From drugs to surgery…epilepsy treatment changing in pursuit of a ‘seizure-free life’
Page information
St. Peter's Hospital 26-07-22 10:06Main content
Epilepsy care is shifting from seizure control through medication toward pursuing both long-term freedom from seizures and improvement in patients' quality of life. As treatment options widen - from anticonvulsants with new mechanisms of action to precision testing using surgical robots, brain stimulation and laser-based minimally invasive treatment - access to treatment is also improving for patients with drug-resistant epilepsy.
Epilepsy is a chronic brain disease known to affect about 50 million people worldwide. There are around 360,000 patients in Korea, with more than 20,000 new cases every year.
Epilepsy is counted, along with stroke and dementia, as one of the three major neurological diseases. It is not a condition that occurs only in a particular age group; it can appear at any age, from infants and young children to the elderly. Because the infrastructure for treating intractable epilepsy has not been sufficient, however, it is still sometimes seen only as a condition in which seizures are managed with drugs. Not a few patients themselves believe that active treatment beyond medication is out of reach.
Hong Seung-bong, Director of the Epilepsy & Sleep Center in the Department of Neurology at St. Peter's Hospital, said, “With new drugs, precision diagnosis and surgical techniques advancing at the same time, epilepsy care is at a turning point,” adding, “As Korea's epilepsy diagnosis and treatment infrastructure continues to expand, the range of treatment options available to patients will become even wider.”
To mark World Brain Day on 22 July, St. Peter's Hospital introduced the rapidly changing treatments for epilepsy and the state of care in Korea.
From third-generation drugs to robots and lasers… a strategic shift towards active treatment
Epilepsy is a disease in which excessive excitation of the brain's nerve cells causes repeated temporary seizures. Besides the generalized convulsions commonly associated with the condition, seizures can take many forms, including brief loss of consciousness, memory lapses, blank spells, repetitive behavior, abnormal sensations in the limbs and autonomic seizures.
In the past there was a strong perception that repeated seizures made social life difficult for people with epilepsy, and treatment focused mainly on suppressing seizures with anticonvulsants.
About 30% of patients with epilepsy, however, have drug-resistant epilepsy, in which seizures are not adequately controlled even with two or more appropriate drug treatments. These patients have found seizures difficult to manage with conventional drug-centered treatment alone and have faced considerable difficulties in the course of their care.
Epilepsy treatment has recently been changing from simply reducing the number of seizures toward maintaining a long-term seizure-free state and improving patients' quality of life and long-term prognosis. The emphasis is on an active treatment strategy that minimizes drug side effects while delivering tailored treatment based on each patient's seizure type, cause, lesion and response to treatment, and that ultimately supports the patient's return to society.
The arrival of new anticonvulsants is also driving this change. Third-generation epilepsy drugs with mechanisms of action distinct from existing second-generation treatments are now being introduced.
Cenobamate, currently under review for national health insurance coverage, is a new drug developed by the Korean company SK Biopharmaceuticals. It is drawing attention as a new treatment option in several types of epilepsy, including drug-resistant epilepsy.
Brivaracetam, a third-generation new drug, also came under full national health insurance coverage from July. Brivaracetam is a compound with an improved molecular structure based on levetiracetam; it reduces the burden of side effects such as depression and personality change while supporting rapid onset of effect and stable blood concentrations.
Surgical treatment is also becoming more precise and sophisticated. Using the Kymero surgical robot allows stereo-EEG electrode implantation (SEEG) to be performed with greater precision. This makes it possible to identify exactly where in the brain seizures begin and to assess whether surgery is feasible and what its appropriate extent should be in patients with drug-resistant epilepsy.
For patients in whom curative surgery to remove a lesion or seizure focus is difficult, neuromodulation treatments such as deep brain stimulation (DBS) and vagus nerve stimulation (VNS) can be applied. The appropriate treatment is determined by considering each patient's brain lesion, seizure focus and seizure pattern.
