Background: Brivaracetam is a novel third-generation antiseizure medication and an analog of levetiracetam with selective affinity for synaptic vesicle protein 2A (SV2A). By binding SV2A, brivaracetam decreases pre-synaptic neurotransmitter release. Aim: We aimed to assess the safety and efficacy of brivaracetam in pediatric epilepsy. Method: We searched PubMed, Scopus, and Web of Science (WOS) for relevant clinical and observational studies from inception until February 2024. We carried out statistical analysis using Open Meta-Analyst. Dichotomous data were pooled as proportions with a 95% confidence interval (CI). Results: Eleven studies with a total of 805 patients were identified. The analysis of four studies revealed the more than 50% responder rate in a cohort of 252 focal epilepsy patients to be 51.5% (95% CI: [32.6%, 70.5%]). The analysis of three studies involving a cohort of 266 patients found a 20.7% incidence (95% CI: [15.8%, 25.6%]) of complete seizure freedom. The analysis of nine studies involving a cohort of 737 epilepsy patients revealed a retention rate of 66% (95% CI: [40%, 92%]). Conclusion: This study highlights the efficacy, tolerability, and safety of brivaracetam as adjunctive therapy in pediatric patients with epilepsy. The findings support its consideration as a valuable treatment option for children and adolescents, particularly those with drug-resistant epilepsy. Further trials with longer follow-up durations are needed to study the optimal doses and explore factors affecting drug response.

Migraine, a chronic neurological disorder, imposes a significant burden on individuals and healthcare systems globally. This systematic review and meta-analysis evaluated the efficacy and safety of atogepant in preventing episodic migraine (EM) in adults. A systematic search was conducted in four major databases (PubMed, Scopus, Web of Science, and Cochrane CENTRAL) up to June 2024. The inclusion criteria targeted randomized controlled trials (RCTs) comparing atogepant to placebo or standard care in patients with EM. Statistical analyses were performed using Review Manager (RevMan) software. Four RCTs with 2,018 patients receiving atogepant and 761 patients receiving placebo or standard care were included. Atogepant significantly reduced monthly migraine days compared to placebo at 10 mg daily (mean difference [MD], –1.16 days; 95% confidence interval [95% CI], –1.60 to –0.73), 30 mg daily (MD, –1.15 days; 95% CI, –1.64 to –0.66), 60 mg daily (MD, –1.48 days; 95% CI: –2.36 to –0.61 days), 30 mg twice daily (MD, –1.30 days; 95% CI, –2.17 to –0.43), and 60 mg twice daily (MD, –1.20 days; 95% CI, –1.90 to –0.50). A ≥50% reduction in migraine days was frequently significantly achieved with atogepant across all dosages. Atogepant was generally well tolerated, though it was associated with higher incidence rates of constipation and nausea compared to placebo. Atogepant is an effective and well-tolerated option for preventing EM, offering patients a noninvasive oral alternative to injectable therapies. Further research is warranted to explore its long-term safety and efficacy in diverse patient populations and refine its role in this field.

Objective: To evaluate the safety and efficacy of recombinant human prourokinase (rhPro-UK) administered via intravenous (IV) and intra-arterial (IA) routes in acute ischemic stroke (AIS) patients compared with standard treatments. Methods: A comprehensive search was conducted in accordance with PRISMA guidelines across Scopus, Web of Science, and PubMed until 11 December 2024. Randomized controlled trials (RCTs) assessing rhPro-UK’s efficacy and safety were included. Outcomes included the modified Rankin Scale (mRS), the National Institutes of Health Stroke Scale (NIHSS), mortality, and adverse events (AEs). Data analysis used risk difference (RD) with 95% confidence intervals (CIs). Results: Six RCTs (n = 3993) met the inclusion criteria. IV rhPro-UK showed comparable efficacy to the comparator for the mRS 0–1 at 90 days (RD: 0.00, 95% CI: [−0.04, 0.04]) and the mRS 0–2 (RD: −0.01, 95% CI: [−0.03, 0.01], P = 0.23). IA rhPro-UK significantly improved the mRS 0–1 (RD: 0.13, 95% CI: [0.01, 0.26], P = 0.04). The NIHSS reduction was significant for IV rhPro-UK (MD: −0.83, 95% [CI: −1.36, −0.29]). IV rhPro-UK did not significantly reduce the risk of systemic bleeding (RD: −0.10, 95% CI: [−0.24, 0.03], P = 0.12), serious AEs (RD: −0.01, 95% CI: [−0.04, 0.02], P = 0.53), or mortality (RD: 0.01, 95% CI: −0.01, 0.02). IA rhPro-UK significantly increased hemorrhage with neurological deterioration (RD: 0.08, 95% CI: [0.01, 0.14], P = 0.02). Conclusions: IV rhPro-UK provides non-inferior efficacy to both alteplase and standard care with a better safety profile at 35 mg, while IA rhPro-UK enhances functional outcomes in middle cerebral artery occlusions, albeit with safety concerns. Further trials are needed to confirm long-term outcomes, optimal dosing, and broader applicability.

