Zahnert Felix, Krause Kristina, Immisch Ilka, Habermehl Lena, Gorny Iris, Chmielewska Izabella, Möller Leona, Weyand Anna M, Mross Peter M, Wagner Jan, Menzler Katja, Knake Susanne
Department of Neurology, Universitätsklinikum Gießen und Marburg, Philipps University of Marburg, Marburg, Germany.
Front Neurol. 2018 Feb 6;9:38. doi: 10.3389/fneur.2018.00038. eCollection 2018.
To assess first clinical experiences with brivaracetam (BRV) in the treatment of epilepsies.
Data on patients treated with BRV from February to December 2016 and with at least one clinical follow-up were collected from electronic patient records. Data on safety and efficacy were evaluated retrospectively.
In total, 93 patients were analyzed; 12 (12.9%) received BRV in monotherapy. The mean duration to follow-up was 4.85 months (MD = 4 months; SD = 3.63). Fifty-seven patients had more than one seizure per month at baseline and had a follow-up of more than 4 weeks; the rate of ≥50% responders was 35.1% ( = 20) in this group, of which five (8.8%) patients were newly seizure-free. In 50.5% (47/93), patients were switched from levetiracetam (LEV) to BRV, of which 43 (46.2%) were switched immediately. Adverse events (AE) occurred in 39.8%, with 22.6% experiencing behavioral and 25.8% experiencing non-behavioral AE. LEV-related AE (LEV-AE) were significantly reduced by switching to BRV. The discontinuation of BRV was reported in 26/93 patients (28%); 10 of those were switched back to LEV with an observed reduction of AE in 70%. For clinical reasons, 12 patients received BRV in monotherapy, 75% were seizure-free, and previous LEV-AE improved in 6/9 patients. BRV-related AE occurred in 5/12 cases, and five patients discontinued BRV.
BRV seems to be a safe, easy, and effective option in the treatment of patients with epilepsy, especially in the treatment of patients who have psychiatric comorbidities and might not be good candidates for LEV treatment. BRV broadens the therapeutic spectrum and facilitates personalized treatment.
评估布瓦西坦（BRV）治疗癫痫的首批临床经验。
从电子病历中收集2016年2月至12月接受BRV治疗且至少有一次临床随访的患者数据。对安全性和有效性数据进行回顾性评估。
共分析了93例患者；12例（12.9%）接受BRV单药治疗。平均随访时间为4.85个月（中位数=4个月；标准差=3.63）。57例患者在基线时每月发作不止一次且随访时间超过4周；该组中≥50%反应者的比例为35.1%（n=20），其中5例（8.8%）患者新达到无发作。50.5%（47/93）的患者从左乙拉西坦（LEV）换用BRV，其中43例（46.2%）立即换用。39.8%的患者发生不良事件（AE），22.6%经历行为性AE，25.8%经历非行为性AE。换用BRV后，与LEV相关的AE（LEV-AE）显著减少。93例患者中有26例（28%）报告停用BRV；其中10例换回LEV，70%的患者AE减少。出于临床原因，12例患者接受BRV单药治疗，75%无发作，9例患者中有6例之前的LEV-AE有所改善。12例中有5例发生与BRV相关的AE，5例患者停用BRV。
BRV似乎是治疗癫痫患者的一种安全、简便且有效的选择，尤其是在治疗伴有精神疾病合并症且可能不适合LEV治疗的患者时。BRV拓宽了治疗谱，便于个性化治疗。
