Sleep-Related Effects of Brivaracetam Monotherapy in Epilepsy: Insights from a Prospective Study

Objective: To evaluate sleep-related effects in patients with epilepsy newly initiated on brivaracetam (BRV) monotherapy in a tertiary care hospital in South India.

Methods: In this prospective analytical study, 46 patients aged ≥12 years with newly diagnosed epilepsy were enrolled. Patients received BRV monotherapy (50–100 mg twice daily; pediatric dose: 0.75–1.5 mg/kg twice daily). Sleep-related adverse events were recorded, and patients were assessed at baseline and one month using the Epworth Sleepiness Scale – Indian version (ESS-I), Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and a one-month sleep log. Paired t-tests and McNemar’s exact test were used to compare baseline and follow-up measures.

Results: The mean age was 37.8 ± 11.9 years; 47.8% were male. The majority had generalized epilepsy (69.6%) and duration of epilepsy <1 year (78.2%). Mean total sleep duration increased from 7.6 ± 1.5 hours to 8.1 ± 1.6 hours (p = 0.005). ESS-I scores increased (2.1 ± 2.5 to 3.4 ± 4.2, p = 0.007), indicating mild increases in daytime sleepiness. ISI and PSQI scores showed non-significant improvements. Proportion of patients with total sleep duration >10 hours/day increased from 4.3% to 17.4% (p = 0.031). Daytime sleep >1 hour/day increased from 6.5% to 21.7% (p = 0.002). No patients discontinued BRV due to adverse effects.

Conclusion: BRV monotherapy is associated with mild increases in daytime sleepiness and sleep duration without serious adverse events. BRV appears safe and well-tolerated in newly diagnosed epilepsy, with manageable effects on sleep. Larger studies with long-term follow-up are needed.