Russo Angelo, Cuteri Vittoria, Bansal Lalit, Bonanni Paolo, Danieli Alberto, Pini Antonella, Gobbi Giuseppe
Pediatric Neurologist and Psychiatrist - Epileptologist IRCCS, Institute of Neurological Sciences of Bologna Bellaria-Maggiore Hospital and Sant'Orsola University Hospital, Bologna Child Neurology Unit - Seizure Unit Bologna, Bologna, Italy.
Child Neurology and Psichiatric Unit, Departement of Medical and Surgical Science (DIMEC), S.Orsola Hospital, University of Bologna, Bologna, Italy.
Iran J Child Neurol. 2021 Fall;15(4):95-104. doi: 10.22037/ijcn.v15i4.29819.
To analyze the efficacy and safety of Brivaracetam in pediatric patients with epileptic encephalopathy or unresponsive focal epilepsy.
MATERIALS & METHODS: This retrospective study included eight pediatric patients with EE or unresponsive focal epilepsy. Inclusion criteria: (1) ≤14 years, (2) history of refractory epilepsy, (3) at least one month of continuous therapy with BRV, and (4) at least six months of follow-up. Exclusion criteria: (1) variation of concomitant antiepileptic drugs during the previous and/or subsequent four weeks of the BRV introduction, (2) levetiracetam in therapy, (3) epilepsy secondary to the progressive cerebral disease, tumor, or any other progressive neurodegenerative diseases, and (4) a status epilepticus a month before screening or during the baseline period. The efficacy of BRV was defined as ≥50% of seizure frequency reduction at the end of the follow-up, compared to baseline.
All patients showed ≥50% seizure frequency reduction, of whom 37.5% were seizure-free, 25% had a frequency reduction of ≥75%, and 37.5% had frequency reduction of ≥ 50%. All patients with an epilepsy onset >12 months and epilepsy duration of ≤6 years were seizure-free. The maximum effect was achieved at 2 mg/kg/day, and focal seizures revealed a better response than epileptic encephalopathy. A remarkably positive effect of the Brivaracetam was noticed in patients with encephalopathy regarding the status epilepticus during sleep; however, no relevant side-effects were noted.
Brivaracetam was an effective and well-tolerated treatment in pediatric patients with epileptic encephalopathy or unresponsive focal epilepsy, especially for the epilepsy onset >12 months and the epilepsy duration ≤6 years. The total effect was not dose-dependent. Brivaracetam could represent an indication of encephalopathy regarding the status epilepticus during sleep.
分析布瓦西坦在小儿癫痫性脑病或局灶性癫痫无反应患者中的疗效和安全性。
本回顾性研究纳入了8例患有癫痫性脑病或局灶性癫痫无反应的儿科患者。纳入标准：（1）年龄≤14岁；（2）难治性癫痫病史；（3）至少接受1个月的布瓦西坦持续治疗；（4）至少随访6个月。排除标准：（1）在引入布瓦西坦之前和/或之后四周内同时使用的抗癫痫药物有变化；（2）正在接受左乙拉西坦治疗；（3）由进行性脑部疾病、肿瘤或任何其他进行性神经退行性疾病继发的癫痫；（4）在筛查前1个月或基线期出现癫痫持续状态。布瓦西坦的疗效定义为随访结束时癫痫发作频率较基线降低≥50%。
所有患者癫痫发作频率均降低≥50%，其中37.5%无癫痫发作，25%发作频率降低≥75%，37.5%发作频率降低≥50%。所有癫痫发作起始>12个月且癫痫病程≤6年的患者均无癫痫发作。最大疗效出现在2mg/kg/天，局灶性癫痫发作的反应比癫痫性脑病更好。布瓦西坦对患有脑病的患者睡眠期间的癫痫持续状态有显著的积极作用；然而，未观察到相关副作用。
布瓦西坦在小儿癫痫性脑病或局灶性癫痫无反应患者中是一种有效且耐受性良好的治疗方法，尤其是对于癫痫发作起始>12个月且癫痫病程≤6年的患者。总体疗效不依赖剂量。布瓦西坦可能对睡眠期间的癫痫持续状态提示脑病。
