A case report of successful seizure treatment using bolus administration of intravenous brivaracetam over 2 minutes in a patient with compromised airway.

As time is brain, it is paramount to rapidly treat seizures and status epilepticus to avoid permanent neuronal injuries. Benzodiazepines are the recommended first-line antiepileptic medications, but with initial and repetitive dosing, airway compromise can occur even before seizure resolution. Alternative fast-acting antiepileptics that can minimize this effect could lead to better outcomes and decreased ICU stays.

Our patient is a 47-year-old male with a history of developmental delay and chronic ventriculomegaly was successfully extubated after external ventricular drain weaning. While his mentation improved, he had ongoing difficulties clearing secretions requiring a heated high-flow nasal cannula and repeated nebulizer treatments. The following day, the patient acutely had a seizure, manifesting as obtundation, whole body rigidity, and left lateral forced gaze deviation. Given ongoing respiration issues, lorazepam was held, and he was given a 2-minute bolus of intravenous brivaracetam 100mg instead.  Post administration, patient's mentation improved with the resolution of the gaze deviation. Continuous video electroencephalogram did not show any electrographic seizures.  Patient was continued on brivaracetam 100 mg twice daily.