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Brivaracetam to Treat Partial Onset Seizures in Adults.

Health Psychol Res

January 2023

University of Central Florida College of Medicine, Orlando, FL and HCA Osceola Hospital, Kissimmee, FL.

Purpose Of Review: Seizures are a hyperexcitable, and hypersynchronous imbalance between excitatory and inhibitory factors (E/I imbalance) in neurotransmission, and epilepsy is the recurrent manifestation of seizures within a reasonable time frame and without being attributable to a reversible cause. Brivaracetam is a derivative of the antiepileptic agent, levetiracetam, that is used as adjuvant therapy for focal onset seizures. It was approved by the FDA in 2016 and has shown promising results with minimal adverse effect reactions in clinical trials.

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Despite the fact that brain rhythms are widely studied and officially classified, there is no consensus on their relationship, which can shed light on the genesis of rhythmic activity, its synchronization, functional role, and the formation of pathological reactions. Using the experimental status epilepticus (SE) as a model of brain in a hypersynchronized state with well-defined rhythms, we aimed to study the relationship between the rhythmic components of the brain electrical activity. Local field potentials (LFPs) were recorded simultaneously from the hippocampus, entorhinal cortex, medial septum, and amygdala during normal conditions and after kainic acid (KA) administration in waking guinea pigs.

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Objective: Epilepsy is characterized by transient alterations in brain synchronization resulting in seizures with a wide spectrum of manifestations. Seizure severity and risks for patients depend on the evolution and spread of the hypersynchronous discharges. With standard visual inspection and pattern classification, this evolution could not be predicted early on.

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The intergeniculate leaflet (IGL) of the thalamus is a retinorecipient structure implicated in orchestrating circadian rhythmicity. The IGL network is highly GABAergic and consists mainly of neuropeptide Y-synthesising and enkephalinergic neurons. A high density of GFAP-immunoreactive astrocytes has been observed in the IGL, with a probable function in guarding neuronal inhibition.

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We perform experiments and phase model simulations with a ring network of oscillatory electrochemical reactions to explore the effect of random connections and nonisochronicity of the interactions on the pattern formation. A few additional links facilitate the emergence of the fully synchronized state. With larger nonisochronicity, complex rotating waves or persistent irregular phase dynamics can derail the convergence to global synchronization.

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