Efficacy of Brivaracetam in children with epilepsy

•As far as we know, our case report is the largest such study of children with refractory epilepsy in which the effects of BRV are analysed.•Despite the refractory epilepsy of our sample we have obtained a significant rate of positive responses.•In our report we showed than a failure to obtain a favourable response with LEV does not predict a lack of effectiveness with BRV.•According to our series of cases, BRV is a drug with a good tolerability and safety profile. To determine the efficacy, tolerance, and safety of BRV in children with epilepsy. A retrospective study of patients with epilepsy who received treatment with BRV before age 16 years and underwent a minimum follow-up of 3 months. Sixty-six patients were included in the study. Patients received BRV at a mean age of 8.8 years (range 1−16 years). The majority (93.4 %) had refractory epilepsy, 27 with epileptic encephalopathy. The median maximum dose used was 4.3 mg/kg/day. In 30.3 % of the cases, seizure frequency was reduced by over 50 %, and 9 % remained seizure-free. Greater efficacy was observed in those patients who received higher doses and when a direct switch from levetiracetam (LEV) to BRV was performed. The ineffectiveness of LEV was not related to a failure to respond to BRV treatment. Side effects were identified in 24.2 % of the cases, the most frequent being irritability and drowsiness. BRV appears to be an effective, safe, and well-tolerated AED in children with refractory epilepsy.