Brivaracetam: A Superior Alternative in Antiepileptic Drug Therapy

Epilepsy affects approximately 70 million people worldwide, with nearly one-third experiencing drug-resistant seizures. Brivaracetam (BRV), a novel antiepileptic drug, exhibits enhanced brain permeability and higher binding affinity to synaptic vesicle protein 2A (SV2A), offering potential therapeutic advantages. This review summarizes data from clinical trials, meta-analyses, and real-world studies from various databases like PubMed, Cochrane etc. on the pharmacokinetics, efficacy, safety, and tolerability of BRV. Comparative evaluation with Levetiracetam (LEV) and application in special populations were also assessed. BRV demonstrated significant seizure reduction, including up to 76.2% reduction in focal-to-bilateral tonic-clonic seizures. It was associated with fewer behavioral adverse effects compared to LEV, including reduced aggression and fatigue. Favorable outcomes were observed in pediatric, geriatric, and drug-resistant populations, including status epilepticus cases. BRV offers a promising alternative in epilepsy treatment, combining rapid brain penetration, robust seizure control, and a superior safety profile. Further studies are warranted in special populations, including pregnant women and children.