癫痫持续状态后静脉转口服布伐西坦的疗效：一项真实世界、多中心西西里研究

IF 2.3 3区医学 Q2 BEHAVIORAL SCIENCES

Epilepsy & Behavior Pub Date : 2025-10-02 DOI:10.1016/j.yebeh.2025.110744

C. Martellino , G. Salafica , G. Tripepi , A. Vinaccia , G. Atanasio , Diana Tilenni , F. Lamanna , O. Pardeo , M. Panebianco , L. Urso , G. Maira , P. Laisa , S. Zappulla , M. Gammino , D.Lo Coco , L. Agrò , R. Avarello , L. Zummo , A. Laganà , A. Labate

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引用次数: 0

摘要

布伐西坦（BRV）是第三代抗癫痫药物（ASM），作为突触囊泡蛋白2A （SV2A）的高亲和力配体，与左乙拉西坦（LEV）具有相似的作用机制。然而，BRV对SV2A具有更高的结合亲和力和选择性，并且具有更有利的安全性。我们的目的是研究在癫痫持续状态（SE）和丛集性癫痫发作后将静脉注射BRV转换为口服BRV的疗效。方法：我们在西西里7个癫痫中心开展了一项多中心、回顾性、观察性研究，并结合现实世界的临床实践。招募的患者接受静脉注射BRV作为SE的二线治疗，随后转为口服给药。结局指标为应答率（癫痫发作减少≥50%）、持续癫痫发作自由和不良事件的发生。定义为不良事件（ae）的发生、数量和类型。结果75例患者被纳入研究，7例因随访6个月前死亡而被排除，5例因随访迷失而被排除。本组共纳入62例患者，平均年龄69.63±12.99岁。8.7个月时，BRV的平均剂量为165 mg/天（SD 50,04） mg/天。BRV保留率为93.7%。随访时，30例（47.6%）患者癫痫发作持续自由，22例（34.9%）患者癫痫发作频率下降≥50%，10例（16.1%）患者出现临床恶化。62名参与者中有2人（3.2%）出现不良事件（ae）。我们未发现性别、年龄、BRV剂量与持续癫痫发作自由或癫痫发作次数减少≥50%之间存在相关性（p = 0.57; p = 0.26; p = 0.57）。血管病因患者的缓解或降低≥50%的可能性约为其他患者的3倍（优势比3.13 (IC 95%: 1.01-9.77), p = 0.05）。结论BRV从静脉给药到口服给药的转变在长期治疗既往SE后癫痫，特别是血管疾病患者中具有良好的有效性和安全性。

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The efficacy of switching intravenous to oral brivaracetam following status epilepticus: A real-world, multicenter Sicilian study

Background

Brivaracetam (BRV) is a third-generation antiseizure medication (ASM) that acts as a high-affinity ligand for synaptic vesicle protein 2A (SV2A), sharing a similar mechanism of action with levetiracetam (LEV). Nevertheless, BRV exhibits higher binding affinity and selectivity for SV2A and a more favorable safety profile. We aim to study the efficacy of switching intravenous to oral BRV following status epilepticus (SE) and cluster seizures.

Methods

We conducted a multicenter, retrospective, observational study performed at seven Sicilian epilepsy centers in the context of real-world clinical practice. Recruited patients received intravenous BRV as a second-line treatment for SE and subsequently switched to oral administration. Outcome measures were responder rate (≥ 50 % seizure reduction), sustained seizure freedom and the occurrence of adverse events. were defined as the occurrence, number, and type of adverse events (AEs).

Results

75 patients were included in the study whereas seven were excluded because of death before six months of follow-up and five were because lost at follow-up. Sixty-two patients (mean age 69.63 ± 12.99) were included in the present analyses. The mean dosage of BRV was 165 mg (SD 50,04) mg/day at 8.7 months. The retention rate of BRV was 93.7 %. At follow-up, 30 (47.6 %) patients showed sustained seizure freedom, in 22 (34.9 %) seizure frequency decreased ≥ 50 % and 10 (16,1%) experienced a clinical worsening. Adverse events (AEs) were observed in two out of 62 participants (3.2 %). We didn’t find any correlation between sex, age, dosage of BRV and the sustained seizure freedom or the reduction in the number of seizures ≥ 50 % (p = 0.57; p = 0.26; p = 0.57, respectively). Patients with vascular aetiology had a likelihood of resolution or a reduction ≥ 50 % approximately three times higher (odds ratio 3.13 (IC 95 %: 1.01–9.77), p = 0.05) than others.

Conclusions

The switch of BRV from intravenous to oral administration has demonstrated a good effectiveness and safety profile in long-term treatment of epilepsy following a prior SE particularly in patients with vascular diseases.

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来源期刊

Epilepsy & Behavior 医学-行为科学

CiteScore

5.40

自引率

15.40%

发文量

385

审稿时长

43 days

期刊介绍： Epilepsy & Behavior is the fastest-growing international journal uniquely devoted to the rapid dissemination of the most current information available on the behavioral aspects of seizures and epilepsy. Epilepsy & Behavior presents original peer-reviewed articles based on laboratory and clinical research. Topics are drawn from a variety of fields, including clinical neurology, neurosurgery, neuropsychiatry, neuropsychology, neurophysiology, neuropharmacology, and neuroimaging. From September 2012 Epilepsy & Behavior stopped accepting Case Reports for publication in the journal. From this date authors who submit to Epilepsy & Behavior will be offered a transfer or asked to resubmit their Case Reports to its new sister journal, Epilepsy & Behavior Case Reports.