SV2A Binders

Reviewed by: HU Medical Review Board | Last reviewed: November 2023 | Last updated: November 2023

Epilepsy is a brain disease that causes people to have seizures. With epilepsy, neurons (nerve cells in the brain) do not work properly. Neurons normally create tiny electrical signals in a highly-regulated rhythm. These signals tell other parts of the brain and body what to do.

During a seizure, neurons create too many electrical signals, too quickly. Some doctors describe this as an electrical storm in the brain.

There are dozens of anti-seizure drugs that may be prescribed for epilepsy. One type is SV2A binders. SV2A stands for synaptic vesicle protein 2A. These drugs do not cure epilepsy but limit abnormal electrical activity in the brain. This helps stop or reduce seizures.1,2

SV2A binders may be prescribed for these types of seizures:1

  • Generalized seizures
  • Focal seizures
  • Myoclonic seizures

How do SV2A binders work?

Normally, brain cells talk to each other using electrical signals and chemicals called neurotransmitters. Neurotransmitters are chemical messengers in the brain. Because epilepsy seizures are caused by nerve cells over-firing, changing neurotransmitter release and limiting excitatory neurotransmitter stimulation can stop or reduce seizures.1,2

SV2A is a protein found in neurons, or brain cells, and is involved in regulating neurotransmitter release in the brain. Neurons use a variety of neurotransmitters to work. Research shows that SV2A binders work to reduce seizures by changing how neurotransmitters are released and signal. Doctors do not fully understand how.1,2


Drugs in this class of anti-seizure medicines include:1

  • Brivaracetam (Briviact®)
  • Levetiracetam (Keppra®, Roweepra®, Spritam®)
  • Levetiracetam XR (Elepsia XRTM, Keppra XR®)

What are the possible side effects?

Side effects are common with any type of anti-seizure medicine. Side effects can vary depending on the specific drug you are taking. The most common side effects of SV2A binders include:2

  • Sleepiness and fatigue
  • Dizziness
  • Headache
  • Infection
  • Pain
  • Sore throat
  • Mood and behavior changes, including psychosis

Sometimes side effects can be reduced by lowering the dose or switching to a different drug.3

These are not all the possible side effects of SV2A binders. Talk to your doctor about what to expect when taking these drugs. You also should call your doctor if you have any changes that concern you when taking SV2A binders.

Things to know about SV2A binders

Your doctor may test your blood periodically to monitor for any possible side effects from this class of medications.3

These drugs are taken by mouth or by infusion. These medications are often combined with other anti-seizure medications if monotherapy (a single anti-seizure medication) is not sufficient to control seizures.2

While comprehensive studies have not been undertaken for all drugs in this class, lamotrigine (Lamictal) and levetiracetam (Keppra) are safer to use during pregnancy than many other anti-seizure medications, having low rates of physical birth defects.4

Other types of anti-seizure medicines work on different pathways and include:

Before beginning treatment for epilepsy, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you take. This includes over-the-counter drugs.

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