How do levetiracetam and brivaracetam reduce seizures by binding SV2A? · Grey Matter

Both drugs bind the same pocket of SV2A, brivaracetam with about 15 to 30 times higher affinity, and across related compounds the strength of binding tracks antiseizure potency, which is the main evidence that SV2A is their target.

How do levetiracetam and brivaracetam reduce seizures by binding SV2A?

Both drugs bind the same pocket of SV2A, brivaracetam with about 15 to 30 times higher affinity, and across related compounds the strength of binding tracks antiseizure potency, which is the main evidence that SV2A is their target. The leading hypothesis is that binding reduces how many vesicles are ready for release, and that the effect shows mostly at synapses driven hard and repeatedly, as during the build-up of a seizure, while ordinary transmission changes little. The step from binding to fewer released vesicles is still being worked out, so the mechanism is best stated as a well-supported hypothesis.