Clinical response to brivaracetam in two cases of drug-resistant juvenile absence epilepsy
DOI:
https://doi.org/10.23938/ASSN.1132Keywords:
Epilepsy, Epilepsy, Absence, Drug Resistant Epilepsy, Valproic Acid, BrivaracetamAbstract
Although only around 20% of individuals with idiopathic generalized epilepsy are drug-resistant, this minority presents a significant therapeutic challenge due to the limited number of approved medications for this condition. For absence seizures, only valproic acid and ethosuximide are approved by both the U.S. Food and Drug administration and the European Medicines Agency, with lamotrigine additionally approved by the European Medicines Agency. Evidence supporting the use of levetiracetam in this seizure type is limited, and brivaracetam has not yet been approved for generalized epilepsy.
We report two cases of juvenile absence epilepsy in women with incomplete response and intolerance to first-line treatments, who demonstrated marked clinical improvement following treatment with brivaracetam.
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1. Scheffer IE, Berkovic S, Capovilla G, Connolly MB, French J, Guilhoto L, et al. ILAE classification of the epilepsies: Position paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017 Apr;58(4):512-521. https://doi:10.1111/epi.13709
2. Coppola G, Piccorossi A, Operto FF, Verrotti A. Anticonvulsant drugs for generalized tonic-clonic epilepsy. Expert Opin Pharmacother. 2017 Jun;18(9):925-936. https://doi:10.1080/14656566.2017.1328499
3. Vorderwülbecke BJ, Kowski AB, Kirschbaum A, Merkle H, Senf P, Janz D, Holtkamp M. Long-term outcome in adolescent-onset generalized genetic epilepsies. Epilepsia. 2017 Jul;58(7):1244-1250. doi: 10.1111/epi.13761. Epub 2017 May 2. PMID: 28464258.
4. Oster, JM. Brivaracetam: A Newly Approved Medication for Epilepsy. Future Neurology, 2018, 14(3). https://doi.org/10.2217/fnl-2015-0002
5. Kwan P, Trinka E, Van Paesschen W, Rektor I, Johnson ME, Lu S. Adjunctive brivaracetam for uncontrolled focal and generalized epilepsies: results of a phase III, double-blind, randomized, placebo-controlled, flexible-dose trial. Epilepsia. 2014 Jan;55(1):38-46. https://doi.org/10.1111/epi.12391
6. Strzelczyk A, Kay L, Bauer S, Immisch I, Klein KM, Knake S, et al. Use of brivaracetam in genetic generalized epilepsies and for acute, intravenous treatment of absence status epilepticus. Epilepsia. 2018 Aug;59(8):1549-1556. https://doi:10.1111/epi.14476
7. Villanueva V, Villar EG, Fernandez-Cabrera A, Zurita J, Lopez-Gonzalez FJ, Rodríguez-Osorio X, et al. BRIVA-ONE study: 12-month outcomes of brivaracetam monotherapy in clinical practice. Epilepsia Open. 2024 Dec;9(6):2429-2442. https://doi:10.1002/epi4.13078
8. Fonseca E, Guzmán L, Quintana M, Abraira L, Santamarina E, Salas-Puig X, et al. Efficacy, retention, and safety of brivaracetam in adult patients with genetic generalized epilepsy. Epilepsy Behav. 2020 Jan;102:106657. https://doi:10.1016/j.yebeh.2019.106657
9. Foo EC, Geldard J, Peacey C, Wright E, Eltayeb K, Maguire M. Adjunctive brivaracetam in focal and generalized epilepsies: A single-center open-label prospective study in patients with psychiatric comorbidities and intellectual disability. Epilepsy Behav. 2019 Oct;99:106505. https://doi:10.1016/j.yebeh.2019.106505
10. Snoeren A, Majoie MHJM, Fasen KCFM, Ijff DM. Brivaracetam for the treatment of refractory epilepsy in patients with prior exposure to levetiracetam: A retrospective outcome analysis. Seizure. 2022 Mar;96:102-107. https://doi:10.1016/j.seizure.2022.02.007
11. Lafortune J, Deacon C, Clément JF. Brivaracetam: First Canadian Experience in an Intractable Epilepsy Population. Can J Neurol Sci. 2020 Mar;47(2):183-188. https://doi:10.1017/cjn.2019.321
12. Stephen L, Brodie MJ. Adjunctive brivaracetam - A prospective audit of outcomes from an epilepsy clinic. Epilepsy Behav. 2021 Mar;116:107746. https://doi:10.1016/j.yebeh.2020.107746
13. Grande-Martín A, Sopelana-Garay D, Pardal-Fernández JM, Sánchez-Honrubia RM, Sánchez-Larsen ÁA. Exceptional response to brivaracetam in a patient with refractory idiopathic generalized epilepsy and absence seizures. Epileptic Disord. 2018 Feb 1;20(1):60-64. https://doi:10.1684/epd.2017.0939
14. Subramonian A, Farrah K. Brivaracetam versus Levetiracetam for Epilepsy: A Review of Comparative Clinical Safety [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2020 Dec 1. PMID: 33555772.
15. Lince-Rivera I, Córdoba NM, la Rosa JSO. Narrative review of brivaracetam for genetic generalized epilepsies. Seizure. 2022 Dec;103:72-81. https://doi:10.1016/j.seizure.2022.10.009
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