous (IV) infusion of BRV in a video-electroencephalogram (VEEG) monitoring unit of a tertiary center, and its retention after hospital discharge.
Methods: This is a retrospective cohort study of patients admitted for VEEG monitoring who received IV BRV between June 2020 and March 2023. We collected baseline clinical characteristics, BRV IV dose, adverse events, seizure frequency at baseline and 24 hours after BRV infusion during inpatient observation. Interictal quantitative EEG activity was analyzed at baseline and post-infusion, including spectrographic analysis of frequency power ratios (alpha/delta ratio; ADR). We also recorded BRV retention and adverse events at follow-up after discharge.
Results: A total of 17 patients were included; mean age 33.6 (± 12.8) years; 68.8% men. All patients but one had focal epilepsy (94.1%), and 94.1% were drug-resistant. The median dose of the BRV infusion was 200mg (100-200mg), and the median maintenance dose was 125mg daily (100-200mg). All patients had ≥1 seizure in the 24h pre-infusion. Significant reductions in ADR were observed in anterior quadrants of the left (p=0.009) and right (p=0.008) hemispheres, and in the right posterior quadrant (p= 0.046), with no differences in ADR of the left posterior quadrant. During the 24 hours post-infusion, 2 patients (11.7%) had seizures and transient adverse events (drowsiness) were reported in 2 (11.7%). After a median follow-up of 21.5 (10.1-23.8) months, 15 patients (88.2%) retained BRV. BRV was discontinued in one patient due to mood disturbance, and 1 patient suffered a seizure cluster due to lack of adherence.
Conclusions: BRV IV infusion is an effective and well-tolerated treatment in a hospital setting, with a good retention rate and long-term adverse event profile. ADR reduction was observed after infusion, possibly due to post-ictal state, with transient drowsiness in a small proportion of patients.
Funding: The presenting author declares travel support from UCB pharma for this abstract.