This study aims to compare the cognitive effects of switching from Levetiracetam (LEV) to Brivaracetam (BRV) and determine whether the switch is beneficial in terms of cognitive performance.

The cognitive side effects of antiseizure medications have become an important research area, particularly on the impact of the transition between different drugs. LEV is one of the first-line treatments for epilepsy. However, the concerns of cognitive impairment associated with LEV led to a growing interest in BRV as an alternative potential.

We conducted a retrospective review of individuals with epilepsy treated with LEV who switched to BRV due to reported side effects. Only patients who were evaluated for cognitive impairment were included. Assessments were conducted at baseline and at least four months post-switch. The Brief Visual Memory Test-Revised (BVMT-R) measured visuospatial memory. The Hopkins Verbal Learning Test-Revised (HVLT-R) assessed verbal memory. The Symbol Digit Modalities Test (SDMT) evaluated processing speed and attention.

Twenty-three individuals were analyzed. The BVMT-R, Total Recall was significantly higher in the BRIV group (M= 22.2±7.4) compared to the LEV group (M= 19.0± 7.0) (p= 0.005). For Delayed Recall, the BRV group (mean= 8.5±3.1) also outranked the LEV group (mean= 7.3±3.2) (p= 0.01). Percent Retained was greater in the BRV group (M= 93.1±14.4) compared to the LEV group (M= 88.3±15.3), but significance was not reached. For the HVLT-R, no significant differences were observed. The SDMT total score was significantly higher in the BRV group (M= 42.0±9.1) compared to the LEV group (M= 39.6±12.0) (p= 0.03). No statistical difference in the number of errors was noted.

Switching from LEV to BRV showed improvement in patient cognitive function, with enhancement in recall, attention, and speed. These results are promising but warrant further investigations with a larger sample size to confirm our results.