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Neurological Research and Practice

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Open Access 01-12-2024 | Research article

Brivaracetam and topiramate serum levels during pregnancy and delivery: a case report and a review of literature

Authors: Wiebke Hahn, Leona Möller, Katja Menzler, Tobias Poeplau, Uwe Wagner, Susanne Knake

Published in: Neurological Research and Practice | Issue 1/2024

Abstract

Background

An increasing use of newer antiseizure medication (ASM) such as SV2A ligand brivaracetam is observed. However, data on newer antiseizure medication and therapeutic drug monitoring during pregnancy is scarce.

Methods

Therapeutic drug monitoring of brivaracetam (BRV) and topiramate (TPM) serum levels were performed during pregnancy, delivery and in the umbilical cord blood at delivery in a 34-year-old female patient with severe drug-resistant epilepsy.

Results

During pregnancy, the serum levels of brivaracetam and topiramate remained stable. At 39th week of pregnancy, the patient gave birth to a healthy daughter. 1.5 h after the last ASM intake, the penetration rate measured in umbilical cord blood was 45% lower for BRV and 35% lower for TPM.

Conclusions

While the pharmacokinetics of topiramate are well known and its use during pregnancy should only be undertaken under special circumstances, there have been few studies on newer ASM in pregnancy such as brivaracetam. Based on our results and other case reports of BRV use during pregnancy, further studies are necessary to confirm its pharmacokinetics and safety during pregnancy.

Biton, V., Berkovic, S. F., Abou-Khalil, B., Sperling, M. R., Johnson, M. E., & Lu, S. (2014). Brivaracetam as adjunctive treatment for uncontrolled partial epilepsy in adults: A phase III randomized, double-blind, placebo-controlled trial. Epilepsia, 55(1), 57–66. https://doi.org/10.1111/epi.12433CrossRefPubMed

Brodie, M. J., Whitesides, J., Schiemann, J., D’Souza, J., & Johnson, M. E. (2016). Tolerability, safety, and efficacy of adjunctive brivaracetam for focal seizures in older patients: A pooled analysis from three phase III studies. Epilepsy Research, 127, 114–118. https://doi.org/10.1016/j.eplepsyres.2016.08.018CrossRefPubMed

Bromley, R., Adab, N., Bluett-Duncan, M., Clayton-Smith, J., Christensen, J., Edwards, K., Greenhalgh, J., Hill, R. A., Jackson, C. F., Khanom, S., McGinty, R. N., Tudur Smith, C., Pulman, J., & Marson, A. G. (2023). Monotherapy treatment of epilepsy in pregnancy: congenital malformation outcomes in the child. Cochrane Database of Systematic Reviews, 8(8), CD010224. https://doi.org/10.1002/14651858.CD010224.pub3CrossRefPubMed

Drug commission of the German medical association: https://www.akdae.de/arzneimittelsicherheit/drug-safety-mail/newsdetail/drug-safety-mail-2023-52 (accessed online: 10.11.2023)

Freund, B., Chen, B., Kaplan, P. W., & Johnson, E. L. (2023). Managing antiseizure medications in pregnancy: Is earlier and more frequent monitoring better? Neurology: Clinical Practice, 13(4), e200169. https://doi.org/10.1212/CPJ.0000000000200169CrossRefPubMed

Fröscher, W. & Jürges, U. Topiramate used during breast feeding. Aktuelle Neurol. 33, 215–217.

Hoeltzenbein, M., Slimi, S., Fietz, A. K., Stegherr, R., Onken, M., Beyersmann, J., Dathe, K., & Schaefer, C. (2023). Increasing use of newer antiseizure medication during pregnancy: An observational study with special focus on lacosamide. Seizure., 107, 107–113. https://doi.org/10.1016/j.seizure.2023.02.015CrossRefPubMed

Hope, O. A., & Harris, K. M. (2023). Management of epilepsy during pregnancy and lactation. BMJ, 382, e074630. https://doi.org/10.1136/bmj-2022-074630CrossRefPubMed

Johnson, E. L., Burke, A. E., Wang, A., & Pennell, P. B. (2018). Unintended pregnancy, prenatal care, newborn outcomes, and breastfeeding in women with epilepsy. Neurology, 91(11), e1031–e1039. https://doi.org/10.1212/WNL.0000000000006173CrossRefPubMed

10.

Klingner, C. M., Denker, M., Grün, S., Hanke, M., Oeltze-Jafra, S., Ohl, F. W., Radny, J., Rotter, S., Scherberger, H., Stein, A., Wachtler, T., Witte, O. W., & Ritter, P. (2023). Research data management and data sharing for reproducible research-results of a community survey of the German national research data infrastructure initiative neuroscience. eNeuro., 10(2), ENEURO.0215-22.2023. https://doi.org/10.1523/ENEURO.0215-22.2023CrossRefPubMedPubMedCentral

11.

Landmark, C. J., Rektorli, L., Burns, M. L., Revdal, E., Johannessen, S. I., & Brodtkorb, E. (2021). Pharmacokinetic data on brivaracetam, lacosamide and perampanel during pregnancy and lactation. Epileptic Disorders, 23(2), 426–431. https://doi.org/10.1684/epd.2021.1273CrossRefPubMed

12.

