What question did this study set out to answer?

The aim is to determine the efficacy and tolerability of Brivaracetam (BRV) as monotherapy in patients with focal and generalized epilepsy.

July 7, 2026Open Access

Brivaracetam as viable monotherapy option for focal and generalized epilepsy

Key Points

The aim is to determine the efficacy and tolerability of Brivaracetam (BRV) as monotherapy in patients with focal and generalized epilepsy.
Retrospective analysis of 157 adult patients treated with BRV monotherapy at the Freiburg Epilepsy Center from 2016 to 2025.
Outcomes assessed included seizure freedom, responder rates, retention, adverse events, and dose-response at 6, 12, and 24 months.
Included patients who received BRV as first-line therapy or after conversion from other antiseizure medications.
44% of patients achieved seizure freedom for ≥6 consecutive months during follow-up.
Responder rate was 79% after 6 months, with a retention rate of 64% at 6 months, declining to 29% at 24 months.
Patients converting from levetiracetam achieved a 52% seizure freedom rate at 6 months, with 92% of pre-existing adverse events resolving.

Abstract

INTRODUCTION: Antiseizure monotherapy is the gold standard of early epilepsy care. We investigated whether Brivaracetam (BRV), a high-affinity SV2A ligand, approved in Europe only as adjunctive therapy for focal epilepsy, may represent a useful monotherapy option in routine clinical practice with regard to seizure reduction and tolerability. METHODS: We retrospectively analyzed 157 adult patients treated with BRV monotherapy between 2016 and 2025 at the Freiburg Epilepsy Center. Patients received BRV as first-line therapy (n = 16), after reduction from polytherapy (n = 30), or after conversion from levetiracetam (LEV; n = 98) or other ASM (n = 13). Outcomes at 6, 12, and 24 months included seizure freedom, responder rates, retention, adverse events (AEs), and dose-response. RESULTS: Overall, 44% of patients achieved seizure freedom (≥6 consecutive months) at any time during follow-up. Responder rate was 79% after 6 months, and retention rate was 64% at 6 months yet declined to 29% at 24 months. Favorable seizure outcomes were observed across different treatment settings. Patients converted from LEV showed particularly high rates of seizure freedom (52% at 6 months) and frequent improvement in tolerability (79.6%). Good seizure control was achieved already at dosages of up to 50 mg/d. Tolerability was often improved following BRV introduction; only 1.9% of patients experienced newly emerging AEs, whereas 92% of pre-existing AEs resolved after switching to BRV monotherapy. AEs occurred in 22.4% of patients and predominantly consisted of mild psychiatric or sleep-related symptoms. CONCLUSION: In this retrospective real-world cohort, BRV monotherapy was associated with favorable short-term seizure outcomes and good tolerability. Particularly favorable outcomes were observed after conversion from LEV. Although long-term retention decreased over time, a substantial proportion of patients continued to benefit from BRV monotherapy over a two-year period, despite BRV being the initial monotherapy in only 25% of the cohort. Overall, these findings suggest that BRV may represent an effective and well-tolerated monotherapy option for selected patients and provide support for further prospective studies evaluating its role in both focal and generalized epilepsies.

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