Minimally invasive surgery that uses a laser to treat the lesion or seizure focus is also being performed.
Director Hong Seung-bong explained, “At leading epilepsy centers in the United States and Europe, epilepsy treatment using radiofrequency and lasers is being carried out actively,” adding, “As precision diagnosis and surgical technology advance, we can now consider a wider range of treatment strategies tailored to the patient's condition than in the past.”
More specialist centers and insurance coverage for magnetoencephalography… better access to diagnosis and treatment
Care infrastructure in Korea for treating drug-resistant epilepsy is also gradually expanding.
Patients whose seizures are not controlled by medication can expect a treatment benefit if they undergo precision testing followed by surgical treatment. In Korea, however, the medical infrastructure for epilepsy surgery is concentrated in Seoul and Busan, so cases have arisen in which patients could not have the possibility of surgery reviewed at all, or had to wait one to two years or more for it.
Recently, specialist medical institutions outside university hospitals have begun to provide precision epilepsy testing and surgical treatment, creating a basis for shorter waiting times for diagnosis and treatment and better access for patients.
Magnetoencephalography (MEG), used to pinpoint the seizure focus before epilepsy surgery, became an essential item covered by national health insurance from February 2026. MEG measures the minute magnetic fields generated by the activity of the brain's nerve cells to identify the location of the seizure focus, and is used in the pre-surgical evaluation of patients with intractable epilepsy.
In April 2025, St. Peter's Hospital opened its Epilepsy & Sleep Center under neurology specialist Director Hong Seung-bong, establishing an epilepsy treatment fast track that runs continuously from precision diagnosis through to treatment.
The center is equipped with seven video EEG monitoring rooms and testing systems including Cadwell and Natus NDX. It has also put in place a system for reading magnetoencephalography results, and performs an average of more than 60 video EEG studies a month for precision diagnosis.
A video EEG study records the patient's behavior and seizure patterns on video while simultaneously measuring changes in brain waves. It is used to determine whether the symptoms a patient shows are epileptic seizures and to identify where the seizures begin and what type they are.
St. Peter's Hospital said it shares the relevant infrastructure so that patients who need precision testing or epilepsy surgery can use its testing and treatment facilities regardless of region or medical institution.
Director Hong has been building up treatment experience by administering cenobamate to patients with intractable epilepsy, and he also took part in bringing Buccolam (buccal midazolam), an emergency epilepsy medicine for use outside hospital, into Korea.
Working with epilepsy clinicians in Japan, he set up a short-term epilepsy surgery training program for Korean neurosurgeons, and also established a cooperative care system so that patients could obtain prescriptions for Buccolam in Japan before it was introduced in Korea.
Next-generation research expands into treatment-response prediction AI and RNA drugs
Research also continues into choosing the right treatment for each patient early and into treating drug-resistant epilepsy.
Earlier this year, a research team at Seoul National University Hospital published the results of a retrospective study of a machine learning model that uses artificial intelligence to predict response to antiseizure medication in epilepsy.
The model was developed to help predict in advance how an individual patient will respond to a particular drug among more than 20 anticonvulsants, so that a suitable drug can be chosen from the start of treatment. It is currently at the basic model stage and will require validation and refinement through clinical research.
Research into RNA therapeutics that address the causes of epilepsy at the genetic level is also under way. SoVarGen, a faculty start-up founded at the KAIST Graduate School of Medical Science and Engineering, has developed an antisense oligonucleotide (ASO)-based RNA drug for the treatment of intractable epilepsy.
On the basis of that technology, SoVarGen signed a technology transfer agreement worth about KRW 770 billion, or USD 550 million, with the global pharmaceutical company Angelini Pharma in September 2025.
Director Hong Seung-bong said, “In the past, a lack of treatment infrastructure made it difficult to provide active treatment suited to each patient's condition, but with new treatments emerging and specialist epilepsy centers opening, the diagnostic and treatment environment is changing rapidly.”
