Brivaracetam-Related Neurological Decline in a Patient With Complex Medical History

Document Type

Conference Proceeding

Publication Date

5-21-2024

Publication Title

Am J Respir Crit Care Med

Abstract

Introduction: Brivaracetam is a newer anticonvulsant that is a propyl analogue of levetiracetam. The medication was initially approved in 2016 as an add-on treatment and was later approved in 2018 as monotherapy for treatment of partial-onset seizures. A review article published in January 2023 concluded that Brivaracetam had a limited impact on cognition and behavior. This case report explores the potential role of Brivaracetam in the patient's deteriorating neurological status. Case Description: A 68-year-old female with past medical history of chronic kidney disease, hypertension and foot osteomyelitis presented with generalized weakness. Of note, during a recent hospitalization, the patient was started on Cefepime for treatment of UTI and developed seizures afterwards, she was later discharged on Brivaracetam. Generalized weakness was thought to be related to Malnutrition. Subsequently, the patient underwent placement of gastrostomy tube and was started on tube feeds. Her hospital course was complicated by gradually worsening mental status and later an episode of somnolence. The patient had stable vital signs at that time. Workup revealed ammonia level of 258, ALP 363, ALT 60, AST 187 and lactate of 2.7. Imaging, including a CT head and abdomen, ruled out acute intracranial or intra-abdominal processes. Further investigations, including infectious workup and EEG did not reveal a possible etiology. Ammonia levels improved with holding tube feeds and treatment with lactulose and Rifaximin; however, there was no improvement in mental status. The patient was transferred to the ICU for airway monitoring in the setting of AMS. A multidisciplinary approach suggested a possible role of Brivaracetam. After holding Brivaracetam, the patient had significant improvement in cognition within 48 hours, further supporting the possibility of Brivaracetam-induced cognitive decline. Case Discussion: Previous studies have generally failed to establish a link between Brivaracetam use and serious neurological side effects. One case report was published in 2022 describing Brivaracetam-induced hyperammonemia and encephalopathy. In our case ammonia levels were elevated as well suggesting a possible association. Further research is needed to better understand the relationship between Brivaracetam and neurological decline in patients with complex medical backgrounds, shedding light on the importance of careful medication reconciliation and close monitoring in such cases.

Volume

209

Issue

9

First Page

A5642

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