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Epilepsy is the third of the common neurological condition affecting individuals of all ages. Pharmacotherapy is the first line and is the primary treatment for providing to control epilepsy and seizure that antiepileptic drugs were developed ongoing. The US Food Drug Administration (FDA) and European approved brivaracetam as adjunctive therapy for treatment partial-onset seizure in patients with epilepsy. Brivaracetam, a selective synaptic vesicle protein 2A inhibitor as same as levetiracetam, has a high specificity target SV2A about 10-30 times than levetiracetam. The pharmacokinetic profiles of these drugs present a rapid and complete absorption, low molecular with low binding plasma protein. However, brivaracetam has a more lipophilicity than levetiracetam. In animal study, lipophilicity is a key for drug penetration in to the brain thus brivaracetam has a faster entry to the brain than levetiracetam. The onset of brivaracetam is approximately 1 hr while levetiracetam is 2 hr from complete absorption. Moreover, brivaracetam is metabolized primarily via liver (major CYP 2C8 and CYP 2C19) while levetiracetam does not undergo extensive metabolism but it is excreted unchanged by renal. The direct efficacy assessment between these two drugs has not been studies yet. Other studies showed that 50 milligram brivaracetam and 1000 milligram levetiracetam can reduced seizure frequency more than placebo. Untorelate side effects has found in brivaracetam 100 milligram/day and levetiracetam 2000 milligram/day. The serious adverse of psychological conditions has 93.4% reduction when switching leveteracetam to brivaracetam.
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