Skip to main content
SpringerLink
Log in

Efficacy and tolerability of brivaracetam in patients with intellectual disability and epilepsy

  • Original article
  • Published:
Acta Neurologica Belgica Aims and scope Submit manuscript

Abstract

Patients with intellectual disability (ID) are often excluded from clinical trials, and little is known about the best approach to treat their epilepsy. Brivaracetam (BRV) is a new antiepileptic drug (AED) for adjunctive treatment in patients with focal-onset seizures with or without secondary generalization. We analyzed the efficacy and tolerability of BRV in patients with ID and epilepsy who either had or had not previously received treatment with levetiracetam (LEV). Data on efficacy and tolerability were retrospectively collected. After the initial start of BRV in our tertiary epilepsy center, we analyzed medical records at 0, 3, 6 and 12 months of follow-up. 116 patients were included (mean age = 34.9 years, 44% female). All had complete data of 3-month follow-up, 76 of 6-month follow-up, and 39 patients of 1-year follow-up. Median starting dose of BRV was 50.0 mg/day and the mean number of concomitant AEDs was 2.6. Seizure reduction and no side effects were reported in more than half of all patients. The most reported side effects were somnolence, dizziness and aggression. Retention rates for BRV were 84.4%, 75.5% and 58.1% after 3, 6 and 12 months, respectively. Seizure reduction and side effects did not differ significantly between the groups with or without previous LEV treatment. We demonstrate that BRV is effective and well tolerated in patients with epilepsy and ID, even in those where previous LEV treatment failed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Stephen LJ, Brodie MJ (2017) Brivaracetam: a novel antiepileptic drug for focal-onset seizures. Ther Adv Neurol Disord. https://doi.org/10.1177/1756285617742081

    Article  PubMed  PubMed Central  Google Scholar 

  2. WHO (2018) Epilepsy factsheet 2018. https://www.who.int/news-room/fact-sheets/detail/epilepsy. Accessed 1 Nov 1 2018

  3. Ngugi AK, Bottomley C, Kleinschmidt I et al (2010) Estimation of the burden of active and life-time epilepsy: a meta-analytic approach. Epilepsia 51:883–890

    Article  Google Scholar 

  4. Andres E, Kerling F, Hamer H et al (2018) Behavioural changes in patients with intellectual disability treated with brivaracetam. Acta Neurol Scand 138:195–202

    Article  CAS  Google Scholar 

  5. Robertson J, Hatton C, Emerson E et al (2015) Prevalence of epilepsy among people with intellectual disabilities: a systematic review. Seizure 29:46–62

    Article  Google Scholar 

  6. Klein P, Diaz A, Gasalla T et al (2018) A review of the pharmacology and clinical efficacy of brivaracetam. Clin Pharmacol 10:1–22

    PubMed  PubMed Central  Google Scholar 

  7. Chen Z, Brodie MJ, Liew D et al (2018) Treatment outcomes in patients with newly diagnosed epilepsy treated with established and new antiepileptic drugs: a 30-year longitudinal cohort study. JAMA Neurol 75:279–286

    Article  Google Scholar 

  8. Zahnert F, Krause K, Immisch I et al (2018) Brivaracetam in the treatment of patients with epilepsy-first clinical experiences. Front Neurol 9:38

    Article  Google Scholar 

  9. Khaleghi F, Nemec EC (2017) Brivaracetam (Briviact): a novel adjunctive therapy for partial-onset seizures. P&T 42:92–96

    Google Scholar 

  10. Brandt C, May TW, Bien CG (2016) Brivaracetam as adjunctive therapy for the treatment of partial-onset seizures in patients with epilepsy: the current evidence base. Ther Adv Neurol Disord 9:474–482

    Article  CAS  Google Scholar 

  11. Biton V, Berkovic SF, Abou-Khalil B et al (2014) Brivaracetam as adjunctive treatment for uncontrolled partial epilepsy in adults: a phase III randomized, double-blind, placebo-controlled trial. Epilepsia 55:57–66

    Article  CAS  Google Scholar 

  12. Ryvlin P, Werhahn KJ, Blaszczyk B et al (2014) Adjunctive brivaracetam in adults with uncontrolled focal epilepsy: results from a double-blind, randomized, placebo-controlled trial. Epilepsia 55:47–56

    Article  CAS  Google Scholar 

  13. Lattanzi S, Cagnetti C, Foschi N et al (2016) Brivaracetam add-on for refractory focal epilepsy: a systematic review and meta-analysis. Neurology 86:1344–1352

