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Brivaracetam as add-on therapy in children with developmental epileptic encephalopathies: A study of 42 patients
Roberto H Caraballo1, Gabriela Reyes1, Santiago Chacón2
1Department of Neurology, Juan P Garrahan Hospital, Buenos Aires, Argentina.
Insights
Brivaracetam (BRV) effectively reduced seizures in children with developmental epileptic encephalopathies (DEE), with over 70% experiencing significant improvement. This add-on therapy demonstrated safety and tolerability in pediatric patients.
Area of Science:
- Pediatric Neurology
- Epileptology
- Pharmacology
Background:
- Developmental epileptic encephalopathies (DEE) are severe childhood-onset epilepsy syndromes.
- Treatment-resistant DEEs pose significant challenges in pediatric neurology.
- Brivaracetam (BRV) is an antiepileptic drug with a distinct pharmacological profile.
Purpose of the Study:
- To evaluate the efficacy and safety of brivaracetam (BRV) as add-on therapy in pediatric patients with DEE.
- To assess BRV's effectiveness in treatment-resistant cases.
- To explore BRV's utility in patients with specific comorbidities like behavioral disturbances.
Main Methods:
- Retrospective analysis of medical records from 42 pediatric patients with DEE across four centers in Argentina.
- Patients received BRV as add-on therapy between January 2021 and July 2023.
- Data collected included seizure frequency, EEG abnormalities, and adverse events.
Main Results:
- A significant reduction in seizure frequency was observed in 62.1% of patients (>50% decrease) and 23.8% experienced a 25-50% reduction.
- Three patients (9.5%) achieved seizure freedom, and interictal EEG abnormalities improved in responders.
- Adverse effects (drowsiness, irritability, decreased appetite) were mild and did not lead to treatment discontinuation in most cases.
Conclusions:
- Brivaracetam is an effective and well-tolerated add-on treatment for pediatric patients with DEE.
- BRV can be considered for patients with behavioral disturbances, even without prior levetiracetam (LEV) treatment.
- The study supports BRV as a valuable therapeutic option in managing difficult-to-treat epilepsies in children.
Objective:
Here we present a multicenter series of patients with developmental epileptic encephalopathies (DEE) who were treated with brivaracetam (BRV) as add-on therapy.
Methods:
Medical records of 42 patients with DEE treated with add-on BRV seen at four pediatric neurology centers in Argentina between January 2021 and July 2023 were retrospectively analyzed.
Results:
We included 42 patients (26 males, 16 females) with a mean age of 7 years (SD, ± 3.8; median, 9; range, 2-16). The children had different types of childhood-onset treatment-resistant DEEs and received BRV as add-on therapy for a mean period of 2 years (SD, ± 1.3 years; median, 1.5 years; range, 0.5-3 years). Thirty-three patients received levetiracetam (LEV) before the introduction of BRV. In nine patients, BRV was started without prior LEV because of behavioral disturbances. Three patients (9.5 %) became seizure free and 26/42 patients (62.1 %) had a greater than 50 % decrease in seizures after a mean follow-up of 21 months. Ten patients (23.8 %) had a 25-50 % seizure reduction, while seizure frequency remained unchanged in two (4.7 %) and increased in one patient (2.4 %). The interictal EEG abnormalities improved in all the responders. Adverse effects, consisting of drowsiness, irritability, and decreased appetite, were observed in seven patients (16.6 %), but did not lead to treatment discontinuation.
Conclusion:
Brivaracetam was found to be effective, safe, and well tolerated in children with DEE. In patients on LEV with behavioral disturbances, BRV may be tried. BRV may also be given without a previous trial with LEV in patients with behavioral problems.
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