Brivaracetam: Pharmacology, Clinical Efficacy, and Safety in Epilepsy

Abstract

Brivaracetam, a high-affinity synaptic vesicle 2A (SV2A) ligand and propyl analog of levetiracetam, has been approved as an adjunctive and monotherapy option for focal onset seizures in various age groups. This review synthesizes data from both clinical trials and real-world studies to evaluate brivaracetam's efficacy, safety, and tolerability profile. Notably, brivaracetam's rapid penetration across the blood-brain barrier, selective SV2A binding, and favorable pharmacokinetic properties contribute to its robust seizure control capabilities, setting it apart from other antiseizure medications. Studies have shown that brivaracetam consistently achieves significant seizure frequency reductions and high responder rates, demonstrating strong efficacy and an overall favorable safety profile. Importantly, brivaracetam also demonstrates effectiveness in special populations, including older individuals and patients with post-stroke epilepsy, maintaining good tolerability and favorable outcomes and achieving high rates of seizure freedom. Future research should further investigate brivaracetam's utility in broader patient groups to better understand its long-term safety and expand its therapeutic reach. With its unique pharmacological properties, clinical flexibility, and promising safety profile, brivaracetam stands as a valuable addition to current epilepsy treatment options, addressing several unmet needs in seizure management. Copyright © 2025 Korean Epilepsy Society.