Pavel Klein, MD: Finding the Right AEDs for Patients With Epilepsy


The director of the Mid-Atlantic Epilepsy and Sleep Center urged physicians to catch refractory epilepsy early and look for the most efficacious treatments for their patients.

"You want to get to patients who show refractoriness of epilepsy as soon as you can and be as aggressive with your treatment choice as you can.”

Findings from a post-hoc analysis of the randomized, double-blind, placebo-controlled (N01358; NCT01261325) and open-label extension (OLE; N01379; NCT01339559) trials that investigated adjunctive brivaracetam (BRV) were presented at the American Epilepsy Society (AES) Annual Meeting, December 4–8, 2020.

Among the study investigators is Pavel Klein, MD, director, Mid-Atlantic Epilepsy and Sleep Center. Klein and colleagues presented data from the analysis that showed that in adults with focal seizure, patients were more likely to discontinue BRV the greater number of lifetime anti-epileptic drugs (AEDs) they had been exposed to, and that discontinuation due to lack of efficacy or treatment-emergent adverse events (TEAEs) was less likely.

Klein and colleagues found that retention rates of BRV were inversely proportional to the number of lifetime AEDs and that long-term efficacy was highest in patients with 1–2 lifetime AEDs and decreased by the number of lifetime AEDs. Patients exposed to ≥7 AEDs still seen to benefit from long-term BRV treatment, although they had a lesser response to treatment with BRV.

NeurologyLive spoke with Klein to learn more about managing refractory epilepsy and the importance of trying different treatments in order to find the best efficacy possible for patients. He urged physicians to not be complacent in the search for AEDs.

For more coverage of AES 2020, click here.

Klein P, Dimova S, Brandt C, Laloyaux C, Nondonfaz X, Elmoufti S. Long-term retention, efficacy and tolerability of adjunctive brivaracetam by number of lifetime antiepileptic drugs in adults with focal seizures: A post hoc analysis. Presented at AES 2020 Annual Meeting; December 4–8, 2020. Abstract 134.
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