He added, “If research on treatment strategies that combine a range of drugs and surgical techniques advances and leads to outcomes such as long-term seizure suppression and cure, we will be able to offer a ‘life without seizures’ to many more patients.”
Epilepsy is a chronic brain disease known to affect about 50 million people worldwide. There are around 360,000 patients in Korea, with more than 20,000 new cases every year.
Epilepsy is counted, along with stroke and dementia, as one of the three major neurological diseases. It is not a condition that occurs only in a particular age group; it can appear at any age, from infants and young children to the elderly. Because the infrastructure for treating intractable epilepsy has not been sufficient, however, it is still sometimes seen only as a condition in which seizures are managed with drugs. Not a few patients themselves believe that active treatment beyond medication is out of reach.
Hong Seung-bong, Director of the Epilepsy & Sleep Center in the Department of Neurology at St. Peter's Hospital, said, “With new drugs, precision diagnosis and surgical techniques advancing at the same time, epilepsy care is at a turning point,” adding, “As Korea's epilepsy diagnosis and treatment infrastructure continues to expand, the range of treatment options available to patients will become even wider.”
To mark World Brain Day on 22 July, St. Peter's Hospital introduced the rapidly changing treatments for epilepsy and the state of care in Korea.
From third-generation drugs to robots and lasers… a strategic shift towards active treatment
Epilepsy is a disease in which excessive excitation of the brain's nerve cells causes repeated temporary seizures. Besides the generalized convulsions commonly associated with the condition, seizures can take many forms, including brief loss of consciousness, memory lapses, blank spells, repetitive behavior, abnormal sensations in the limbs and autonomic seizures.
In the past there was a strong perception that repeated seizures made social life difficult for people with epilepsy, and treatment focused mainly on suppressing seizures with anticonvulsants.
About 30% of patients with epilepsy, however, have drug-resistant epilepsy, in which seizures are not adequately controlled even with two or more appropriate drug treatments. These patients have found seizures difficult to manage with conventional drug-centered treatment alone and have faced considerable difficulties in the course of their care.
Epilepsy treatment has recently been changing from simply reducing the number of seizures toward maintaining a long-term seizure-free state and improving patients' quality of life and long-term prognosis. The emphasis is on an active treatment strategy that minimizes drug side effects while delivering tailored treatment based on each patient's seizure type, cause, lesion and response to treatment, and that ultimately supports the patient's return to society.
The arrival of new anticonvulsants is also driving this change. Third-generation epilepsy drugs with mechanisms of action distinct from existing second-generation treatments are now being introduced.
Cenobamate, currently under review for national health insurance coverage, is a new drug developed by the Korean company SK Biopharmaceuticals. It is drawing attention as a new treatment option in several types of epilepsy, including drug-resistant epilepsy.
Brivaracetam, a third-generation new drug, also came under full national health insurance coverage from July. Brivaracetam is a compound with an improved molecular structure based on levetiracetam; it reduces the burden of side effects such as depression and personality change while supporting rapid onset of effect and stable blood concentrations.
Surgical treatment is also becoming more precise and sophisticated. Using the Kymero surgical robot allows stereo-EEG electrode implantation (SEEG) to be performed with greater precision. This makes it possible to identify exactly where in the brain seizures begin and to assess whether surgery is feasible and what its appropriate extent should be in patients with drug-resistant epilepsy.
For patients in whom curative surgery to remove a lesion or seizure focus is difficult, neuromodulation treatments such as deep brain stimulation (DBS) and vagus nerve stimulation (VNS) can be applied. The appropriate treatment is determined by considering each patient's brain lesion, seizure focus and seizure pattern.
Minimally invasive surgery that uses a laser to treat the lesion or seizure focus is also being performed.
