Brivaracetam Use in Managing Seizures Following Traumatic Brain Injury

BACKGROUND: Traumatic brain injury (TBI) is a major cause of disability and mortality worldwide, frequently complicated by post-traumatic seizures (PTS). Levetiracetam (LEV) is widely used for seizure prophylaxis but is often associated with behavioral adverse effects. Brivaracetam (BRV), a newer antiseizure medication with higher synaptic vesicle 2A (SV2A) affinity, may offer similar efficacy with improved tolerability. This study compared the effectiveness and neurobehavioral outcomes of BRV versus LEV in TBI patients. METHODS: This prospective cohort study was conducted in the Department of Neurosurgery at a tertiary care hospital. A total of 132 adults with neuroimaging-confirmed TBI were enrolled and followed for six months. Patients were allocated into two groups based on the antiseizure medication prescribed at the treating physician's discretion: Group A received BRV and Group B received LEV. The primary outcome was the occurrence of post-traumatic seizures, classified as early (7 days post-injury). Secondary outcomes included functional recovery assessed by the Glasgow Outcome Scale-Extended (GOSE) and neurobehavioral symptoms measured using the Neurobehavioral Symptom Inventory (NSI). RESULTS: Baseline characteristics, including age (mean 47.4 ± 20.8 vs. 47.0 ± 21.8 years; p = 0.38), sex distribution (p = 0.14), and TBI severity (p = 0.15), were comparable between groups. Over six months, 11 patients (16.6%) in the BRV group and 17 patients (25.7%) in the LEV group experienced seizures (p = 0.20). Early PTS occurred in six BRV (9.1%) and 10 LEV (15.1%) patients (p = 0.32), while late PTS occurred in five BRV (7.5%) and seven LEV (10.6%) patients (p = 0.46). GOSE scores were similar at all follow-up points (overall mean 7.09 ± 1.78 vs. 7.06 ± 1.76; p = 0.93). However, BRV-treated patients showed significantly lower NSI scores at day 14 (10.74 ± 7.11 vs. 40.06 ± 4.93; p = 0.005) and three months (4.70 ± 4.78 vs. 13.23 ± 2.44; p < 0.001), with no significant difference at six months. The overall mean NSI score remained lower in the BRV group (5.72 ± 5.08 vs. 22.85 ± 2.89; p < 0.001). CONCLUSIONS: BRV and LEV demonstrated comparable efficacy in preventing post-traumatic seizures in TBI patients. However, seizure incidence did not differ significantly in this sample. Although the study was underpowered for this outcome, BRV was associated with superior neurobehavioral outcomes, particularly during the early recovery period. These findings suggest that BRV may offer a more favorable tolerability profile for seizure prophylaxis following TBI. Larger multicenter studies are warranted to validate these results.