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Rapid switching from levetiracetam to brivaracetam in pharmaco-resistant epilepsy in people with and without intellectual disabilities: a naturalistic case control study

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Abstract

Background

Approximately one quarter of people with an intellectual disability (PwID) have epilepsy of whom nearly three-quarters are pharmaco-resistant. There are higher reported neuropsychiatric side-effects to anti-seizure medication (ASM) in this group. Levetiracetam (LEV) is a first-line ASM with a stronger association with neuropsychiatric symptoms for PwID than other ASMs. Brivaracetam (BRV) is a newer ASM. Recent studies suggest a beneficial effect of swap** people who experience neuropsychiatric events with LEV to BRV. However, there is limited evidence of this for PwID. This evaluation analyses real world outcomes of LEV to BRV swap for PwID compared to those without ID.

Methods

We performed a multicentre, retrospective review of clinical records. Demographic, clinical characteristics and reported adverse events of patients switched from LEV to BRV (2016–2020) were recorded at 3 months pre and 6- and 12-month post-BRV initiation. Outcomes were compared between PwID and those without and summarised using cross-tabulations and logistic regression models. A Bonferroni correction was applied.

Results

Of 77 participants, 46 had ID and 52% had a past psychiatric illness. 71% participants switched overnight from LEV to BRV. Seizure reduction of > 50% was seen in 40% patients. Psychiatric illness history was predictive of having neuropsychiatric side-effects with LEV but not BRV (p = 0.001). There was no significant difference for any primary outcomes between PwID versus without ID.

Conclusions

Switching from LEV to BRV appears as well tolerated and efficacious in PwID as those without ID with over 90% still on BRV after 12 months.

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Data statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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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. Swansea Bay University Health Board, Port Talbot, UK

    L. V. Watkins, H. Dunstall & S. Moon

  2. University of South Wales, Aberdare, UK

    L. V. Watkins & C. Bright

  3. University of Plymouth, Plymouth, UK

    L. V. Watkins, C. Musicha, V. Allgar, B. McLean, R. Laugharne & Rohit Shankar

  4. Aneurin Bevan University Health Board, Newport, UK

    C. Lawthom, K. John, C. Bright, C. Richings & K. Harding

  5. Swansea University, Swansea, UK

    C. Lawthom

  6. Oxleas NHS Foundation Trust, Kent, UK

    S. E. Pape & R. Winterhalder

  7. Newcastle University, Newcastle upon Tyne, UK

    R. H. Thomas

  8. The Newcastle Upon Tyne Hospital NHS Foundation Trust, Newcastle upon Tyne, UK

    R. H. Thomas

  9. Cornwall Partnership NHS Foundation Trust, Threemilestone Industrial Estate, Truro, TR4 9LD, UK

    Rohit Shankar

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  1. L. V. Watkins
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Contributions

All authors satisfy the ICMJE guidance by substantially contributing to the design, analysis and interpretation of the work, drafting of the manuscript, final approval of the manuscript and all agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work is appropriately investigated and resolved.

Corresponding author

Correspondence to Rohit Shankar.

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Conflicts of interest

RHT has received honoraria from Angelini, Bial, Biocodex, Eisai, Jazz, LivaNova, Neuraxpharm, Sanofi, Takeda, UCB Pharma and Zogenix, meeting support from Angelini, Bial, UCB Pharma, unrestricted funding support from Angelini and UnEEG and a joint working partnership with UCB Pharma. CL has received consultancy fees from Lundbeck, and speaker fees from Sanovi. RS has received institutional and research support from LivaNova, UCB, Eisai, Veriton Pharma, Bial, Angelini, UnEEG and Jazz/GW pharma outside the submitted work. He holds grants from NIHR AI, SBRI and other funding bodies all outside this work. No other author has any declared conflict of interest related to this paper.

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Watkins, L.V., Dunstall, H., Musicha, C. et al. Rapid switching from levetiracetam to brivaracetam in pharmaco-resistant epilepsy in people with and without intellectual disabilities: a naturalistic case control study. J Neurol 270, 5889–5902 (2023). https://doi.org/10.1007/s00415-023-11959-w

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