Abstract

This is a case series of 25 patients with drug-resistant epilepsy and psychiatric comorbidities started on Brivaracetam (BRV) at St George’s University Hospitals and Frimley Health in London. Median BRV dose was 125 mg for a median follow period of 8 months. Nineteen had focal epilepsy, four had generalized epilepsies and one had unclassified epilepsy; 76% had mood disorders (either depression or bipolar disorder), 12% intellectual disabilities with autism spectrum disorder and challenging behavior and 12% psychoses. 40% of patients presented at least 50% seizure reduction but none of them became seizure free. A total of 44% patients discontinued BRV, 20% because of adverse events, 20% because of inefficacy and 4% because of both. Depression was reported by 8%, aggressive behavior by 8% while 4% reported both. A total of 91.6% had received Levetiracetam (LEV) before, in whom LEV was discontinued because of psychiatric adverse events (PAEs) in half. 77% of patients who developed PAEs with LEV didn’t do so on BRV suggesting that BRV is better tolerated than LEV in complex patients with psychiatric comorbidities and that the SV2A protein modulation is unlikely to be implicated in LEV-related PAEs.