Current Role of Brivaracetam in the Management of Epilepsy in Adults and Children: A Systematic Review

Epilepsy, a neurological condition, has a devastating effect on the quality of life (QoL) of patients if left untreated. Brivaracetam (BRV), a third-generation antiepileptic drug (AED), acts by modulating synaptic vesicle proteins, making it a valuable addition to the arsenal of drugs for epilepsy management. This study aims to assess the efficacy, safety, and reasons for switching from prior AEDs to BRV in patients with epilepsy. A systematic electronic search was performed in PubMed and Google Scholar for English-language articles published from 1 June 2013 to 2 June 2023 on the safety, efficacy, and behavioral adverse effects (BAEs) of BRV when used as monotherapy, add-on therapy, and after switching from prior AEDs (switch therapy; along with reasons for switching to BRV from prior AEDs in adult and pediatric populations), irrespective of the route of administration. A qualitative assessment was conducted using the Joanna Briggs Institute (JBI) tool. A qualitative synthesis of the data was performed. Sixty-one articles involving a total of 15,186 patients with epilepsy were included for qualitative synthesis. In adults, seizure reduction was reported in 31.4%-72.0%, 4.4%-82.1%, and 6.8%-54.3% of patients; seizure freedom in 12.10%-25.6%, 2.0%-80%, and 6.5%-30.6% of patients; and a responder rate of ≥50% in 30.8%, 21.9%-83.8%, and 16.7%-69.1% of patients with monotherapy, add-on therapy, and after switch therapy, respectively. In the pediatric population, seizure reduction was reported in 39.1%‍-‍62.5% and 21%-59% of patients, seizure freedom in 4.4%-37.5% and 12% of patients, and a responder rate of ≥50% in 19.7%-65% and 21%-45.2% of patients with add-on therapy and after switch therapy, respectively. BAEs such as irritability, mood changes, emotional lability, aggression, and agitation were reported in adults for all types of therapies, while anger was reported with only monotherapy and add-on therapy, hyperactivity with add-on therapy, and agitation with monotherapy and add-on therapy with BRV. In the pediatric population, irritability and aggression were reported with add-on and switch therapies, while emotional lability was reported with only switch therapy with BRV. The reasons for switching to BRV from previous AEDs were lack of efficacy and treatment-related adverse effects (AEs). BRV has a favorable efficacy and safety profile. The drug reduces seizure frequency, provides seizure freedom, and achieves a ≥50% responder rate in adult and pediatric patients with add-on therapy and after switching to BRV from other AEDs. However, there is limited evidence supporting its use as monotherapy.