Abstracts

Rationale: Epilepsy, one of the most frequent chronic neurological diagnoses in the pediatric population, is characterized by frequent, unprovoked or reflex seizures. Seizures are caused by abnormal, excessive neural activity in the brain. One widely used anti-epileptic drug (AED) is Levetiracetam (LEV), a second-generation AED used as adjunctive treatment for primary generalized tonic-clonic seizures and myoclonic seizures associated with juvenile myoclonic epilepsy and monotherapy for partial onset seizures. However, neurobehavioral adverse effects (AEs) cause many patients to switch from (LEV) to another AED despite attaining effective seizure control. Brivaracetam (BRV), a new drug with a similar chemical makeup as that of LEV, is thought to maintain the seizure control of LEV, while reducing AEs. Research on the neurobehavioral effects and seizure reduction rates of this drug in the pediatric population has been limited. Here, we investigate the clinical response and prevalence of neurobehavioral AE in 27 pediatric patients on BRV. Methods: We retrospectively evaluated the electronic medical records of patients on BRV in a multidisciplinary center specializing in pediatric epilepsy to determine their response to the new drug. Clinical response was evaluated 3 months before and after initiation of BRV. Results: Twenty-seven patients on BRV were selected for this study. Patient age range was 6-19 years. Of the 27 patients, 33% had autism spectrum disorder. The total dose of BRV per day ranged from 10mg- 200 mg. At the time of BRV initiation, 63% of patients remained on concomitant AEDs and a rescue medication, while the rest of the patients were only on BRV and a rescue medication (Table 1). Seizure control was maintained in 48% of patients (n=27). Of those patients, 46% had attained seizure freedom prior to initiation of BRV. Seizure reduction was reported in 37% of patients. An increase in seizure frequency was observed in 4% of patients.Patients on BRV Monotherapy10 patients were on BRV and a rescue drug. Of those patients, 70% (n=7) reported unchanged seizure frequency. A >50% reduction in seizures was reported in 20% of patients, and a <50% reduction in seizures was reported in 10% of patients. 2 patients had AEs within 3 months of initiating BRV.Patients with Behavioral Problems on LEV11 patients (41%) were switched from LEV to BRV with the goal of reduced neurobehavioral effects while maintaining adequate seizure control. Of those patients, 73% reported maintained or decreased seizure frequency. 64% of patients reported decreased behavioral issues on BRV compared to LEV. Neurobehavioral AEs were reported in 27% of patients in this subset (Table 2). Patients with Neurobehavioral Adverse Effects on BRVNeurobehavioral AEs were reported in 19% (n=5) of patients within 3 months of initiating BRV that led to the discontinuation of the drug. These AEs consisted of biting, aggression, lability in mood, suicidal ideation, and slowed speech. Of those patients, 40% were on BRV monotherapy. Prior behavioral issues on LEV were reported in 60% of patients who also reported behavioral AEs on BRV. Seizure frequency was maintained or reduced in 80% of patients. Conclusions: These preliminary findings suggest that BRV appears to be effective at attaining seizure control while reducing AEs found with LEV in some patients. However, similar AEs found in LEV were also observed within 3 months of BRV initiation. It is possible that adverse neurobehavioral effects on LEV can predict whether or not patients will experience AEs on BRV. A larger prospective study may be necessary to determine the superiority of BRV to LEV. Funding: No funding