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Brivaracetam and levetiracetam dose adjustments leading to behavioural adverse effects
  1. May Yung Tiet,
  2. Jithin George
  1. Department of Neurology, Leicester General Hospital, Leicester, UK
  1. Correspondence to Dr May Yung Tiet, Department of Neurology, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK; m.tiet{at}nhs.net

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With the recent approval of brivaracetam, the high-affinity synaptic vesicle protein 2A (SV2A) ligand, it has previously been suggested that patients on levetiracetam may benefit from switching to brivaracetam.1 The behavioural issues related to its predecessor, levetiracetam, are well known. Treatment with levetiracetam was associated with a seven-fold increase in the risk of depression.2 Nonetheless, rapid loading, easy conversion from oral to intravenous preparations, efficacy for focal and generalised seizures,3 and despite lack of supportive evidence, its use as a preferred third-line …

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