This issue includes a comprehensive review article on the clinical utility of brivaracetam (BRV), the currently unavailable ASM in Korea.3 The BRV has been used in Western countries for almost 10 years. BRV was approved in Korea in 2019, but is expected to be launched as a generic in 2026 due to financial issues with the National Health Insurance Service.

BRV is a prolyl analog of levetiracetam (LEV) and has a similar mechanism of action to LEV. In Korea, it is only approved as an adjunctive treatment for patients with focal seizures aged 16 years or older, but previous studies have shown that it is effective as monotherapy in patients with focal seizures and has good effects on generalized seizures. BRV has also been shown to be effective in pediatric patients and has been approved for this age group in other countries.4

BRV is thought to have a similar mechanism of action as LEV and is effective in a similar patient population. However, BRV is thought to be associated with a significantly lower risk of adverse psychiatric events than LEV is. Therefore, it may be a good choice for patients at high risk of psychiatric adverse events, or for patients who are effective with LEV but cannot fully use it due to psychiatric adverse events.5 In addition, LEV is mainly metabolized by renal excretion, whereas BRV is metabolized by hepatic metabolism, and may therefore be preferred for patients with impaired renal function. Finally, BRV has a lower effective dose than LEV because of its higher affinity for the synaptic vesicle protein 2A (SV2) receptor, resulting in a smaller pill size. This may be helpful for elderly and pediatric patients with epilepsy who have difficulty swallowing.6

Clinicians welcome the introduction of new treatment options. We believe that this new ASM will be helpful in the treatment of patients with epilepsy and look forward to the early introduction of future ASMs into practice for patients with epilepsy suffering from recurrent seizures or troublesome adverse events.