Rapid intravenous loading of brivaracetam during invasive and non-invasive video-EEG monitoring

Purpose: The pharmacokinetics of Brivaracetam (BRV) and its ability to penetrate the blood-brain barrier quickly make it a suitable drug for emergencies. In this study, our aim was to investigate the tolerability, safety, and acute efficacy of rapid intravenous (IV) loading of BRV during invasive and non-invasive video-EEG monitoring in patients with drug-resistant focal epilepsy (DRFE).Methods: Eleven adult patients, six during stereo-electroencephalography (SEEG) and five in scalp video-EEG evaluation, received a 10-minute IV infusion of BRV 100 mg after a period of total withdrawal from antiseizure medications (ASMs). The ictal and interictal EEG activity was assessed through visual and spectrographic analysis before and after intravenous BRV administration. Patients completed the Liverpool Adverse Events Profile (LAEP) scale to evaluate tolerability and adverse events.Results: Rapid BRV IV infusion was well tolerated in all patients. The mean LAEP values showed no significant differences (p = 0.40). Loading BRV resulted in a reduction in interictal activity in six patients. The mean seizure frequency significantly decreased five hours after BRV administration (a 79.2 % reduction across the entire group, p = 0.027). A significant change in spectral band analysis was observed ten minutes after BRV administration.Conclusion: Our data suggest that rapid BRV IV infusion has a favorable safety profile and is effective in controlling seizure series in the short term. The electrophysiological changes observed ten minutes after the BRV load correlate with its effects on brain dynamics after blood-brain barrier diffusion.