Efficacy and safety of Brivaracetam as adjunctive therapy in pediatric epilepsy: A systematic review and meta-analysis.

Background: Brivaracetam is a novel third-generation antiseizure medication and an analog of levetiracetam with selective affinity for synaptic vesicle protein 2A (SV2A). By binding SV2A, brivaracetam decreases pre-synaptic neurotransmitter release.

Aim: We aimed to assess the safety and efficacy of brivaracetam in pediatric epilepsy.

Method: We searched PubMed, Scopus, and Web of Science (WOS) for relevant clinical and observational studies from inception until February 2024. We carried out statistical analysis using Open Meta-Analyst. Dichotomous data were pooled as proportions with a 95% confidence interval (CI).

Results: Eleven studies with a total of 805 patients were identified. The analysis of four studies revealed the more than 50% responder rate in a cohort of 252 focal epilepsy patients to be 51.5% (95% CI: [32.6%, 70.5%]). The analysis of three studies involving a cohort of 266 patients found a 20.7% incidence (95% CI: [15.8%, 25.6%]) of complete seizure freedom. The analysis of nine studies involving a cohort of 737 epilepsy patients revealed a retention rate of 66% (95% CI: [40%, 92%]).

Conclusion: This study highlights the efficacy, tolerability, and safety of brivaracetam as adjunctive therapy in pediatric patients with epilepsy. The findings support its consideration as a valuable treatment option for children and adolescents, particularly those with drug-resistant epilepsy. Further trials with longer follow-up durations are needed to study the optimal doses and explore factors affecting drug response.