Mann, C., Zinger, E., Schmitz, B., May, T., Rosenow, F., Pfäfflin, M., Schulz, J., Menzler, K., Langenbruch, L., Bierhansl, L., Knake, S., Hamacher, M., Süß, A., von Podewils, F., Schubert-Bast, S., & Strzelczyk, A. (2022). Persistent knowledge gaps between 2005 and 2020 in women with epilepsy: Comparison of multicenter studies from Germany. Seizure., 100, 36–43. https://doi.org/10.1016/j.seizure.2022.06.004CrossRefPubMed

13.

Marxer, C. A., Rüegg, S., Rauch, M. S., Panchaud, A., Meier, C. R., & Spoendlin, J. (2021). A review of the evidence on the risk of congenital malformations and neurodevelopmental disorders in association with antiseizure medications during pregnancy. Expert Opinion on Drug Safety, 20(12), 1487–1499. https://doi.org/10.1080/14740338.2021.1943355CrossRefPubMed

14.

Navarro, C. E. (2023). A healthy outcome of a pregnant woman with drug-resistant juvenile myoclonic epilepsy treated with brivaracetam. Neurological Sciences, 44(2), 753–755. https://doi.org/10.1007/s10072-022-06444-7CrossRefPubMed

15.

Paolini, S. L., Pilato, M., Rajasekaran, V., Waters, J. F. R., Bagic, A., & Urban, A. (2020). Outcomes in three cases after brivaracetam treatment during pregnancy. Acta Neurologica Scandinavica, 141(5), 438–441. https://doi.org/10.1111/ane.13222CrossRefPubMed

16.

Rolan, P., Sargentini-Maier, M. L., Pigeolet, E., & Stockis, A. (2008). The pharmacokinetics, CNS pharmacodynamics and adverse event profile of brivaracetam after multiple increasing oral doses in healthy men. British Journal of Clinical Pharmacology, 66(1), 71–75. https://doi.org/10.1111/j.1365-2125.2008.03158.xCrossRefPubMedPubMedCentral

17.

Sargentini-Maier, M. L., Rolan, P., Connell, J., Tytgat, D., Jacobs, T., Pigeolet, E., Riethuisen, J. M., & Stockis, A. (2007). The pharmacokinetics, CNS pharmacodynamics and adverse event profile of brivaracetam after single increasing oral doses in healthy males. British Journal of Clinical Pharmacology, 63(6), 680–688. https://doi.org/10.1111/j.1365-2125.2006.02829.xCrossRefPubMedPubMedCentral

18.

Schmidt, C. T., Deligiannidis, K. M., Kittel-Schneider, S., Frodl, T., Spigset, O., Paulzen, M., & Schoretsanitis, G. (2023). Transfer of anticonvulsants and lithium into amniotic fluid, umbilical cord blood & breast milk: A systematic review & combined analysis. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 124, 110733. https://doi.org/10.1016/j.pnpbp.2023.110733CrossRefPubMed

19.

Schoemaker, R., Wade, J. R., & Stockis, A. (2016). Brivaracetam population pharmacokinetics and exposure-response modeling in adult subjects with partial-onset seizures. Journal of Clinical Pharmacology, 56(12), 1591–1602. https://doi.org/10.1002/jcph.761CrossRefPubMed

20.

Steinig, I., von Podewils, F., Möddel, G., Bauer, S., Klein, K. M., Paule, E., Reif, P. S., Willems, L. M., Zöllner, J. P., Kunz, R., Runge, U., Kurlemann, G., Schubert-Bast, S., Rosenow, F., & Strzelczyk, A. (2017). Postmarketing experience with brivaracetam in the treatment of epilepsies: A multicenter cohort study from Germany. Epilepsia, 58(7), 1208–1216. https://doi.org/10.1111/epi.13768CrossRefPubMed

21.

Tomson, T., Battino, D., Bonizzoni, E., Craig, J., Lindhout, D., Perucca, E., Sabers, A., Thomas, S. V., & Vajda, F. (2018). EURAP Study Group: Comparative risk of major congenital malformations with eight different antiepileptic drugs: a prospective cohort study of the EURAP registry. Lancet Neurology, 17(6), 530–538. https://doi.org/10.1016/S1474-4422(18)30107-8CrossRefPubMed

22.

Vegrim, H. M., Dreier, J. W., Alvestad, S., et al. (2022). Cancer risk in children of mothers with epilepsy and high-dose folic acid use during pregnancy. JAMA Neurology, 79(11), 1130–1138.CrossRefPubMedPubMedCentral

23.

Yates, S. L., Fakhoury, T., Liang, W., Eckhardt, K., Borghs, S., & D’Souza, J. (2015). An open-label, prospective, exploratory study of patients with epilepsy switching from levetiracetam to brivaracetam. Epilepsy & Behavior, 52(Pt A), 165–168. https://doi.org/10.1016/j.yebeh.2015.09.005CrossRef

Title: Brivaracetam and topiramate serum levels during pregnancy and delivery: a case report and a review of literature
Authors: Wiebke Hahn
Leona Möller
Katja Menzler
Tobias Poeplau
Uwe Wagner
Susanne Knake
Publication date: 01-12-2024
Publisher: BioMed Central
Published in: Neurological Research and Practice / Issue 1/2024
Electronic ISSN: 2524-3489
DOI: https://doi.org/10.1186/s42466-024-00312-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Brivaracetam and topiramate serum levels during pregnancy and delivery: a case report and a review of literature

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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