Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG & Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, United Kingdom; Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom.
Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom.
Epilepsy Behav. 2022 Oct;135:108868. doi: 10.1016/j.yebeh.2022.108868. Epub 2022 Aug 16.
Brivaracetam (BRV) is licensed as an adjunctive treatment for focal epilepsy. We describe our clinical experience with BRV at a large UK tertiary center.
Adults initiated on BRV between July 2015 and July 2020 were followed up until they discontinued BRV or September 2021. Data on epilepsy syndrome, duration, seizure types, concomitant and previous antiseizure medication (ASM) use, BRV dosing, efficacy, and side effects were recorded. Efficacy was categorized as temporary (minimum three months) or ongoing (at last follow-up) seizure freedom, ≥50% seizure reduction, or other benefits (e.g., no convulsions or daytime seizures). Brivaracetam retention was estimated using Kaplan-Meier survival analysis.
Two-hundred people were treated with BRV, of whom 81% had focal epilepsy. The mean (interquartile range [IQR]) follow-up time was 707 (688) days, and the dose range was 50-600 mg daily. The mean (IQR) of the previous number of used ASMs was 6.9 (6.0), and concomitant use was 2.2 (1.0). One-hundred and eighty-eight people (94%) had previously discontinued levetiracetam (LEV), mainly due to side effects. 13/200 (6.5%) were seizure free for a minimum of six months during treatment, and 46/200 (23%) had a ≥50% reduction in seizure frequency for six months or more. Retention rates were 83% at six months, 71% at 12 months, and 57% at 36 months. Brivaracetam was mostly discontinued due to side effects (38/75, 51%) or lack of efficacy (28/75, 37%). Concomitant use of carbamazepine significantly increased the hazard ratio of discontinuing BRV due to side effects (p = 0.006). The most commonly reported side effects were low mood (20.5%), fatigue (18%) and aggressive behavior (8.5%). These side effects were less prevalent than when the same individuals took LEV (low mood, 59%; aggressive behavior, 43%). Intellectual disability was a risk factor for behavioral side effects (p = 0.004), and a pre-existing mood disorder significantly increased the likelihood of further episodes of low mood (p = 0.019).
Brivaracetam was effective at a broad range of doses in managing drug-resistant epilepsy across various phenotypes, but less effective than LEV in those who switched due to poor tolerability on LEV. There were no new tolerability issues, but 77% of the individuals experiencing side effects on BRV also experienced similar side effects on LEV.
布瓦西坦（BRV）被批准作为局灶性癫痫的辅助治疗药物。我们描述了在英国一家大型三级中心使用 BRV 的临床经验。
2015 年 7 月至 2020 年 7 月期间开始使用 BRV 的成年人，在停药或 2021 年 9 月前进行随访。记录癫痫综合征、病程、发作类型、同时使用和先前使用的抗癫痫药物（ASM）、BRV 剂量、疗效和副作用的数据。疗效分为临时（至少三个月）或持续（最后一次随访）无发作、≥50%发作减少或其他益处（如无抽搐或白天发作）。使用 Kaplan-Meier 生存分析估计 BRV 保留率。
共有 200 人接受 BRV 治疗，其中 81%为局灶性癫痫。平均（四分位距[IQR]）随访时间为 707（688）天，剂量范围为 50-600mg/天。之前使用的 ASM 数量的平均值（IQR）为 6.9（6.0），同时使用的数量为 2.2（1.0）。188 人（94%）之前因副作用而停用左乙拉西坦（LEV）。13/200（6.5%）在治疗期间至少有 6 个月无发作，46/200（23%）发作频率减少≥50%，持续 6 个月或更长时间。6 个月时的保留率为 83%，12 个月时为 71%，36 个月时为 57%。BRV 停药的主要原因是副作用（38/75，51%）或疗效不佳（28/75，37%）。卡马西平的同时使用显著增加了因副作用而停用 BRV 的风险比（p=0.006）。最常见的不良反应是情绪低落（20.5%）、疲劳（18%）和攻击性行为（8.5%）。这些副作用的发生率低于相同个体服用 LEV 时（情绪低落，59%；攻击性行为，43%）。智力残疾是行为不良反应的危险因素（p=0.004），而先前存在的情绪障碍显著增加了进一步出现情绪低落的可能性（p=0.019）。
BRV 在广泛的剂量范围内对各种表型的耐药性癫痫均有效，但在因 LEV 耐受性差而改用 BRV 的患者中，其疗效不如 LEV。没有新的耐受性问题，但 77%的在服用 BRV 时出现副作用的患者在服用 LEV 时也出现了类似的副作用。
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