Department of Adult Epilepsy, Kork Epilepsy Center, Landstr. 1, Kehl-Kork, Germany; Department of Neurology and Clinical Neuroscience, Medical Faculty, University of Freiburg, Breisacher Str. 64, Freiburg, Germany.
Department of Adult Epilepsy, Kork Epilepsy Center, Landstr. 1, Kehl-Kork, Germany.
Seizure. 2024 Apr;117:193-197. doi: 10.1016/j.seizure.2024.02.022. Epub 2024 Feb 29.
Brivaracetam is often used as an alternative to levetiracetam in patients with epilepsy (PWE) encountering efficacy issues or adverse events with levetiracetam. This study evaluated the psychological status of PWE who were switched from levetiracetam to brivaracetam due to psychiatric tolerability concerns in comparison to those who remained on levetiracetam.
We used various psychological assessments including the Symptom Checklist SCL-90-R, the Beck Depression Inventory-II, and the adverse event profile. Eligible participants completed the questionnaires at baseline and again 8 days later. Psychological changes were assessed using standard statistical methods to show differences between a group that immediately switched from levetiracetam to brivaracetam and another group with unchanged levetiracetam.
Between May 2020 and May 2021, 63 patients participated in the study, of whom 34 switched from levetiracetam to brivaracetam. At baseline, participants who switched to brivaracetam had fewer antiseizure medications but experienced more monthly seizures. Baseline scores for anxiety (p = 0.020) and psychoticism (p = 0.046) on SCL-90-R in PWE switched to brivaracetam were higher than in the remaining group. In the subsequent assessment, all psychological scores were reduced and were no longer significantly different between both groups. Using multiple regression, initial treatment with a single antiseizure medication and male gender emerged as predictors of psychological improvement.
Our study found no increased risk of adverse events or psychiatric symptoms after switching from levetiracetam to brivaracetam. Though statistically non-significant, a trend towards improved psychiatric outcomes in the switch group warrants further investigation in future trials with stronger designs for enhanced statistical power.
在癫痫患者（PWE）中，当使用左乙拉西坦出现疗效问题或不良反应时，常将其替换为布瓦西坦。本研究评估了因精神病学耐受性问题从左乙拉西坦转为布瓦西坦的 PWE 的心理状态，并与继续使用左乙拉西坦的患者进行比较。
我们使用了各种心理评估，包括症状清单 SCL-90-R、贝克抑郁量表 II 和不良事件概况。合格的参与者在基线时和 8 天后再次完成问卷。使用标准统计方法评估心理变化，以显示立即从左乙拉西坦转为布瓦西坦的组与左乙拉西坦不变的组之间的差异。
2020 年 5 月至 2021 年 5 月期间，共有 63 名患者参与了这项研究，其中 34 名患者从左乙拉西坦转为布瓦西坦。在基线时，转用布瓦西坦的患者使用的抗癫痫药物较少，但每月发作次数更多。在 SCL-90-R 上，转用布瓦西坦的 PWE 的焦虑（p=0.020）和精神病性（p=0.046）得分高于其余组。在随后的评估中，所有心理评分均降低，两组之间不再有显著差异。使用多元回归分析，初始单一抗癫痫药物治疗和男性性别是心理改善的预测因素。
我们的研究未发现从左乙拉西坦转为布瓦西坦后出现不良反应或精神病症状的风险增加。虽然统计学上无显著性，但转换组的精神科结局改善趋势需要在未来具有更强设计的试验中进一步研究，以提高统计效力。
