To determine if  intranasal seletracetam treatment prevents seizures in a patient drug resistant reflex epilepsy.

Acute rescue therapy for repetitive seizures relies on benzodiazepines, whose sedation, respiratory depression, and addiction risks limit repeated use. A fast-acting, effective, non-sedating non-benzodiazepine is needed. Seletracetam (SEL), a levetiracetam analogue ~100-fold and ~10-fold more potent than levetiracetam and brivaracetam, respectively, showed favorable efficacy and safety to Phase 2 at UCB Pharma. PrevEp has developed intranasal SEL for acute rescue. We report the first human nasal-spray administration of SEL in reflex reading epilepsy.

A 42-year-old man with reading epilepsy, with predictable reading-induced focal aware seizures (orofacial clicking) and prior focal-to-bilateral tonic-clonic seizures during continued reading, inadequately controlled on levetiracetam 3000 mg/day, was treated under Austria’s “Named Patient Use” (Article 83, Regulation 726/2004/EC; §8 Abs.1 Z2, Medicinal Products Act 2009). SEL (200 mg/mL) was given as 30 mg in 150 µL mucoadhesive aqueous solution via a syringe-mounted vaporizer. After identifying text provoking three unequivocal seizures, saline was given first; after the third, 30 mg intranasal SEL was administered. If seizures persisted, a second 30 mg dose followed. Magnetoencephalography (MEG) was recorded continuously.

In this compassionate-use case, 60 mg intranasal SEL fully prevented reflex seizures. Bitter taste after first, not second, dose suggests partial swallowing, explaining residual seizures and reduced spike frequency. Data support SEL’s potential as the first non-benzodiazepine acute seizure treatment.