Intravenous brivaracetam in status epilepticus: A multicentric retrospective study in Italy

Orlandi, Niccolò; Bartolini, Emanuele; Audenino, Daniela; Moja, Mario Coletti; Urso, Lidia; D’Orsi, G.; Pauletto, Giada; Nilo, Annacarmen; Zinno, Lucia; Cappellani, Roberto; Zummo, Leila; Giordano, Antonello; Dainese, Filippo; Nazerian, Peiman; Pescini, Francesca; Beretta, Simone; Gaudio, Luigi Del; Ferlisi, Monica; Marino, Daniela; Piccioli, Marta; Renna, Rosaria; Rosati, Eleonora; Rum, A.; Strigaro, Gionata; Giovannini, Giada; Meletti, Stefano; Cavalli, Salvatore M.; Contento, Margherita; Cottone, Salvatore; Claudio, Maria Teresa Di; Florindo, Irene; Guadagni, M.; Kiferle, Lorenzo; Lazzaretti, Delia; Lazzari, Matilde; Coco, Daniele Lo; Pradella, Silvia; Rikani, Klaudio; Rodorigo, Davide; Sabetta, Annarita; Sicurella, Luigi; Tontini, Valentina; Turchi, Giulia; Vaudano, Anna Elisabetta; Zanoni, Tiziano

doi:10.1016/j.seizure.2021.01.014

Cited by 16 publications

(8 citation statements)

References 24 publications

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“…62 A retrospective, observational, multicenter study of 56 patients with status epilepticus in hospital neurology units reported that resolution of status epilepticus was significantly faster when IV BRV was administered earlier, and resolution occurred within a few minutes in 2 patients who received IV BRV as first-line treatment (instead of a benzodiazepine). 63 Overall, the sample sizes of the included studies were small, and there were gaps in the literature relating to the use of IV BRV for the treatment of acute seizures in the hospital and critical care setting. Very few studies have examined the pharmacology of IV BRV in patients in the hospital setting, and a limited number have assessed the effectiveness and tolerability of IV BRV in the critical care setting.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…54 In addition, IV BRV shows effectiveness and is generally well tolerated in patients in hospital with prior LEV treatment. 58,[61][62][63] Respiratory depression has not been reported with BRV, 69 and no cardiorespiratory adverse events were observed in patients treated with IV BRV. 59,62 This makes IV BRV a good treatment option for patients with acute seizures, as it may not increase the need for endotracheal intubation that is often required for excessive use of IV benzodiazepines or anesthetic medications such as continuous IV lorazepam, midazolam, propofol, or pentobarbital.…”

Section: Discussionmentioning

confidence: 97%

“…In numerous studies, resolution of status epilepticus or NCSE was observed directly by clinical observation and EEG within minutes of administration of IV BRV treatment. 58 , 59 , 62 , 63 A retrospective analysis reported that doses of IV BRV higher than 1.9 mg/kg were associated with a greater likelihood of resolution of status epilepticus, and the authors suggested a loading dose of at least 2 mg/kg in adults for the treatment of status epilepticus. 60 However, this is outside of the current approved label for BRV, and the dosing for status epilepticus (including weight-based vs. flat dose) has not been formally assessed.…”

Section: Discussionmentioning

confidence: 99%

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Intravenous Brivaracetam in the Management of Acute Seizures in the Hospital Setting: A Scoping Review

Lee

Klein

Dongre

et al. 2022

J Intensive Care Med

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Background Clinical considerations for drug treatment of acute seizures involve variables such as safety, tolerability, drug-drug interactions, dosage, route of administration, and alterations in pharmacokinetics because of critical illness. Therapy options that are easily and quickly administered without dilution, well tolerated, and effective are needed for the treatment of acute seizures. The objective of this review is to focus on the clinical considerations relating to the use of intravenous brivaracetam (IV BRV) for the treatment of acute seizures in the hospital, focusing on critically ill patients. Methods This was a scoping literature review of PubMed from inception to April 13, 2021, and search of the American Academy of Neurology (AAN) 2021 Annual Meeting website for English language publications/conference abstracts reporting the results of IV BRV use in hospitalized patients, particularly in the critical care setting. Outcomes of interest relating to the clinical pharmacology, safety, tolerability, efficacy, and effectiveness of IV BRV were reviewed and are discussed. Results Twelve studies were included for analysis. One study showed that plasma concentrations of IV BRV 15 min after the first dose were similar between patients receiving IV BRV as bolus or infusion. IV BRV was generally well tolerated in patients with acute seizures in the hospital setting, with a low incidence of individual TEAEs classified as behavioral disorders. IV BRV demonstrated efficacy and effectiveness and had a rapid onset, with clinical and electrophysiological improvement in seizures observed within minutes. Although outside of the approved label, findings from several studies suggest that IV BRV reduces seizures and is generally well tolerated in patients with status epilepticus. Conclusions IV BRV shows effectiveness, and is generally well tolerated in the management of acute seizures in hospitalized patients where rapid administration is needed, representing a clinically relevant antiseizure medication for potential use in the critical care setting.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Intravenous Brivaracetam in the Management of Acute Seizures in the Hospital Setting: A Scoping Review

Lee

Klein

Dongre

et al. 2022

J Intensive Care Med

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“…The largest study so far is an Italian study of 56 cases. Brivaracetam was administered IV as the first drug after benzodiazepine failure in 21% and as second and third (or later used) drug in 38% and 38%, respectively (73). Median loading dose was 100 mg ranging from 50 to 300 mg over 10 to15 min (only 3 min in three cases without complications observed).…”

Section: Newer Antiseizure Medicationsmentioning

confidence: 99%

Modern Treatment of Status Epilepticus in Adults

2022

Epilepsy

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Status epilepticus is a serious epileptic condition associated with significant morbidity and mortality. It can be divided into four stages: developing (seizures leading up to status epilepticus), established (>5 minutes convulsive status epilepticus, nonconvulsive/focal status epilepticus >10 min), refractory (failure of two adequately dosed antiseizure medications in different drug classes), and super-refractory (persisting despite >24 hours of anesthesia). All seizure types can develop to status epilepticus. Generalized convulsive status epilepticus has the largest potential for brain damage. The drug treatment algorithms for status epilepticus Note to the Reader: This chapter is part of the book Epilepsy (ISBN: 978-0-6453320-4-9), scheduled for publication in March 2022. The book is being published by Exon Publications,

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