Epilepsy care expands beyond seizure control to combined new drugs and surgery
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St. Peter's Hospital 26-07-22 16:01Main content
Epilepsy care is broadening from a focus on seizure control with antiseizure drugs towards an approach that combines new drugs, precision diagnosis and surgical treatment.
For patients with drug-resistant epilepsy, who account for about 30% of all patients, the introduction of new drugs and surgical techniques is making treatment strategies that suppress seizures over the long term and support a return to daily life increasingly important.
On the 22nd, World Brain Day, St. Peter's Hospital said that epilepsy treatment has recently been moving beyond a simple reduction in the number of seizures toward tailored treatment that takes each patient's seizure cause and lesion into account.
Epilepsy is a chronic brain disease in which excessive excitation of the brain's nerve cells causes repeated seizures. Besides generalized convulsions, it can take many forms, including brief loss of consciousness and memory lapses, repetitive behavior, abnormal sensations in the limbs and autonomic symptoms.
Until now, suppressing seizures with anticonvulsants has been the main form of treatment. In drug-resistant patients whose seizures are not controlled even with two or more drugs, however, additional medication and surgical treatment need to be actively considered.
Recently, third-generation epilepsy drugs — using mechanisms different from existing agents, or with fewer side effects — have continued to be introduced.
Cenobamate, developed by SK Biopharmaceuticals, is going through the national health insurance reimbursement process in Korea and is being discussed as a treatment option for patients with drug-resistant epilepsy.
A treatment containing brivaracetam also came under national health insurance coverage from July this year. Brivaracetam has a mechanism similar to that of levetiracetam but was developed to reduce the mood changes and behavior-related adverse reactions seen in some patients.
Surgical treatment is advancing towards identifying the site where seizures begin more precisely and reducing damage to normal brain tissue.
Stereo-EEG electrode implantation (SEEG) is a test in which electrodes are placed inside the brain to pinpoint the seizure focus. Surgical robots are now being used to improve the accuracy of the electrodes' placement and trajectory.
For patients whose seizure-causing lesion is difficult to resect, neuromodulation therapies such as deep brain stimulation (DBS) and vagus nerve stimulation (VNS) can be used.
Minimally invasive treatment that removes the seizure focus using radiofrequency or lasers is also being carried out, mainly at leading epilepsy centers abroad. It is being studied as a treatment alternative because it can reduce the extent of the incision and damage to healthy tissue compared with conventional craniotomy.
Hong Seung-bong, Director of the Epilepsy & Sleep Center at St. Peter's Hospital, said, "As new drugs, precision diagnosis and surgical techniques advance together, the treatment options for patients with epilepsy are widening," adding, "Patients whose seizures are not controlled by medication should undergo a precision evaluation that includes assessing whether surgery is possible."
In Korea, only a limited number of medical institutions can perform epilepsy surgery and detailed testing, and it has repeatedly been pointed out that access to treatment for drug-resistant patients is therefore poor.
Recently, specialist centers outside university hospitals offering video EEG studies, magnetoencephalography and pre-surgical evaluation have expanded, building the infrastructure to shorten waiting times for testing and treatment.
Magnetoencephalography (MEG), which identifies the location of the seizure focus, became an essential item covered by national health insurance from February this year. MEG measures the magnetic fields generated by the activity of the brain's nerve cells to find the area where seizures begin.
St. Peter's Hospital opened its Epilepsy & Sleep Center in April last year and built seven video EEG monitoring rooms along with EEG testing equipment. The center performs an average of more than 60 video EEG studies a month and operates a continuous care system for patients who need precision testing and surgery.
Research into artificial intelligence and gene-based treatment is also under way.
Researchers in Korea are developing machine learning models that use artificial intelligence to predict how individual patients will respond to anticonvulsant treatment. The aim is to use a patient's clinical information to select at an early stage the drug among several anticonvulsants that is most likely to work.
Development of RNA therapeutics targeting the causative genes of intractable epilepsy is also continuing. SoVarGen, a Korean biotech company, is developing an antisense oligonucleotide-based epilepsy treatment and signed a technology transfer agreement with the global pharmaceutical company Angelini Pharma last year.
