From drugs to surgery…the changing epilepsy treatment paradigm
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St. Peter's Hospital 26-07-22 21:34Main content
Epilepsy is a condition affecting some 50 million people worldwide. In Korea alone about 360,000 people have it, and more than 20,000 new patients are diagnosed every year.
Epilepsy is a representative chronic brain disorder counted, along with stroke and dementia, as one of the three major neurological diseases, and it is also a major condition that develops regardless of age, from 0 to 100. Even so, because infrastructure for treating intractable epilepsy is lacking, it is still often seen only as a condition managed mainly with drugs to control seizures. In Korea in particular, not a few patients themselves believe that active treatment beyond medication is out of reach.
Over the past few years, however, the direction of epilepsy treatment has been changing rapidly. 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 all 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 should widen further in the years ahead."
How are the treatments now emerging changing clinical practice? To mark World Brain Day on the 22nd, we looked at the current state of rapidly changing epilepsy treatment with Director Hong Seung-bong of the Department of Neurology at St. Peter's Hospital.
■ From third-generation drug launches to surgical robots and minimally invasive laser surgery... a strategic shift to ‘active treatment’
Epilepsy is a chronic brain disorder in which transient seizures recur because of excessive excitation of the nerve cells in the brain. Besides generalized convulsions, epileptic seizures can take many forms depending on the patient, including brief loss of consciousness, memory lapses, blank staring, repetitive behavior, abnormal sensations in the arms and legs, and autonomic seizures.
Because seizures recur in this way, patients with epilepsy were in the past often regarded as people with a chronic illness that made social life difficult. Treatment, too, focused mainly on first-line seizure suppression with anticonvulsants. Patients with drug-resistant epilepsy, who account for about 30% of all patients, have had a particularly hard time, as their seizures remain difficult to control even on two or more medications.
Recent trends in epilepsy treatment go beyond simply reducing seizures, moving toward maintaining long seizure-free periods and improving patients' quality of life. Active treatment strategies are emerging that reduce drug side effects, improve long-term prognosis through individually tailored treatment and ultimately take a return to social life into account.
The first development that stands out is the brisk launch of new drugs. A variety of third-generation drugs with mechanisms of action distinct from existing second-generation epilepsy medications have recently begun to appear. Cenobamate, currently under review for national health insurance reimbursement, is a new drug developed by the Korean company SK Biopharmaceuticals and is showing excellent efficacy in a range of epilepsies, including drug-resistant epilepsy.
Brivaracetam, a third-generation new drug, also came under full insurance coverage in July. It was derived by improving the molecular structure of levetiracetam, and it reduces side effects such as depression and personality change while helping to produce a rapid effect and maintain stable blood levels.
Surgical techniques are also becoming more precise and sophisticated. More accurate detailed evaluation using stereo-EEG electrode implantation (SEEG) with the Kymero surgical robot is now possible, and cure rates for intractable epilepsy are rising as a result. When curative surgery is not feasible, tailored procedures such as deep brain stimulation (DBS) and vagus nerve stimulation (VNS), which take each patient's brain lesion and seizure focus carefully into account, are also expanding.
Minimally invasive treatments using lasers are being performed as well. Director Hong Seung-bong said, "Major epilepsy centers in the United States and Europe are actively performing epilepsy treatment using radiofrequency or lasers."
■ More specialist epilepsy centers covering everything from precision diagnosis to treatment... better access to care ↑
The clinical infrastructure for treating drug-resistant epilepsy is also being steadily expanded. Drug-resistant epilepsy can benefit greatly from surgical treatment, but epilepsy surgery infrastructure in Korea (available only in Seoul and Busan) is so limited that many patients never even consider surgery, or wait one to two years or more for it.
Recently, as specialized medical institutions offering detailed epilepsy evaluation and surgical treatment have opened outside university hospitals, waiting times have shortened and access has widened considerably. Magnetoencephalography (MEG), which helps pinpoint the seizure focus before epilepsy surgery, also becomes an essential national health insurance benefit from February 2026.
