Experience With Brivaracetam in the Acute Care Setting at a Large Tertiary Care Center

Data analyzing usage patterns, efficacy, tolerability, and long-term continuation of brivaracetam (BRV) when initiated in the acute, inpatient setting is lacking.

Retrospective chart review of adult patients who initiated BRV in the emergency or inpatient setting at Yale New Haven Hospital over 5-year span.

Of 133 patients, BRV was used for status epilepticus (SE) in 37% (n = 49), seizures in 38% (n = 51), and rhythmic/periodic patterns (RPP) in 21% (n = 28). Eighty-six (65%) were in an ICU and 33 (25%) were in a non-ICU setting. BRV was the first anti-seizure medication (ASM) tried in 9 (7%), while 124 (93%) tried other ASMs first (mean ASMs = 2; SD = 1). Initial dosing ranged from 50-400 mg (median = 200 mg, IQR = 200-300 mg), then median maintenance dosing of 200 mg/day (IQR = 200-300 mg/day). Of patients with RPP, seizures, or SE on EEG (n = 115, 86%), 46% (n = 53) had electrographic and/or clinical improvement, including 23 (20%) with complete resolution. In patients with clinical seizures (n = 10) or SE (n = 2) not on EEG, BRV was effective in 10 patients. BRV was discontinued in 49 (36%) patients, typically for inefficacy. Of 88 survivors to discharge, 86 (98%) were discharged on ASMs, including 62% (n = 54) discharged on BRV. Follow-up data were available for 53 (60%) patients - 51 (96%) remained on ASMs, with 33 (65%) remaining on BRV (median follow-up = 30 d, IQR = 18-65 d).

BRV appears safe, well-tolerated, and efficacious for acute, inpatient management of RPP, seizures, and SE. Prospective studies validating these findings and directly comparing BRV with other ASMs are warranted.