    Article  Google Scholar 

  14. Brodtkorb E, Klees TM, Nakken KO et al (2004) Levetiracetam in adult patients with and without learning disability: focus on behavioral adverse effects. Epilepsy Behav 5:231–235

    Article  Google Scholar 

  15. Klein P, Schiemann J, Sperling MR et al (2015) A randomized, double-blind, placebo-controlled, multicenter, parallel-group study to evaluate the efficacy and safety of adjunctive brivaracetam in adult patients with uncontrolled partial-onset seizures. Epilepsia 56:1890–1898

    Article  CAS  Google Scholar 

  16. Kwan P, Trinka E, Van Paesschen W et al (2014) Adjunctive brivaracetam for uncontrolled focal and generalized epilepsies: results of a phase III, double-blind, randomized, placebo-controlled, flexible-dose trial. Epilepsia 55:38–46

    Article  CAS  Google Scholar 

  17. Huber B, Hauser I, Horstmann V et al (2005) Seizure freedom with different therapeutic regimens in intellectually disabled epileptic patients. Seizure 14:381–386

    Article  Google Scholar 

  18. Doran Z, Shankar R, Keezer MR et al (2016) Managing anti-epileptic drug treatment in adult patients with intellectual disability: a serious conundrum. Eur J Neurol 23:1152–1157

    Article  CAS  Google Scholar 

  19. Foo EC, Geldard J, Peacey C et al (2019) Adjunctive brivaracetam in focal and generalized epilepsies: a single-center open-label prospective study in patients with psychiatric comorbidities and intellectual disability. Epilepsy Behav 99:106505

    Article  Google Scholar 

  20. World Health Organization (1992) The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. Geneva: World Health Organization. https://www.who.int/iris/handle/10665/37958. Accessed 1 Dec 2018

  21. Steinig I, von Podewils F, Moddel G et al (2017) Postmarketing experience with brivaracetam in the treatment of epilepsies: a multicenter cohort study from Germany. Epilepsia 58:1208–1216

    Article  CAS  Google Scholar 

  22. McGrother CW, Bhaumik S, Thorp CF et al (2006) Epilepsy in adults with intellectual disabilities: prevalence, associations and service implications. Seizure 15:376–386

    Article  Google Scholar 

  23. Jackson CF, Makin SM, Marson AG, Kerr M (2015) Pharmacological interventions for epilepsy in people with intellectual disabilities. Cochrane Database Syst Rev 18:CD005399

    Google Scholar 

Download references

Acknowledgement

The help of Loes Jacobs with the data collection was much appreciated.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Residential Care, Epilepsy Center Kempenhaeghe, Postbus 61, 5590 AB, Heeze, The Netherlands

    Ruby M. E. Gillis & In Y. Tan

  2. Department of Pharmacy, Academic Center for Epileptology Kempenhaeghe, Postbus 61, 5590 AB, Heeze, The Netherlands

    Elisabeth A. Wammes-van der Heijden

  3. Department of Neurology, Academic Center for Epileptology Kempenhaeghe, Postbus 61, 5590 AB, Heeze, The Netherlands

    Helenius J. Schelhaas & Marian H. J. M. Majoie

  4. Department of General Practice, Intellectual Disability Medicine, Erasmus MC, Postbus 2040, 3000 CA, Rotterdam, The Netherlands

    Dederieke A. M. Festen

  5. School of Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands

    Marian H. J. M. Majoie

  6. Faculty of Health, Medicine and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands

    Marian H. J. M. Majoie

Authors
  1. Ruby M. E. Gillis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elisabeth A. Wammes-van der Heijden
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Helenius J. Schelhaas
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. In Y. Tan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dederieke A. M. Festen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Marian H. J. M. Majoie
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ruby M. E. Gillis.

Ethics declarations

conflict of interest

We certify that there is no conflict of interest to disclose regarding the materials and data discussed in this manuscript. The contents of this manuscript have not been copyrighted or published previously.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gillis, R.M.E., Wammes-van der Heijden, E.A., Schelhaas, H.J. et al. Efficacy and tolerability of brivaracetam in patients with intellectual disability and epilepsy. Acta Neurol Belg 121, 677–684 (2021). https://doi.org/10.1007/s13760-020-01324-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13760-020-01324-3

Keywords

Search

Navigation