No abstract

Glucose is the most important substrate for proper brain functioning and development, with an increased glucose consumption in relation to the need of creating new brain structures and connections. Therefore, alterations in glucose homeostasis will inevitably be associated with changes in the development of the Nervous System. Several studies demonstrated how the alteration of glucose homeostasis - both hyper and hypoglycemia- may interfere with the development of brain structures and cognitivity, including deficits in intelligence quotient, anomalies in learning and memory, as well as differences in the executive functions. Importantly, differences in brain structure and functionality were found after a single episode of diabetic ketoacidosis suggesting the importance of glycemic control and stressing the need of screening programs for type 1 diabetes to protect children from this dramatic condition. The exciting progresses of the neuroimaging techniques such as diffusion tensor imaging, has helped to improve the understanding of the effects, outcomes and mechanisms underlying brain changes following dysglycemia, and will lead to more insights on the physio-pathological mechanisms and related neurological consequences about hyper and hypoglycemia.

Brivaracetam (BRV), which is considered to be the second generation of the drug of levetiracetam (LEV), 1 is a new antiseizure medication (ASM). It is a 2S)-2-[(4R)-2-oxo-4-propylpyrrolidin-1-yl] butanamide with four different diastereomers 2 capable of binding to SV2A vesicles with high affinity. 3 It was discovered as part of a program established by UCB Pharma to identify selective, high-affinity SV2A ligands that have higher antiepileptic properties than LEV. 2,4,5 Brivaracetam has a 10-30 times greater affinity and selectivity than LEV 6,7 and, compared to the latter, shows greater permeability of the blood-brain barrier in rodent models. 8 In recent years, it has been tested as an ASM in adult and pediatric patients. Most of the studies on the tolerability and efficacy of BRV concern the adult population; the data on the pediatric population are still sparse. The purpose of this review is to provide a comprehensive overview of the available data published about its efficacy and tolerability at the pediatric age.