An uncommon case of nonconvulsive status epilepticus successfully treated with enteral Brivaracetam: nonconvulsive status epilepticus successfully treated with Brivaracetam

Alfredo De Liso; Lorenzo Ricci; Maria Cristina Bravi; Francesca Romana Pezzella; Sabrina Anticoli

doi:10.23750/abm.v92iS1.9649

An uncommon case of nonconvulsive status epilepticus successfully treated with enteral Brivaracetam

nonconvulsive status epilepticus successfully treated with Brivaracetam

Authors

Alfredo De Liso Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome
Lorenzo Ricci Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome
Maria Cristina Bravi Department of Neuroscience, Stroke Unit San Camillo Hospital, Rome
Francesca Romana Pezzella Department of Neuroscience, Stroke Unit San Camillo Hospital, Rome
Sabrina Anticoli Department of Neuroscience, Stroke Unit San Camillo Hospital, Rome

Keywords:

Brivaracetam, nonconvulsive status epilepticus, status epilepticus, carotid endarterectomy, cerebral hyperperfusion syndrome

Abstract

Background and aim of the work. We present a case of a woman affected by nonconvulsive status epilepticus (NCSE) caused by cerebral hyperperfusion syndrome (CHS) after carotid endarterectomy (CEA) who was successfully treated with Brivaracetam (BRV) administered via nasogastric tube (NGT). Case Presentation. An 82-years old woman was referred for increasing blood pressure, severe headache and two focal motor seizures on postoperative day four after right CEA. CT scan showed edema of the right hemisphere with a midline shift of 5 mm. The patient underwent daily Electroencephalography (EEG) monitoring which showed continuous epileptiform discharges over the right hemisphere, compatible with a diagnosis of status epilepticus. She was treated with standard antiepileptic drugs (Phenytoin, Lacosamide and Levetiracetam iv) without clinical response. A therapeutic trial with BRV 200mg administered via nasogastric tube (NGT) was tried which resulted in substantial clinical benefit. Conclusions. The administration of new antiepileptic drugs (AEDs) such as BRV may result in significant clinical improvement in refractory cases of status epilepticus. The enteral administration of AEDs via NGT should always be considered for refractory cases of status epilepticus when standard iv treatment has failed or is not possible.

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