Director Hong Seung-bong explained, “At leading epilepsy centers in the United States and Europe, epilepsy treatment using radiofrequency and lasers is being carried out actively,” adding, “As precision diagnosis and surgical technology advance, we can now consider a wider range of treatment strategies tailored to the patient's condition than in the past.”
More specialist centers and insurance coverage for magnetoencephalography… better access to diagnosis and treatment
Care infrastructure in Korea for treating drug-resistant epilepsy is also gradually expanding.
Patients whose seizures are not controlled by medication can expect a treatment benefit if they undergo precision testing followed by surgical treatment. In Korea, however, the medical infrastructure for epilepsy surgery is concentrated in Seoul and Busan, so cases have arisen in which patients could not have the possibility of surgery reviewed at all, or had to wait one to two years or more for it.
Recently, specialist medical institutions outside university hospitals have begun to provide precision epilepsy testing and surgical treatment, creating a basis for shorter waiting times for diagnosis and treatment and better access for patients.
Magnetoencephalography (MEG), used to pinpoint the seizure focus before epilepsy surgery, became an essential item covered by national health insurance from February 2026. MEG measures the minute magnetic fields generated by the activity of the brain's nerve cells to identify the location of the seizure focus, and is used in the pre-surgical evaluation of patients with intractable epilepsy.
In April 2025, St. Peter's Hospital opened its Epilepsy & Sleep Center under neurology specialist Director Hong Seung-bong, establishing an epilepsy treatment fast track that runs continuously from precision diagnosis through to treatment.
The center is equipped with seven video EEG monitoring rooms and testing systems including Cadwell and Natus NDX. It has also put in place a system for reading magnetoencephalography results, and performs an average of more than 60 video EEG studies a month for precision diagnosis.
A video EEG study records the patient's behavior and seizure patterns on video while simultaneously measuring changes in brain waves. It is used to determine whether the symptoms a patient shows are epileptic seizures and to identify where the seizures begin and what type they are.
St. Peter's Hospital said it shares the relevant infrastructure so that patients who need precision testing or epilepsy surgery can use its testing and treatment facilities regardless of region or medical institution.
Director Hong has been building up treatment experience by administering cenobamate to patients with intractable epilepsy, and he also took part in bringing Buccolam (buccal midazolam), an emergency epilepsy medicine for use outside hospital, into Korea.
Working with epilepsy clinicians in Japan, he set up a short-term epilepsy surgery training program for Korean neurosurgeons, and also established a cooperative care system so that patients could obtain prescriptions for Buccolam in Japan before it was introduced in Korea.
Next-generation research expands into treatment-response prediction AI and RNA drugs
Research also continues into choosing the right treatment for each patient early and into treating drug-resistant epilepsy.
Earlier this year, a research team at Seoul National University Hospital published the results of a retrospective study of a machine learning model that uses artificial intelligence to predict response to antiseizure medication in epilepsy.
The model was developed to help predict in advance how an individual patient will respond to a particular drug among more than 20 anticonvulsants, so that a suitable drug can be chosen from the start of treatment. It is currently at the basic model stage and will require validation and refinement through clinical research.
Research into RNA therapeutics that address the causes of epilepsy at the genetic level is also under way. SoVarGen, a faculty start-up founded at the KAIST Graduate School of Medical Science and Engineering, has developed an antisense oligonucleotide (ASO)-based RNA drug for the treatment of intractable epilepsy.
On the basis of that technology, SoVarGen signed a technology transfer agreement worth about KRW 770 billion, or USD 550 million, with the global pharmaceutical company Angelini Pharma in September 2025.
Director Hong Seung-bong said, “In the past, a lack of treatment infrastructure made it difficult to provide active treatment suited to each patient's condition, but with new treatments emerging and specialist epilepsy centers opening, the diagnostic and treatment environment is changing rapidly.”
He added, “If research on treatment strategies that combine a range of drugs and surgical techniques advances and leads to outcomes such as long-term seizure suppression and cure, we will be able to offer a ‘life without seizures’ to many more patients.”