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Possible role of brivaracetam in controlling acute seizures

AAN 2019
In an exploratory trial, efficacy and safety of brivaracetam and lorazepam for controlling acute seizures were compared. The similar efficacy suggests a possible role of brivaracetam in this setting [1].

The study was designed as a phase 2, open-label, randomised, parallel-group, active-controlled proof-of-concept trial. Participants were adult patients admitted to an Epilepsy Monitoring Unit (EMU) in Birmingham, USA. They were randomised 1:1:1 to single-dose bolus intravenous lorazepam, brivaracetam 100 mg (BRV100), or brivaracetam 200 mg (BRV200), which was administered when a seizure required intervention. The primary efficacy outcome was time to next seizure or use of rescue medication.

Of 45 randomised patients who received trial medication for a qualifying seizure, 11 (24.4%) had a seizure within 12 hours (lorazepam n=5, BRV100 n=3, BRV200n =3), suggesting similar efficacy across treatments. Most patients were seizure-free at 12 hours (lorazepam 60.0%, BRV100 80.0%, BRV200 80.0%). Rescue medication use at 12 hours was numerically higher for lorazepam (40.0%) than for brivaracetam (6.7% and 13.3%, respectively). Safety results were as expected. One lorazepam patient reported a seizure cluster.

1. Szaflarski J, et al. AAN 2019, S36.008.

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