Brivaracetam for status epilepticus: a systematic review

Status epilepticus (SE) is a neurological emergency characterized by prolonged or recurrent seizures leading to secondary brain injury, morbidity and mortality. Timely and aggressive management is essential to mitigate these negative effects. Brivaracetam (BRV), a novel antiseizure medication, has emerged as a potential treatment option for SE, but its efficacy and safety profile remain inadequately characterized.

This systematic review aims to evaluate the available evidence regarding the administration, effectiveness, and safety of BRV in the management of SE, refractory status epilepticus (RSE), and super-refractory status epilepticus (SRSE).

PRISMA guidelines were followed. A literature search was conducted across MEDLINE, EMBASE, CINAHL and Cochrane CENTRAL. Original research involving adult patients with SE treated with BRV was included and quality assessed. Data on patient demographics, treatment protocols and outcomes were extracted.

A total of 12 studies encompassing 263 patients suffering from SE, RSE, and SRSE were included. Patients suffered from both generalized and focal seizures with or without prominent motor features due to various etiologies. Eighty-two patients received levetiracetam prior to BRV. The overall seizure cessation rate following BRV administration was 56%, predominantly within 72 h. The timing of BRV initiation was variable, with intravenous loading doses ranging from 50 to 400 mg, followed by maintenance doses of 80-400 mg per day, administered every 8-12 h enterally. Adverse events were reported in nine studies, with drowsiness and psychiatric effects being the most common.

BRV may be an effective treatment for SE, RSE, and SRSE, demonstrating efficacy across various seizure semiologies and etiologies, although there are substantial limitations within the available literature.