Authors :
Presenting Author: Uneeb Khan, MBBS – Ziauddin University
Muhammad Ansab, MBBS – Services Institute of Medical Sciences
Phan Hung, MBBS – University of Medicine and Pharmacy, HCMC
Ghadeer Abbas, MBBS – Kufa University
Ali Talpur, MBBS – Ziauddin University
Muhammad Kamran, MBBS – Ziauddin University
Ayman Ahmed, MBBS – Ziauddin University
Syeda Hasan, MBBS – Ziauddin University
Rationale: Epilepsy affects 0.5% to 1% of children per year globally, occurring in 3.2 to 5.5 per 1,000 children in developed countries, and 3.6 to 44.3 per 1,000 children from underdeveloped regions. Recently, a novel anti-epileptic drug called Brivaracetam (BRV) was introduced that inhibits neurotransmitter release, with 15 to 30 times the affinity of Levetiracetam, and demonstrates a higher blood-brain barrier permeability. In recent years, intensive studies have been conducted to better understand the effectiveness of BRV as a monotherapy, which has led to the introduction of promising therapeutic results for patients with long-standing epilepsy, and in some cases, drug-resistant epilepsy as well.
Methods: This study extracted data from PubMed, Embase, Cochrane and ClinicalTrials.gov, and was registered on PROSPERO (CRD42024607301). The eligibility criteria targeted clinical original studies that reported safety and efficacy outcomes associated with BRV use in children with primary epilepsy. Our primary outcome was BRV retention rate, and responder rate, seizure freedom, rate of treatment-emergent adverse events (TEAEs) and behavioral adverse events (BAEs) were taken as secondary outcomes. Risk of bias was evaluated using MINORS and JBI. Outcomes were pooled using the inverse variance method, and the confidence intervals (CI) were determined using the Clopper-Pearson method. Baujat plots were used to spot outliers, and leave-one-out analyses were conducted to understand overall study influence. Radial plots were used to assess the relationship between effect sizes and precision. Publication bias was assessed using contour and sunset funnel plots, which incorporates study-level information.
Results:
The final quantitative synthesis included 12 studies, reporting 952 children. The pooled 1 year retention rate was 60% [95% CI: 0.45 to 0.73], and the end-of-study retention rate was 66% [95% CI: 0.45 to 0.82] using the inverse variance method to depict efficacy (p < 0.0001). Reported overall responder rate was 35% [95% CI: 0.24 to 0.47] (p < 0.0001), with a seizure freedom rate of 13% [95% CI: 0.07 to 0.21] (p = 0.0004).