Behavioral And Psychiatric Adverse Events Induced By Brivaracetam: A Case Report

Abstract

Background: Brivaracetam (BRV) is an anti-convulsant belonging to third-generation antiepileptic and approved by FDA as an add-on therapy as well as monotherapy for management of partial onset seizures in both adults and pediatrics as young as 1 month of age. Brivaracetam induces psychiatric adverse reactions, including non-psychotic and psychotic symptoms. Case Report: A 26-year-old male patient having a past medical history of dyslexia was diagnosed with Seizure disorder during February 2021. Initially, the patient was prescribed Levetiracetam 500 mg BD to control his seizure. The drug was well tolerated and there were no episodes of seizure for a period of 6 months. In August 2021, the patient had a recurrence of convulsions. As a consequence, Brivaracetam 50mg BD and Sodium Valproate 500mg BD were prescribed. The patient gradually started exhibiting unusual behavioral and psychiatric adverse events. The reaction was primarily ascribable to brivaracetam based on the temporal association between non-contributable disease and co-medication. The WHO causality assessment scale graded the ADR to be ‘probable’ and Naranjo’s algorithm with a score of 6. The physician recommended discontinuation of Brivaracetam and advised to continue Sodium Valproate 500mg BD, while Clobazam 5mg BD was added to patient treatment regimen. The patient’s symptoms progressively alleviated, and his behavior returned to normal within one week of discontinuing the Brivaracetam. Conclusion: When initiating treatment with Brivaracetam, close clinical assessment and monitoring is required and recommended to identify any behavioral and psychiatric adverse effects to achieve optimum treatment outcome.