Anger Assessment in Patients Treated With Brivaracetam

Ortega, Gemma; Abraira, Laura; Martí, Gloria Novel; Quintana, Manuel; Mazuela, Gonzalo; Santamarina, Estevo; Salas‐Puig, Xavier; Toledo, Manuel

doi:10.1097/wnf.0000000000000258

Cited by 9 publications

(13 citation statements)

References 22 publications

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“…The prospective design and objective evaluation of the anger levels are the main differential factors of this research. In line with previous literature, the results basically show that in an overall group of patients, which includes focal onset and idiopathic generalized epilepsies, BRV can be well tolerated with regard to drug-related irritability [13,[15][16][17]. However, seizure control in patients treated with BRV seems to be relevant to improve anger levels.…”

Section: Discussionsupporting

confidence: 89%

“…Even in the presence of a psychiatric background or history of LEV-related adverse events, BRV can be safely used and is an effective AED alternative [13,20]. In a previous publication by our group independent from this study, we observed similar anger levels in BRV patients to other AEDs, and lower than those exposed to LEV [17]. Unlike some previous studies, we did not include patients with active psychiatric comorbidities and, therefore, we could not assess the antiaggression or mood stabiliser effects of BRV in that population setting [13].…”

Section: Discussionsupporting

confidence: 74%

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Effect of brivaracetam on the anger levels of epilepsy patients. A prospective open-labelled controlled study

Toledo

Abraira

Mazuela

et al. 2019

Seizure

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The rate of brivaracetam-related behavioural adverse events is a current focus of discussion. This study aims to assess the effect of brivaracetam on anger levels in patients with epilepsy, adjusted by mood symptoms, history of psychiatric disorders and seizure response. Method: Prospective analysis of 37 patients assessed for anger levels (STAXI-2), depression-anxiety (HADS) and quality of life (QOLIE-10) before adjunctive brivaracetam treatment and reassessed 3-6 months later. A control group following the same protocol of assessment was used for 1:1 comparison. A high percentage of mood stabilisers were included in this control group. Results: Brivaracetam was indicated for patients including focal onset (79%) and generalised epilepsies (21%). Nearly 60% of responders and no psychiatric adverse events were found. This was similar to controls. The overall results revealed that brivaracetam was assoiciated with better in anger levels, mood scores and quality of life at baseline. Prior use of levetiracetam or the presence of a psychiatric background did not influence the results. However, improvements in anger levels were seen in the brivaracetam responders. Conclusion:This study shows that brivaracetam is not associated with an increased level of anger in patients with either focal or generalised epilepsies in the absence of psychiatric comorbidity. However, an improvement in anger levels is possibly influenced by a good seizure response.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 74%

Effect of brivaracetam on the anger levels of epilepsy patients. A prospective open-labelled controlled study

Toledo

Abraira

Mazuela

et al. 2019

Seizure

Self Cite

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“…LEV, PER, and TPM are associated with the highest reported frequency of AB among AEDs, particularly in patients with a previous history of psychiatric symptoms [4, 20, 21]. The recently introduced BRV, which is chemically closely related to LEV, is said to have less potential to induce behavioral side effects than LEV [6, 22, 23]. However, no studies that directly compare LEV and BRV have been published.…”

Section: Aggressive Behavior As An Adverse Effect Of Aedsmentioning

confidence: 99%

“…The broad pharmacological effect of LEV makes it difficult to determine the exact cause of AB. The high rate of AB with LEV may not necessarily be related to SV2A, since it has been suggested that BRV, which has a 15–30 times higher affinity to SV2A than LEV, is associated with a lower incidence of AB than LEV [6, 22, 23, 95]. Interestingly, it seems that BRV does not modulate NMDA, AMPA, or kainate receptors [96, 97].…”

Section: Possible Neuropharmacological Mechanisms Of Aed-induced Amentioning

confidence: 99%

Mechanisms Underlying Aggressive Behavior Induced by Antiepileptic Drugs: Focus on Topiramate, Levetiracetam, and Perampanel

Hansen

Ljung

Brodtkorb

et al. 2018

Behavioural Neurology

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Antiepileptic drugs (AEDs) are effective against seizures, but their use is often limited by adverse effects, among them psychiatric and behavioral ones including aggressive behavior (AB). Knowledge of the incidence, risk factors, and the underlying mechanisms of AB induced by AEDs may help to facilitate management and reduce the risk of such side effects. The exact incidence of AB as an adverse effect of AEDs is difficult to estimate, but frequencies up to 16% have been reported. Primarily, levetiracetam (LEV), perampanel (PER), and topiramate (TPM), which have diverse mechanisms of action, have been associated with AB. Currently, there is no evidence for a specific pharmacological mechanism solely explaining the increased incidence of AB with LEV, PER, and TPM. Serotonin (5-HT) and GABA, and particularly glutamate (via the AMPA receptor), seem to play key roles. Other mechanisms involve hormones, epigenetics, and “alternative psychosis” and related phenomena. Increased individual susceptibility due to an underlying neurological and/or a mental health disorder may further explain why people with epilepsy are at an increased risk of AB when using AEDs. Remarkably, AB may occur with a delay of weeks or months after start of treatment. Information to patients, relatives, and caregivers, as well as sufficient clinical follow-up, is crucial, and there is a need for further research to understand the complex relationship between AED mechanisms of action and the induction/worsening of AB.

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“…It seems that BRV provides a more favorable neuropsychiatric safety profile than LEV [3] , [4] . Numerous studies have assessed the effect of this switch [4] , [5] , [6] , [7] , [8] , [9] , sometimes by means of an overlapping period of the two drugs. An overnight switch may improve therapeutic adherence and minimize AEs [10] .…”

Section: Introductionmentioning

confidence: 99%

Overnight switch from levetiracetam to brivaracetam. Safety and tolerability

Abraira

Salas-Puig

Quintana

et al. 2021

Epilepsy & Behavior Reports

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Anger Assessment in Patients Treated With Brivaracetam

Abstract: This small, open study suggests that BRV increases anger measures less than LEV in epilepsy patients. However, larger, blinded control studies are required to establish whether this apparent difference can be confirmed.

Cited by 9 publications

References 22 publications

Effect of brivaracetam on the anger levels of epilepsy patients. A prospective open-labelled controlled study

Effect of brivaracetam on the anger levels of epilepsy patients. A prospective open-labelled controlled study

Mechanisms Underlying Aggressive Behavior Induced by Antiepileptic Drugs: Focus on Topiramate, Levetiracetam, and Perampanel

Overnight switch from levetiracetam to brivaracetam. Safety and tolerability

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