Safety and Efficacy of Intravenous Brivaracetam versus Levetiracetam in the Management of Status Epilepticus in Children
Intravenous Brivaracetam versus Levetiracetam in the Management of Status Epilepticus
DOI:
https://doi.org/10.54393/pjhs.v7i3.3586Keywords:
Levetiracetam, Mortality, Safety, Seizures, Status EpilepticusAbstract
Status epilepticus (SE) is one of the most common pediatric neurological emergencies and a major cause of all pediatric epilepsy-related hospital admissions. Objectives: To compare the safety and efficacy of intravenous (IV) brivaracetam versus levetiracetam in the management of SE in children. Methods: This randomized controlled trial was performed at the Department of Pediatric Neurology, Institute of Child Health, Multan, Pakistan, from January to September 2025. A total of 152 children (76 in each group), aged 1 month to 16 years with SE, were randomly assigned to receive IV brivaracetam (2 mg/kg) or levetiracetam (40 mg/kg). Seizure cessation within 30 minutes of infusion, time to cessation, recurrence, hospitalization duration, and adverse events were documented. Data were analyzed using SPSS v26.0, with p<0.05 considered significant. Results: In a total of 152 children, the median age was 6.2 years (IQR 3.4–10.7), and 84 (55.3%) children were males. Seizure cessation within 30 minutes was noted in 65 (85.5%) children receiving brivaracetam and 55 (72.4%) receiving levetiracetam (p=0.047). The median time to cessation was 4.5 (IQR 3.0–7.0) minutes in bivarectam, vs. 6.0 (IQR 4.0–9.5) minutes with levetiracetam (p=0.009). The median hospital stay was 4.0 (IQR 3.0–6.0) days vs 5.5 (IQR 4.5–7.0) days (p=0.034) in brivarecetam and levetiracetam groups, respectively. Adverse events occurred in 10 (13.2%) children in the Bivaracetam group vs. 14 (18.4%) with levetiracetam (p=0.374), while no mortality was documented. Conclusions: IV brivaracetam achieves faster and more effective seizure cessation compared with levetiracetam in children with SE, with lower rates of adverse effects.
References
Wylie T, Sandhu DS, Murr NI. Status Epilepticus. Last Update: 2023 May. Stat Pearls [Internet]. 2025.
Xu MY. Poststroke Seizure: Optimizing Its Management. Stroke and Vascular Neurology. 2019 Mar; 4(1). doi: 10.1136/svn-2018-000175. DOI: https://doi.org/10.1136/svn-2018-000175
Toker RT, Bodur M, Okan MS. Etiologies of Convulsive Status Epilepticus in Children. The Journal of Current Pediatrics. 2023; 21: 195-201. doi: 10.4274/jcp.2023.74508. DOI: https://doi.org/10.4274/jcp.2023.74508
Rosati A, Bartolotta P, Marini C, Mondardini MC, Cordelli DM, Fetta A et al. Optimizing Pediatric Status Epilepticus Management: The Role of Early Midazolam Infusion and Adherence to Clinical Practice Guidelines. Epilepsia. 2025 May; 66(9): 3193-3206. doi: 10.1111/epi.18455. DOI: https://doi.org/10.1111/epi.18455
Lugli L, Bariola MC, Guidotti I, Pugliese M, Roversi MF, Bedetti L et al. Neurodevelopmental Outcome of Neonatal Seizures: A Longitudinal Study. European Journal of Pediatric Neurology. 2024 Mar; 49: 17-26. doi: 10.1016/j.ejpn.2024.01.007. DOI: https://doi.org/10.1016/j.ejpn.2024.01.007
Mayer SA, Claassen J, Lokin J, Mendelsohn F, Dennis LJ, Fitzsimmons BF. Refractory Status Epilepticus: Frequency, Risk Factors, and Impact on Outcome. Archives of Neurology. 2002 Feb; 59(2): 205-10. doi: 10.1001/archneur.59.2.205. DOI: https://doi.org/10.1001/archneur.59.2.205
Haddad N, Melikyan G, Hail HA, Khodair RH, Thekkumpurath T, Alrabi A. Advances in the Treatment of Status Epilepticus. Status Epilepticus - Recent Advances in Epidemiology, Electroencephalography, Etiology, Diagnosis, and Treatment in Adults and Children. 2023 Oct. doi: 10.5772/intechopen.106022. DOI: https://doi.org/10.5772/intechopen.106022
Jamali A, Ali W, Rehman FU. Comparison of Phenobarbital and Sodium Valproate for the Treatment of Status Epilepticus in Children. The Professional Medical Journal. 2020 Jul; 27(07): 1353-7. doi: 10.29309/TPMJ/2020.27.07.3543. DOI: https://doi.org/10.29309/TPMJ/2020.27.07.3543
Steinhoff BJ and Staack AM. Levetiracetam and Brivaracetam: A Review of Evidence from Clinical Trials and Clinical Experience. Therapeutic Advances in Neurological Disorders. 2019 Sep; 12: 1756286419873518. doi: 10.1177/1756286419873518. DOI: https://doi.org/10.1177/1756286419873518
Kartek M, Kannan A, Anand V, Sahoo MR. Intravenous Levetiracetam Versus Intravenous Phenytoin as Second-Line Treatment in Pediatric Convulsive Status Epilepticus-Open-Label Randomized Controlled Trial. Journal of Family Medicine and Primary Care. 2024 Aug; 13(8): 3368-73. doi: 10.4103/jfmpc.jfmpc_1747_23. DOI: https://doi.org/10.4103/jfmpc.jfmpc_1747_23
