Quantitative EEG analysis of brivaracetam in drug-resistant epilepsy: A pharmaco-EEG study

• Published in: Clinical neurophysiology 2024-07, Vol.163, p.152-159
• Main Authors: Ricci, Lorenzo, Tombini, Mario, Savastano, Ersilia, Pulitano, Patrizia, Piccioli, Marta, Forti, Marco, Sancetta, Biagio, Boscarino, Marilisa, Narducci, Flavia, Mecarelli, Oriano, Ciccozzi, Massimo, Di Lazzaro, Vincenzo, Assenza, Giovanni
• Format: Article
• Language: English
• Subjects: Adult; Anticonvulsants - adverse effects; Anticonvulsants - pharmacology; Anticonvulsants - therapeutic use; Brivaracetam; Drug Resistant Epilepsy - drug therapy; Drug Resistant Epilepsy - physiopathology; Drug-resistant epilepsy; Electroencephalography - drug effects; Electroencephalography - methods; Female; Functional connectivity; Humans; Longitudinal Studies; Male; Middle Aged; Pharmaco-EEG; Pyrrolidinones - adverse effects; Pyrrolidinones - therapeutic use; Quantitative EEG analysis; Retrospective Studies; Young Adult
• ISSN: 1388-2457; 1872-8952
• DOI: 10.1016/j.clinph.2024.04.023

•The impact of BRV on cortical activity and connectivity can be explored using pharmaco-EEG analysis.•BRV treatment does not alter power spectral density across various frequency bands in people with epilepsy.•BRV therapy aligns theta phase locking value connectivity in responders to the drug to levels seen in healthy controls. Brivaracetam (BRV) is a recent antiseizure medication (ASM) approved as an add-on therapy for people with focal epilepsy. BRV has a good efficacy and safety profile compared to other ASMs. However, its specific effects on resting-state EEG activity and connectivity are unknown. The aim of this study is to evaluate quantitative EEG changes induced by BRV therapy in a population of adult people with drug-resistant epilepsy (PwE) compared to healthy controls (HC). We performed a longitudinal, retrospective, pharmaco-EEG study on a population of 23 PwE and a group of 25 HC. Clinical outcome was dichotomized into drug-responders (i.e., >50% reduction in seizures’ frequency; RES) and non-responders (N-RES) after two years of BRV. EEG parameters were compared between PwE and HC at baseline (pre-BRV) and after three months of BRV therapy (post-BRV). We investigated BRV-related variations in EEG connectivity using the phase locking value (PLV). BRV therapy did not induce modifications in power spectrum density across different frequency bands. PwE presented lower PLV connectivity values compared to HC in all frequency bands. RES exhibited lower theta PLV connectivity compared to HC before initiating BRV and experienced an increase after BRV, eliminating the significant difference from HC. This study shows that BRV does not alter the EEG power spectrum in PwE, supporting its favourable neuropsychiatric side-effect profile, and induces the disappearance of EEG connectivity differences between PwE and HC. The integration of EEG quantitative analysis in epilepsy can provide insights into the efficacy, mechanism of action, and side effects of ASMs.