Date: {{$ActivityAssignDate}}

Dear Dr. {{$doctorName}},

Subject: A retrospective, cross-sectional, observational survey study to analyse the role of Brivaracetam as a first add-on in partial onset seizures

Epilepsy is a chronic noncommunicable disease of the brain, characterized by recurrent seizures, which are brief episodes of involuntary movement that may involve a part of the body (partial) or the entire body (generalized) and are sometimes accompanied by loss of consciousness and control of bowel or bladder function.¹

Epilepsy is the most common chronic brain disease and affects people of all ages. More than 50 million people worldwide have epilepsy; nearly 80% of them live in low- and middle-income countries.²

As per the study published in 2019, in 2016, there were 45•9 million (95% UI 39•9–54•6) patients with all-active epilepsy (both idiopathic and secondary epilepsy globally; age-standardised prevalence 621•5 per 100 000 population; 540•1–737•0).³

As per the 2019 study, the prevalence of epilepsy in India as per year 2016 was 3 934 737 (3 176 019 to 4 766 534). The prevalence of epilepsy in India has been mentioned as crude prevalence of 5.35/1,000, while as another study observed age-adjusted prevalence rate as 4.71 per 1000.^4,5,6

People with epilepsy and their families frequently suffer from stigma and discrimination. In many parts of the world the true nature of epilepsy has also long been distorted by myths, fear and mistaken notions about the disorder.²

ASDs, previously also termed antiepileptic or anticonvulsant drugs, are the main form of symptomatic treatment of people with epilepsy. About 30 ASDs are currently used, of which most were approved over the last 30 years.⁷

Brivaracetam has high lipid solubility and rapid brain penetration, with engagement of target molecule, SV2A, within minutes of administration. BRV is selective, high-affinity ligand for synaptic vesicle 2A (SV2A) with 15-30 fold higher affinity than levetiracetam. Brivaracetam exhibits high permeability across the blood–brain barrier, likely because of its higher lipophilicity compared with levetiracetam, and binds with high selectivity to the synaptic vesicle protein 2A (SV2A) with 15- to 30-fold higher affinity than levetiracetam.^8,9

Brivaracetam is an AED of the synaptic vesicle protein 2A (SV2A) ligand class, with high selectivity and affinity for SV2A & faster onset of action.¹⁰ Phase III studies have demonstrated promising efficacy and a good safety and tolerability profile in the adjunctive treatment of refractory focal seizures & long-term data indicate that the response to BRV is sustained, with good tolerability and retention rate.¹¹ Brivaracetam was also effective, well‑tolerated and improved health‑related quality of life in Indian patients with uncontrolled focal epilepsy, along with a favourable tolerability profile. According to a Retrospective, Multicenter, Real World Study, Brivaracetam was effective and well tolerated both as first add-on and late adjunctive treatment in patients with focal epilepsy. The addition of Brivaracetam to the armamentarium for the epilepsy treatment is to address the diverse needs of patients living with inadequately controlled seizures.