Department of Neurology, Division of Stroke and Critical Care, Rutgers, The State University of New Jersey, 12287Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Mid-Atlantic Epilepsy and Sleep Center, Bethesda, MD, USA.
J Intensive Care Med. 2022 Sep;37(9):1133-1145. doi: 10.1177/08850666211073598. Epub 2022 Mar 21.
Clinical considerations for drug treatment of acute seizures involve variables such as safety, tolerability, drug-drug interactions, dosage, route of administration, and alterations in pharmacokinetics because of critical illness. Therapy options that are easily and quickly administered without dilution, well tolerated, and effective are needed for the treatment of acute seizures. The objective of this review is to focus on the clinical considerations relating to the use of intravenous brivaracetam (IV BRV) for the treatment of acute seizures in the hospital, focusing on critically ill patients.
This was a scoping literature review of PubMed from inception to April 13, 2021, and search of the American Academy of Neurology (AAN) 2021 Annual Meeting website for English language publications/conference abstracts reporting the results of IV BRV use in hospitalized patients, particularly in the critical care setting. Outcomes of interest relating to the clinical pharmacology, safety, tolerability, efficacy, and effectiveness of IV BRV were reviewed and are discussed.
Twelve studies were included for analysis. One study showed that plasma concentrations of IV BRV 15 min after the first dose were similar between patients receiving IV BRV as bolus or infusion. IV BRV was generally well tolerated in patients with acute seizures in the hospital setting, with a low incidence of individual TEAEs classified as behavioral disorders. IV BRV demonstrated efficacy and effectiveness and had a rapid onset, with clinical and electrophysiological improvement in seizures observed within minutes. Although outside of the approved label, findings from several studies suggest that IV BRV reduces seizures and is generally well tolerated in patients with status epilepticus.
IV BRV shows effectiveness, and is generally well tolerated in the management of acute seizures in hospitalized patients where rapid administration is needed, representing a clinically relevant antiseizure medication for potential use in the critical care setting.
急性癫痫发作的药物治疗需要考虑安全性、耐受性、药物相互作用、剂量、给药途径以及因危重病而改变的药代动力学等变量。需要选择易于快速给予、无需稀释、耐受性良好且有效的治疗急性癫痫发作的药物。本综述的目的是重点关注静脉内布瓦西坦（IV BRV）在治疗医院内急性癫痫发作中的临床注意事项，特别是关注危重症患者。
这是一项从创建到 2021 年 4 月 13 日在 PubMed 上进行的范围界定文献综述，以及对美国神经病学学会（AAN）2021 年年会网站的搜索，以查找报告 IV BRV 在住院患者中使用结果的英语出版物/会议摘要，特别是在重症监护环境中。审查了与 IV BRV 的临床药理学、安全性、耐受性、疗效和有效性相关的结果，并进行了讨论。
共纳入 12 项研究进行分析。一项研究表明，首次给药后 15 分钟时，接受 IV BRV 推注或输注的患者的 IV BRV 血浆浓度相似。在医院环境中患有急性癫痫发作的患者中，IV BRV 通常具有良好的耐受性，个别被归类为行为障碍的 TEAEs 发生率较低。IV BRV 显示出疗效和有效性，起效迅速，在几分钟内观察到癫痫发作的临床和电生理改善。尽管超出了批准的标签范围，但几项研究的结果表明，IV BRV 可减少癫痫发作，并且在癫痫持续状态患者中通常具有良好的耐受性。
IV BRV 在需要快速给药的住院患者急性癫痫发作的管理中显示出有效性，并且通常具有良好的耐受性，代表一种潜在用于重症监护环境的具有临床相关性的抗癫痫药物。