Source: MediPana News (https://www.medipana.com)
For patients with drug-resistant epilepsy, who account for about 30% of all patients, the introduction of new drugs and surgical techniques is making treatment strategies that suppress seizures over the long term and support a return to daily life increasingly important.
On the 22nd, World Brain Day, St. Peter's Hospital said that epilepsy treatment has recently been moving beyond a simple reduction in the number of seizures toward tailored treatment that takes each patient's seizure cause and lesion into account.
Epilepsy is a chronic brain disease in which excessive excitation of the brain's nerve cells causes repeated seizures. Besides generalized convulsions, it can take many forms, including brief loss of consciousness and memory lapses, repetitive behavior, abnormal sensations in the limbs and autonomic symptoms.
Until now, suppressing seizures with anticonvulsants has been the main form of treatment. In drug-resistant patients whose seizures are not controlled even with two or more drugs, however, additional medication and surgical treatment need to be actively considered.
Recently, third-generation epilepsy drugs — using mechanisms different from existing agents, or with fewer side effects — have continued to be introduced.
Cenobamate, developed by SK Biopharmaceuticals, is going through the national health insurance reimbursement process in Korea and is being discussed as a treatment option for patients with drug-resistant epilepsy.
A treatment containing brivaracetam also came under national health insurance coverage from July this year. Brivaracetam has a mechanism similar to that of levetiracetam but was developed to reduce the mood changes and behavior-related adverse reactions seen in some patients.
Surgical treatment is advancing towards identifying the site where seizures begin more precisely and reducing damage to normal brain tissue.
Stereo-EEG electrode implantation (SEEG) is a test in which electrodes are placed inside the brain to pinpoint the seizure focus. Surgical robots are now being used to improve the accuracy of the electrodes' placement and trajectory.
For patients whose seizure-causing lesion is difficult to resect, neuromodulation therapies such as deep brain stimulation (DBS) and vagus nerve stimulation (VNS) can be used.
Minimally invasive treatment that removes the seizure focus using radiofrequency or lasers is also being carried out, mainly at leading epilepsy centers abroad. It is being studied as a treatment alternative because it can reduce the extent of the incision and damage to healthy tissue compared with conventional craniotomy.
Hong Seung-bong, Director of the Epilepsy & Sleep Center at St. Peter's Hospital, said, "As new drugs, precision diagnosis and surgical techniques advance together, the treatment options for patients with epilepsy are widening," adding, "Patients whose seizures are not controlled by medication should undergo a precision evaluation that includes assessing whether surgery is possible."
In Korea, only a limited number of medical institutions can perform epilepsy surgery and detailed testing, and it has repeatedly been pointed out that access to treatment for drug-resistant patients is therefore poor.
Recently, specialist centers outside university hospitals offering video EEG studies, magnetoencephalography and pre-surgical evaluation have expanded, building the infrastructure to shorten waiting times for testing and treatment.
Magnetoencephalography (MEG), which identifies the location of the seizure focus, became an essential item covered by national health insurance from February this year. MEG measures the magnetic fields generated by the activity of the brain's nerve cells to find the area where seizures begin.
St. Peter's Hospital opened its Epilepsy & Sleep Center in April last year and built seven video EEG monitoring rooms along with EEG testing equipment. The center performs an average of more than 60 video EEG studies a month and operates a continuous care system for patients who need precision testing and surgery.
Research into artificial intelligence and gene-based treatment is also under way.
Researchers in Korea are developing machine learning models that use artificial intelligence to predict how individual patients will respond to anticonvulsant treatment. The aim is to use a patient's clinical information to select at an early stage the drug among several anticonvulsants that is most likely to work.
Development of RNA therapeutics targeting the causative genes of intractable epilepsy is also continuing. SoVarGen, a Korean biotech company, is developing an antisense oligonucleotide-based epilepsy treatment and signed a technology transfer agreement with the global pharmaceutical company Angelini Pharma last year.
Source: MediPana News (https://www.medipana.com)