Department of Epileptology, University of Bonn Medical Center, Bonn, Germany.
Department of Epileptology, University of Bonn Medical Center, Bonn, Germany.
Seizure. 2018 Nov;62:49-54. doi: 10.1016/j.seizure.2018.09.016. Epub 2018 Sep 25.
To assess short-term and longer-term effects of brivaracetam (BRV) on cognition and behavior in a naturalistic clinical setting.
Analyses were based on 43 patients with epilepsy who had undergone a neuropsychological screening before adjunctive treatment with BRV and a follow-up evaluation either after 5 days or 25 weeks. The standard assessment focused on reaction times (Neurocog FX), attention and executive functions (EpiTrack), and verbal memory (short version of the VLMT). Self-perceived cognition and behavior was evaluated by an extended version of the Adverse Events Profile. In addition, health-related quality of life (QOLIE-10) was reassessed at the longer-term interval.
Repeated measures analysis of variance revealed a significant improvement under BRV with regard to attention and executive functions (p = .03) without an interaction with the length of the observation interval. A statistical trend in the same direction was also seen for the reaction times (p = .07), but not for the unchanged verbal memory performance. Subjective measures indicated improvements in concentration (p = .02) and especially in comprehension (p < .001), and health-related quality of life (p = .002). Mood and aggression scores were unchanged. At the longer-term follow-up, an at least 50 percent reduction in seizure frequency was observed in 53% of the patients, 21% were seizure free.
These preliminary data point to a favorable cognitive profile of BRV similar to its precursor levetiracetam. Objective gains in attention and executive functions were accompanied by self-reported improvements in concentration and comprehension. Future studies with larger sample sizes and better control conditions are needed to confirm these findings.
在自然临床环境中评估布里瓦卡坦（BRV）对认知和行为的短期和长期影响。
分析基于 43 名接受 BRV 辅助治疗的癫痫患者，这些患者在接受附加治疗前接受了神经心理学筛查，并在 5 天或 25 周后进行了随访评估。标准评估侧重于反应时间（Neurocog FX）、注意力和执行功能（EpiTrack）以及言语记忆（VLMT 短版）。自我感知的认知和行为通过不良事件概况的扩展版本进行评估。此外，在较长的间隔时间内重新评估了与健康相关的生活质量（QOLIE-10）。
重复测量方差分析显示，BRV 下注意力和执行功能有显著改善（p = .03），且与观察间隔长度无相互作用。反应时间也呈现出相同方向的统计学趋势（p = .07），但言语记忆表现没有变化。主观测量表明注意力（p = .02），特别是理解能力（p < .001）和与健康相关的生活质量（p = .002）有所改善。情绪和攻击评分没有变化。在长期随访中，53%的患者癫痫发作频率至少减少了 50%，21%的患者无癫痫发作。
这些初步数据表明 BRV 的认知特征有利，类似于其前体左乙拉西坦。注意力和执行功能的客观提高伴随着注意力和理解能力的自我报告改善。需要更大样本量和更好对照条件的未来研究来证实这些发现。
