Brivaracetam in neuropathic pain: preclinical evidence and early clinical data

Brivaracetam, a third-generation antiepileptic drug, has garnered increasing interest as a potential therapeutic alternative for the treatment of neuropathic pain. Unlike its precursor, levetiracetam, it exhibits markedly higher affinity for synaptic vesicle protein 2A and also acts on ion channels involved in neuronal hyperexcitability. Although its approved indication is currently limited to seizure control, various preclinical studies and preliminary clinical observations suggest an analgesic potential that remains insufficiently explored. This narrative review examines the underlying mechanisms of action, summarizes findings from both animal and human models, and contextualizes the emerging role of brivaracetam as a pharmacological candidate in the management of neuropathic pain. The still preliminary evidence underscores the need for specific clinical trials to confirm its efficacy and safety profile in this novel therapeutic domain.