Intravenous brivaracetam for the management of refractory focal non-convulsive status epilepticus

BMJ Case Rep. 2020 Nov 23;13(11):e234955. doi: 10.1136/bcr-2020-234955.

Abstract

Diagnosis and management of status epilepticus (SE), including non-convulsive status epilepticus (NCSE), is challenging, with a reported 30%-50% of epilepticus patients not responding to available antiseizure medications (ASMs). Injectable benzodiazepines, fosphenytoin, valproate, levetiracetam, lacosamide and phenobarbital are commonly used for treating SE. Brivaracetam, a new ASM, with higher affinity and greater selectivity for the synaptic vesicle glycoprotein 2A than levetiracetam, has been approved as monotherapy or adjunct for treatment of focal onset seizures. Brivaracetam may have a role in the management of SE. However, limited data exist on brivaracetam's efficacy in SE. We describe a patient case with focal NCSE refractory to levetiracetam, fosphenytoin, lacosamide and valproate who demonstrated clinical and electrographic improvement on continuous electroencephalography monitoring after brivaracetam administration.

Keywords: epilepsy and seizures; neurology (drugs and medicines); pharmacology and therapeutics.

Publication types

  • Case Reports

MeSH terms

  • Administration, Intravenous
  • Aged
  • Anticonvulsants / administration & dosage
  • Dose-Response Relationship, Drug
  • Electroencephalography
  • Female
  • Follow-Up Studies
  • Humans
  • Monitoring, Physiologic
  • Pyrrolidinones / administration & dosage*
  • Status Epilepticus / diagnosis
  • Status Epilepticus / drug therapy*
  • Status Epilepticus / physiopathology

Substances

  • Anticonvulsants
  • Pyrrolidinones
  • brivaracetam