Clinical Perspectives of Managing Epilepsy Across Different Patient Populations with a Focus on Brivaracetam: A Cross-sectional Study among Indian Physicians

Objective: To evaluate clinicians' preferences, prescribing patterns, and clinical experiences with brivaracetam compared to other antiepileptic drugs, particularly levetiracetam, in the management of epilepsy across different patient populations. Methodology: This cross-sectional study used a 24-item multi-response questionnaire to gather expert opinion across different Indian settings regarding their perspectives on epilepsy and brivaracetam. Data analysis employed descriptive statistics, with results reported as frequencies and percentages. Results: The survey included 360 participants. Clinicians showed a strong preference for brivaracetam as the first-line antiepileptic drug in patients with newly diagnosed epilepsy, with 72% favoring it for younger patients and 74% for elderly. This preference was particularly notable for managing partial-onset seizures, as cited by 71% of clinicians. Additionally, 65% reported that partial-onset seizures were the primary reason for switching to brivaracetam from other antiepileptics. Behavioral and psychiatric adverse effects were cited by 60% of clinicians as the main reasons for transitioning from levetiracetam to brivaracetam. Moreover, 47% reported that 10-20% of patients experiencing behavioral changes on levetiracetam were switched to brivaracetam, with 49% noting improved efficacy and behavioral outcomes in 20-30% of these cases. The minimal psychiatric and behavioral side effects of brivaracetam were noted as its main advantage by 41% of clinicians in managing partial-onset seizures. Furthermore, 70% of clinicians preferred brivaracetam for treatment-resistant epilepsy, and approximately half of them preferred it for pediatric partial seizures. Conclusion: This study highlighted brivaracetam as a preferred antiepileptic drug in clinical practice, especially for managing partial-onset seizures. It serves as an effective alternative for patients experiencing adverse effects with levetiracetam.