Rapid Switching from Levetiracetam to Brivaracetam in Pharmaco-resistant Epilepsy in People with and Without Intellectual Disabilities: a Naturalistic Case Control Study

Overview

Journal J Neurol

Specialty Neurology

Date 2023 Aug 23

PMID 37610448

Authors

L V Watkins

H Dunstall

C Musicha

C Lawthom

K John

C Bright

C Richings

K Harding

S Moon

S E Pape

R Winterhalder

V Allgar

R H Thomas

B McLean

R Laugharne

Rohit Shankar

Affiliations

Soon will be listed here.

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 swapping 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.

Citing Articles

Treatment of Seizures in People with Intellectual Disability.

Vincent Watkins L, Kinney M, Shankar R CNS Drugs. 2025; 39(2):161-183.

PMID: 39752068 DOI: 10.1007/s40263-024-01149-1.

References

Bell G, Neligan A, Sander J . An unknown quantity--the worldwide prevalence of epilepsy. Epilepsia. 2014; 55(7):958-62. DOI: 10.1111/epi.12605. View

McGrother C, Bhaumik S, Thorp C, Hauck A, Branford D, Watson J . Epilepsy in adults with intellectual disabilities: prevalence, associations and service implications. Seizure. 2006; 15(6):376-86. DOI: 10.1016/j.seizure.2006.04.002. View

Glover G, Williams R, Oyinlola J . An observational cohort study of numbers and causes of preventable general hospital admissions in people with and without intellectual disabilities in England. J Intellect Disabil Res. 2020; 64(5):331-344. DOI: 10.1111/jir.12722. View

Young C, Shankar R, Palmer J, Craig J, Hargreaves C, McLean B . Does intellectual disability increase sudden unexpected death in epilepsy (SUDEP) risk?. Seizure. 2014; 25:112-6. DOI: 10.1016/j.seizure.2014.10.001. View

Watkins L, Linehan C, Brandt C, Snoeijen-Schouwenaars F, McGowan P, Shankar R . Epilepsy in adults with neurodevelopmental disability - what every neurologist should know. Epileptic Disord. 2021; 24(1):9-25. DOI: 10.1684/epd.2021.1366. View

Sun J, Perera B, Henley W, Angus-Leppan H, Sawhney I, Watkins L . Epilepsy related multimorbidity, polypharmacy and risks in adults with intellectual disabilities: a national study. J Neurol. 2022; 269(5):2750-2760. DOI: 10.1007/s00415-021-10938-3. View

Sun J, Watkins L, Henley W, Laugharne R, Angus-Leppan H, Sawhney I . Mortality risk in adults with intellectual disabilities and epilepsy: an England and Wales case-control study. J Neurol. 2023; 270(7):3527-3536. PMC: 10078066. DOI: 10.1007/s00415-023-11701-6. View

Doran Z, Shankar R, Keezer M, Dale C, McLean B, Kerr M . Managing anti-epileptic drug treatment in adult patients with intellectual disability: a serious conundrum. Eur J Neurol. 2016; 23(7):1152-7. DOI: 10.1111/ene.13016. View

Watkins L, ODwyer M, Kerr M, Scheepers M, Courtenay K, Shankar R . Quality improvement in the management of people with epilepsy and intellectual disability: the development of clinical guidance. Expert Opin Pharmacother. 2019; 21(2):173-181. DOI: 10.1080/14656566.2019.1695780. View

10.

Branford D, Sun J, Shankar R . Antiseizure medications prescribing for behavioural and psychiatric concerns in adults with an intellectual disability living in England. Br J Psychiatry. 2023; 222(5):191-195. DOI: 10.1192/bjp.2022.182. View

11.

Branford D, Sun J, Burrows L, Shankar R . Patterns of antiseizure medications prescribing in people with intellectual disability and epilepsy: A narrative review and analysis. Br J Clin Pharmacol. 2023; 89(7):2028-2038. DOI: 10.1111/bcp.15748. View

12.

Watkins L, Henley W, Sun J, Perera B, Angus-Leppan H, Sawhney I . Tackling increased risks in older adults with intellectual disability and epilepsy: Data from a national multicentre cohort study. Seizure. 2022; 101:15-21. DOI: 10.1016/j.seizure.2022.05.022. View

13.

ODwyer M, Watkins L, McCallion P, McCarron M, Henman M, Shankar R . Optimising medicines use in older adults with intellectual disability who have epilepsy: challenges and perspectives. Ther Adv Drug Saf. 2021; 12:20420986211025157. PMC: 8361510. DOI: 10.1177/20420986211025157. View

14.

Winterhalder R, Shankar R . Bone health in adults with epilepsy and intellectual disability. Br J Gen Pract. 2022; 72(716):100-101. PMC: 8884425. DOI: 10.3399/bjgp22X718553. View

15.

Winterhalder R, McCabe J, Young C, Lamb K, Sawhney I, Jory C . Bone health, intellectual disability and epilepsy: An observational community-based study. Acta Neurol Scand. 2022; 145(6):753-761. PMC: 9310839. DOI: 10.1111/ane.13612. View

16.

Maslen C, Hodge R, Tie K, Laugharne R, Lamb K, Shankar R . Constipation in autistic people and people with learning disabilities. Br J Gen Pract. 2022; 72(720):348-351. PMC: 9256070. DOI: 10.3399/bjgp22X720077. View

17.

Snoeijen-Schouwenaars F, Young C, Rowe C, van Ool J, Schelhaas H, Shankar R . People with epilepsy and intellectual disability: More than a sum of two conditions. Epilepsy Behav. 2021; 124:108355. DOI: 10.1016/j.yebeh.2021.108355. View

18.

Allard J, Henley W, McLean B, Sellers A, Hudson S, Rajakulendran S . Lacosamide in the general population and in people with intellectual disability: Similar responses?. Seizure. 2020; 76:161-166. PMC: 7113834. DOI: 10.1016/j.seizure.2020.02.013. View

19.

Allard J, Henley W, Snoeijen-Schouwenaars F, van Ool J, Tan I, Jurgen Schelhaas H . European perspective of perampanel response in people with Intellectual Disability. Acta Neurol Scand. 2020; 142(3):255-259. DOI: 10.1111/ane.13261. View

20.

Lynch B, Lambeng N, Nocka K, Kensel-Hammes P, Bajjalieh S, Matagne A . The synaptic vesicle protein SV2A is the binding site for the antiepileptic drug levetiracetam. Proc Natl Acad Sci U S A. 2004; 101(26):9861-6. PMC: 470764. DOI: 10.1073/pnas.0308208101. View