We compared the effectiveness and safety of deep brain stimulation (DBS) and magnetic resonance-guided focused ultrasound (MRgFUS) in patients with essential tremor (ET). A comprehensive search was conducted across four databases (Web of Science, Scopus, PubMed, and Cochrane CENTRAL) till June 2025. Clinical trials and observational studies comparing DBS and MRgFUS in patients with ET were included. Meta-analysis was performed using RevMan version 5.4 and OpenMetaAnalyst, applying a random-effect model. Five cohort studies (463 patients) were included. In the total Clinical Rating Scale for Tremor (CRST) score, there was a significant difference between the two groups favoring DBS (mean difference (MD): 5.12, 95% confidence interval (CI): [1.08, 9.16], P = 0.01), while in part A of the CRST, there was no significant difference ( P = 0.15). No significant difference was found between the two groups in response rate as well ( P = 0.56). Paresthesia (13.3% vs. 2.2%; risk ratio (RR): 4.57, 95% CI: [1.31, 15.94], P = 0.02), gait instability (26.56% vs. 4.06%; RR: 2.85, 95% CI: [1.14, 7.08], P = 0.025), and dysphagia (7.77% vs. 1.37%; RR: 3.40, 95% CI: [1.01, 11.46], P = 0.049) were significantly more frequent in the FUS group compared with DBS. Other serious but rare adverse events (AEs), such as infection and hemorrhage, were more common in the DBS group, but none significantly differed between the two groups. Both DBS and MRgFUS showed similar response rates; however, DBS may provide greater improvement in the total CRST score, potentially due to the comparison of bilateral DBS against predominantly unilateral MRgFUS. Regarding safety, MRgFUS was more associated with sensory and motor AEs, while infrequent but potentially serious complications were only reported with DBS. Future high-quality prospective studies with larger sample sizes and longer follow-up periods are needed.

Objective: To evaluate the safety and efficacy of Diroximel Fumarate (DRF) in patients with different relapsing forms of MS (RMS) through systematic review and meta-analysis. Methods: A systematic review and meta-analysis adhering to PRISMA guidelines was conducted. Scopus, PubMed, and Cochrane CENTRAL databases were searched until December 6, 2024, for clinical trials and observational studies on DRF in RMS. Eligibility criteria included studies evaluating DRF’s safety or efficacy, excluding case reports and non-clinical outcomes. The risk of bias was assessed using the Newcastle–Ottawa Scale and ROBINS-I tools. Statistical analyses were performed using OpenMetaAnalyst, focusing on pooled mean differences and incidence rates with 95% confidence intervals. Results: Seven studies with 3,075 participants were included. The overall persistence rate was 75.6% (95% CI: 63.5%, 87.7%). The discontinuation rate due to safety concerns was 6.1% (95% CI: 4.1%, 8.1%). Lymphocyte count decreased significantly by -355.02 cells/µL (95% CI: -636.71, -73.32). Mild adverse events (AEs) occurred in 33% (95% CI: 18.6%, 47.4%), moderate in 30% (95% CI: -9.9%, 69.9%), and severe in 5% (95% CI: -3.8%, 13.7%). Gastrointestinal (GI) AEs were observed in 17.4% (95% CI: 6%, 28.8%), flushing in 18.5% (95% CI: 5.7%, 31.3%), and lymphopenia in 24.3% (95% CI: 10.2%, 38.4%). The relapse rate was 7.1% (95% CI: -4.8%, 19%). Conclusion: DRF demonstrates efficacy in reducing relapse rates and offers an improved safety profile compared to its predecessor, Dimethyl Fumarate (DMF), particularly in GI tolerability. However, lymphopenia requires monitoring. Further research is recommended to evaluate long-term safety and efficacy in diverse populations.