Appleton RE, Rainford NE, Gamble C, Messahel S, Humphreys A, Hickey H et al. Levetiracetam as an Alternative to Phenytoin for Second-Line Emergency Treatment of Children with Convulsive Status Epilepticus: The Eclipse Rct. Health Technology Assessment (Winchester, England). 2020 Nov; 24(58): 1. doi: 10.3310/hta24580. DOI: https://doi.org/10.3310/hta24580
Moalong KM, Espiritu AI, Fernandez ML. Efficacy and Tolerability of Intravenous Brivaracetam for Status Epilepticus: A Systematic Review. Journal of the Neurological Sciences. 2020 Jun; 413: 116799. doi: 10.1016/j.jns.2020.116799. DOI: https://doi.org/10.1016/j.jns.2020.116799
McGuire S, Silva G, Lal D, Khurana DS, Legido A, Hasbani D et al. Safety and Efficacy of Brivaracetam in Pediatric Refractory Epilepsy: A Single-Center Clinical Experience. Journal of Child Neurology. 2020 Feb; 35(2): 102-5. doi: 10.1177/0883073819879276. DOI: https://doi.org/10.1177/0883073819879276
Hwang H and Kim WJ. Brivaracetam: Pharmacology, Clinical Efficacy, and Safety in Epilepsy. Journal of Epilepsy Research. 2025 Jun; 15(1): 42. doi: 10.14581/jer.25005. DOI: https://doi.org/10.14581/jer.25005
Klein P and Bourikas D. Narrative Review of Brivaracetam: Preclinical Profile and Clinical Benefits in the Treatment of Patients with Epilepsy. Advances in Therapy. 2024 Jul; 41(7): 2682-99. doi: 10.1007/s12325-024-02876-z. DOI: https://doi.org/10.1007/s12325-024-02876-z
Alsabri M, Elsayed SM, Rath S, Abdul-Hafez HA, Abo-Elnour DE, Kurian E. Efficacy and Safety of Levetiracetam for Pediatric Convulsive Status Epilepticus in Emergency Settings: A Systematic Review and Meta-Analysis. BioMed Central Neurology. 2025 Jul; 25(1): 309. doi: 10.1186/s12883-025-04323-0. DOI: https://doi.org/10.1186/s12883-025-04323-0
Orlandi N, d'Orsi G, Pauletto G, Nilo A, Sicurella L, Pescini F et al. A Retrospective Multicentric Study on the Effectiveness of Intravenous Brivaracetam in Seizure Clusters: Data from the Italian Experience. Seizure: European Journal of Epilepsy. 2023 May; 108: 72-80. doi: 10.1016/j.seizure.2023.04.015. DOI: https://doi.org/10.1016/j.seizure.2023.04.015
Martellino C, Laganà A, Atanasio G, Lamanna F, Attardo S, Cascino S et al. The Real-World Effectiveness of Intravenous Brivaracetam as a Second-Line Treatment in Status Epilepticus. Epilepsy and Behavior. 2023 Nov; 148: 109464. doi: 10.1016/j.yebeh.2023.109464. DOI: https://doi.org/10.1016/j.yebeh.2023.109464
Besli GE, Karatoprak EY, Yilmaz S. Efficacy and Safety Profile of Intravenous Levetiracetam Versus Phenytoin in Convulsive Status Epilepticus and Acute Repetitive Seizures in Children. Epilepsy and Behavior. 2020 Oct; 111: 107289. doi: 10.1016/j.yebeh.2020.107289. DOI: https://doi.org/10.1016/j.yebeh.2020.107289
Song T, Feng L, Xia Y, Pang M, Geng J, Zhang X et al. Safety and Efficacy of Brivaracetam in Children Epilepsy: A Systematic Review and Meta-Analysis. Frontiers in Neurology. 2023 Jul; 14: 1170780. doi: 10.3389/fneur.2023.1170780. DOI: https://doi.org/10.3389/fneur.2023.1170780
Sivadasan S, Raj FB, John K, Murugan S, Sam SS, Elumalai SK. Effectiveness and Safety of Brivaracetam in Comparison with Levetiracetam in Seizures. Acta Epileptologica. 2025 Dec; 7(1): 47. doi: 10.1186/s42494-025-00229-z. DOI: https://doi.org/10.1186/s42494-025-00229-z
Gillard M, Fuks B, Leclercq K, Matagne A. Binding Characteristics of Brivaracetam, A Selective, High Affinity SV2A Ligand in Rat, Mouse and Human Brain: Relationship to Anti-Convulsant Properties. European Journal of Pharmacology. 2011 Aug; 664(1-3): 36-44. doi: 10.1016/j.ejphar.2011.04.064. DOI: https://doi.org/10.1016/j.ejphar.2011.04.064
Lattanzi S, Chiesa V, Di Gennaro G, Ferlazzo E, Labate A, La Neve A et al. Brivaracetam Use in Clinical Practice: A Delphi Consensus on Its Role as First Add-on Therapy in Focal Epilepsy and Beyond. Neurological Sciences. 2024 Sep; 45(9): 4519-27. doi: 10.1007/s10072-024-07485-w. DOI: https://doi.org/10.1007/s10072-024-07485-w
Villanueva V, Rodriguez-Osorio X, Juiz-Fernández Á, Sayas D, Hampel K, Castillo A et al. Real-Life Evidence About the Use of Intravenous Brivaracetam in Urgent Seizures: The BRIV-IV Study. Epilepsy and Behavior. 2023 Oct; 147: 109384. doi: 10.1016/j.yebeh.2023.109384. DOI: https://doi.org/10.1016/j.yebeh.2023.109384
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