Expert perspectives on the clinical use of brivaracetam for the management of epilepsy in Indian clinical settings

Objective: To gather expert opinion on the clinical use and prescription practices of brivaracetam for the management of epilepsy in Indian settings. Methodology: This cross-sectional study comprised 23 questions and collected insights from experts across India regarding the prescription practices of antiepileptic drugs. Descriptive statistics were used for data analysis, with categorical variables presented as percentages to illustrate response distributions. Results: A total of 323 experts participated in the study. Approximately 72% of clinicians preferred brivaracetam as the first-line treatment for elderly patients with newly diagnosed epilepsy. Similarly, 63% favored it over other antiepileptic drugs for partial-onset seizures, and 61% reported a preference for switching to brivaracetam in such cases. Behavioral and psychiatric adverse effects were cited by 74% of clinicians as the primary reasons for discontinuing levetiracetam and transitioning to brivaracetam. Additionally, 46% of clinicians reported shifting 11-20% of patients with behavioral changes from levetiracetam to brivaracetam, while 39% highlighted its minimal psychiatric and behavioral side effects as a key advantage. Brivaracetam was the preferred drug of choice for partial seizures in pediatric patients, according to 52% of clinicians, while 68% favored it for elderly patients with resistant epilepsy. Among elderly patients, 42% of clinicians identified tolerability as the most important factor in selecting brivaracetam. Conclusion: The study highlights brivaracetam as a promising antiepileptic drug with versatile clinical applications, particularly noted for its tolerability and effectiveness across different age groups and seizure types.