St. Peter's Hospital opened its Epilepsy & Sleep Center in April last year around Director Hong Seung-bong, a neurologist and leading authority in epilepsy, and built an epilepsy treatment fast track that provides continuous care from diagnosis through treatment. With seven video EEG rooms and advanced testing equipment including Cadwell and Natus NDX, the center is the largest epilepsy center facility in Korea.
Director Hong Seung-bong, who heads the center, administers cenobamate, a new drug for patients with intractable epilepsy, to more patients than any other physician in Korea, and led the introduction into Korea of Buccolam (oromucosal midazolam), an out-of-hospital rescue medication for epilepsy. Working with epilepsy clinicians in Japan, he also set up a short-term epilepsy surgery training program for Korean neurosurgeons, and established a cooperative care system so that patients could obtain prescriptions for Buccolam in Japan before it was introduced in Korea.
■ Next-generation research is also active, from AI-based prediction of treatment response to gene therapy
Beyond this, a wide range of research to find new epilepsy treatment strategies is under way.
Early this year, Seoul National University Hospital published a retrospective study of a machine learning model that uses AI to predict the response to anticonvulsant treatment in epilepsy. The model predicts in advance how an individual patient will respond to particular drugs among more than 20 anticonvulsants, helping clinicians choose a more appropriate medication at the early stage of treatment. It is a basic model for now, but it is expected to be expanded into clinical research.
SoVarGen, a faculty startup founded out of the KAIST Graduate School of Medical Science and Engineering, has developed an RNA drug (ASO) for the treatment of intractable epilepsy. On the strength of that technology, SoVarGen signed a technology transfer agreement worth about 770 billion won (550 million dollars) with the global pharmaceutical company Angelini Pharma last September.
Hong Seung-bong, neurologist and Director of the Epilepsy & Sleep Center at St. Peter's Hospital, 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," adding, "If, through research into and development of a variety of strategies that combine various drugs and surgical techniques, we can achieve outcomes such as long-term seizure control and cure, we expect to be able to offer 'a life without seizures' to many more patients."
Source: Medworld News (http://www.medworld.co.kr)
Epilepsy is a representative chronic brain disorder counted, along with stroke and dementia, as one of the three major neurological diseases, and it is also a major condition that develops regardless of age, from 0 to 100. Even so, because infrastructure for treating intractable epilepsy is lacking, it is still often seen only as a condition managed mainly with drugs to control seizures. In Korea in particular, not a few patients themselves believe that active treatment beyond medication is out of reach.
Over the past few years, however, the direction of epilepsy treatment has been changing rapidly. 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 all 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 should widen further in the years ahead."
How are the treatments now emerging changing clinical practice? To mark World Brain Day on the 22nd, we looked at the current state of rapidly changing epilepsy treatment with Director Hong Seung-bong of the Department of Neurology at St. Peter's Hospital.
■ From third-generation drug launches to surgical robots and minimally invasive laser surgery... a strategic shift to ‘active treatment’
Epilepsy is a chronic brain disorder in which transient seizures recur because of excessive excitation of the nerve cells in the brain. Besides generalized convulsions, epileptic seizures can take many forms depending on the patient, including brief loss of consciousness, memory lapses, blank staring, repetitive behavior, abnormal sensations in the arms and legs, and autonomic seizures.
Because seizures recur in this way, patients with epilepsy were in the past often regarded as people with a chronic illness that made social life difficult. Treatment, too, focused mainly on first-line seizure suppression with anticonvulsants. Patients with drug-resistant epilepsy, who account for about 30% of all patients, have had a particularly hard time, as their seizures remain difficult to control even on two or more medications.
Recent trends in epilepsy treatment go beyond simply reducing seizures, moving toward maintaining long seizure-free periods and improving patients' quality of life. Active treatment strategies are emerging that reduce drug side effects, improve long-term prognosis through individually tailored treatment and ultimately take a return to social life into account.
