Expert Opinion: Brivaracetam in Management of Epilepsy

Abstract

Epilepsy is prevalent with about 50 million patients affected worldwide. There are many treatment gaps in the management of epilepsy in India. Within Anti-epileptic drugs (AED), Brivaracetam, which is a high-affinity, selective, and reversible ligand for synaptic vesicle 2A is approved by the Food and Drug Administration for monotherapy as well as adjunctive treatment of focal seizures. A series of meeting occurring during April 2020 inviting neurologist across India as panel members, reviewed the efficacy and safety of brivaracetam and discussed the use of brivaracetam in clinical settings and the drivers and barriers for the use of brivaracetam in the management of epilepsy. Brivaracetam has good efficacy and tolerability as adjunctive therapy in the treatment of focal (partial onset) seizures in patients 16 years of age and older. Brivaracetam is safe for prolonged use in patients with epilepsy and in children with epilepsy. The most common adverse events with brivaracetam are related to central nervous system and include fatigue, dizziness, and somnolence; these may improve or resolve during treatment. A consensus was sought for the use of brivaracetam in epilepsy management in routine neurology practices Brivaracetam is a safer AED with lesser behavioral AEs, lack of cognitive impairment, and no clinically relevant drug-drug interactions or dose adjustment for renal patients.