title: Real-life experience with brivaracetam in 101 patients with difficult-to-treat epilepsy-A monocenter survey.
abstract: OBJECTIVE
  To assess the efficiency of brivaracetam under real-world conditions in a tertiary referral epilepsy center.
  
  
  METHODS
  We consecutively collected patients treated at our center with brivaracetam (BRV). After a minimum observation period of six months we retrospectively analyzed the efficiency of BRV.
  
  
  RESULTS
  Data of 101 patients (mean age 42 years, range 18-81 years, 54 females,) were analyzed. The median number of antiepileptic drugs (AEDs) used prior to BRV was 10 (range 2-18). The initial dose of BRV was at least 50mg per day, the mean maintenance dose at cut-off was 168.6mg (median 200mg, range 50-400mg). Efficacy data were assessed for the last three months or at the time of the last observation carried forward if BRV had been discontinued prematurely. Responder rate was 27.8% (n=28) with 7% seizure-free patients. Adverse events (AEs) occurred in 37 patients (37%). Most frequent AEs were dizziness (16%) and somnolence (11%). Psychiatric adverse events comprised irritability, aggression, depression and psychosis in single cases. Retention rate after six months was 51.5%. Main reason for discontinuation was a lack of efficacy. In 43 cases LEV and BRV were switched. The switch was performed abruptly without complications. In 26 cases (60%) BRV was discontinued and re-switched to LEV within weeks, mainly due to a lack of better efficacy. After the switch from LEV to BRV we even saw an aggravation both of seizure frequency and severity in 5 cases. Retention rate in patients who had not been on LEV was 57%.
  
  
  CONCLUSIONS
  In our hands BRV appeared to be well tolerated and easy to handle. The retention rate was influenced by patients who were switched from LEV and re-switched because BRV was not more efficient. Switching from and re-switching to LEV was easy.
authors.affiliation: Kork Epilepsy Center, Kehl-Kork, Germany. Electronic address: bsteinhoff@epilepsiezentrum.de.
authors.forename: Bernhard J
authors.initials: BJ
authors.lastname: Steinhoff
authors.affiliation: Kork Epilepsy Center, Kehl-Kork, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Bacher
authors.affiliation: Kork Epilepsy Center, Kehl-Kork, Germany.
authors.forename: Iancu
authors.initials: I
authors.lastname: Bucurenciu
authors.affiliation: Kork Epilepsy Center, Kehl-Kork, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Hillenbrand
authors.affiliation: Kork Epilepsy Center, Kehl-Kork, Germany.
authors.forename: Tassanai
authors.initials: T
authors.lastname: Intravooth
authors.affiliation: Kork Epilepsy Center, Kehl-Kork, Germany.
authors.forename: Reinhold
authors.initials: R
authors.lastname: Kornmeier
authors.affiliation: Kork Epilepsy Center, Kehl-Kork, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Kurth
authors.affiliation: Kork Epilepsy Center, Kehl-Kork, Germany.
authors.forename: Jakob
authors.initials: J
authors.lastname: Stockinger
authors.affiliation: Kork Epilepsy Center, Kehl-Kork, Germany.
authors.forename: Anke M
authors.initials: AM
authors.lastname: Staack
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000927:Anticonvulsants / Q000627:therapeutic use*; D057915:Drug Substitution; D004827:Epilepsy / Q000188:drug therapy*; D005260:Female; D006801:Humans; D000077287:Levetiracetam; D008297:Male; D008875:Middle Aged; D010889:Piracetam / Q000031:analogs & derivatives / Q000627:therapeutic use; D011760:Pyrrolidinones / Q000627:therapeutic use*; D017211:Treatment Failure; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000927:Anticonvulsants; D011760:Pyrrolidinones; D000077287:Levetiracetam; C482793:brivaracetam; D010889:Piracetam
keywords: Antiepileptic drugs; Brivaracetam; Epilepsy; Real world experience