Short-Term psychiatric stability after brivaracetam initiation in patients with Epilepsy: A prospective Observational study.
TL;DR
Among treatment completers, BRV initiation was not associated with significant group-level worsening of aggression, depressive symptoms, or daytime sleepiness, and these findings support short-term psychiatric stability among patients who continued BRV treatment in routine clinical practice.
Abstract
Objective
Behavioral and psychiatric adverse effects are important considerations when selecting antiseizure medications for patients with epilepsy. Levetiracetam (LEV) may be associated with irritability and aggression, whereas brivaracetam (BRV) has been suggested to have a more favorable psychiatric tolerability profile. However, prospective evidence using validated psychiatric rating scales in routine clinical practice remains limited. This study evaluated changes in aggression, depressive symptoms, and daytime sleepiness after BRV initiation.
Methods
Adult patients with epilepsy who initiated BRV at two outpatient centers completed standardized self-report questionnaires at baseline and again approximately 8-12 weeks later. Aggression, depressive symptoms, and daytime sleepiness were assessed using the Buss-Perry Aggression Questionnaire (BAQ), Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), and a modified seven-item Epworth Sleepiness Scale (ESS), respectively. Reported seizure counts were assessed as exploratory secondary outcomes.
Results
Of 73 adult patients who initiated BRV, 63 completed both baseline and follow-up assessments. Among treatment completers, BAQ total and subscale scores, NDDI-E scores, and modified ESS scores showed no significant changes over time. Regression analysis did not identify predictors of change in BAQ total scores. Two patients discontinued BRV before follow-up because of irritability. Reported seizure counts decreased in a secondary exploratory analysis.
Conclusion
Among treatment completers, BRV initiation was not associated with significant group-level worsening of aggression, depressive symptoms, or daytime sleepiness. These findings support short-term psychiatric stability among patients who continued BRV treatment in routine clinical practice. However, early discontinuation due to irritability in two patients indicates the need for monitoring behavioral adverse effects.