The first development that stands out is the brisk launch of new drugs. A variety of third-generation drugs with mechanisms of action distinct from existing second-generation epilepsy medications have recently begun to appear. Cenobamate, currently under review for national health insurance reimbursement, is a new drug developed by the Korean company SK Biopharmaceuticals and is showing excellent efficacy in a range of epilepsies, including drug-resistant epilepsy.
Brivaracetam, a third-generation new drug, also came under full insurance coverage in July. It was derived by improving the molecular structure of levetiracetam, and it reduces side effects such as depression and personality change while helping to produce a rapid effect and maintain stable blood levels.
Surgical techniques are also becoming more precise and sophisticated. More accurate detailed evaluation using stereo-EEG electrode implantation (SEEG) with the Kymero surgical robot is now possible, and cure rates for intractable epilepsy are rising as a result. When curative surgery is not feasible, tailored procedures such as deep brain stimulation (DBS) and vagus nerve stimulation (VNS), which take each patient's brain lesion and seizure focus carefully into account, are also expanding.
Minimally invasive treatments using lasers are being performed as well. Director Hong Seung-bong said, "Major epilepsy centers in the United States and Europe are actively performing epilepsy treatment using radiofrequency or lasers."
■ More specialist epilepsy centers covering everything from precision diagnosis to treatment... better access to care ↑
The clinical infrastructure for treating drug-resistant epilepsy is also being steadily expanded. Drug-resistant epilepsy can benefit greatly from surgical treatment, but epilepsy surgery infrastructure in Korea (available only in Seoul and Busan) is so limited that many patients never even consider surgery, or wait one to two years or more for it.
Recently, as specialized medical institutions offering detailed epilepsy evaluation and surgical treatment have opened outside university hospitals, waiting times have shortened and access has widened considerably. Magnetoencephalography (MEG), which helps pinpoint the seizure focus before epilepsy surgery, also becomes an essential national health insurance benefit from February 2026.
St. Peter's Hospital opened its Epilepsy & Sleep Center in April last year around Director Hong Seung-bong, a neurologist and leading authority in epilepsy, and built an epilepsy treatment fast track that provides continuous care from diagnosis through treatment. With seven video EEG rooms and advanced testing equipment including Cadwell and Natus NDX, the center is the largest epilepsy center facility in Korea.
Director Hong Seung-bong, who heads the center, administers cenobamate, a new drug for patients with intractable epilepsy, to more patients than any other physician in Korea, and led the introduction into Korea of Buccolam (oromucosal midazolam), an out-of-hospital rescue medication for epilepsy. Working with epilepsy clinicians in Japan, he also set up a short-term epilepsy surgery training program for Korean neurosurgeons, and established a cooperative care system so that patients could obtain prescriptions for Buccolam in Japan before it was introduced in Korea.
■ Next-generation research is also active, from AI-based prediction of treatment response to gene therapy
Beyond this, a wide range of research to find new epilepsy treatment strategies is under way.
Early this year, Seoul National University Hospital published a retrospective study of a machine learning model that uses AI to predict the response to anticonvulsant treatment in epilepsy. The model predicts in advance how an individual patient will respond to particular drugs among more than 20 anticonvulsants, helping clinicians choose a more appropriate medication at the early stage of treatment. It is a basic model for now, but it is expected to be expanded into clinical research.
SoVarGen, a faculty startup founded out of the KAIST Graduate School of Medical Science and Engineering, has developed an RNA drug (ASO) for the treatment of intractable epilepsy. On the strength of that technology, SoVarGen signed a technology transfer agreement worth about 770 billion won (550 million dollars) with the global pharmaceutical company Angelini Pharma last September.
Hong Seung-bong, neurologist and Director of the Epilepsy & Sleep Center at St. Peter's Hospital, 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," adding, "If, through research into and development of a variety of strategies that combine various drugs and surgical techniques, we can achieve outcomes such as long-term seizure control and cure, we expect to be able to offer 'a life without seizures' to many more patients."
Source: Medworld News (http://www.medworld.co.kr)