From drugs to surgery…the epilepsy treatment paradigm evolves
Page information
St. Peter's Hospital 26-08-06 05:31Main content
The direction of epilepsy treatment is changing fast. With new drugs, precision diagnosis and surgical techniques all advancing at once, the field is at a turning point.
Epilepsy, which affects about 50 million people worldwide and about 360,000 in Korea, is a major chronic brain disorder counted along with stroke and dementia as one of the three main neurological diseases.
More than 20,000 new patients are diagnosed each year, and it can develop at any age, from 0 to 100.
Because infrastructure for treating intractable epilepsy is lacking, however, it still tends to be seen as a condition managed mainly with drugs to control seizures. 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, predicted, "As Korea's epilepsy diagnosis and treatment infrastructure continues to expand, the range of treatment options will widen further."
In the past, epilepsy treatment focused on suppressing seizures as a first line of care using antiseizure drugs.
Patients with drug-resistant epilepsy, who account for about 30% of all cases, have had a particularly hard time, as their seizures remain difficult to control even on two or more drugs.
Recent treatment trends, however, are shifting beyond simply reducing seizures toward active treatment strategies that maintain long seizure-free periods, improve patients' quality of life and ultimately help them return to social life.
The most striking change is the arrival of third-generation drugs. New agents with mechanisms that set them apart from existing second-generation drugs are entering use one after another.
‘Cenobamate’, developed by the Korean company SK Biopharmaceuticals and under health insurance reimbursement review, is showing excellent results in drug-resistant epilepsy and other conditions.
‘Brivaracetam’ formulations, whose insurance coverage took full effect in July, reduce side effects such as depression and personality change and help maintain stable blood levels.
Surgical techniques have also become more precise and sophisticated. Detailed evaluation using stereo-EEG electrode implantation (SEEG) with the Kymero surgical robot is now possible, raising cure rates for intractable epilepsy.
When curative surgery is difficult, patient-tailored procedures such as deep brain stimulation (DBS) and vagus nerve stimulation (VNS) are emerging as alternatives, and minimally invasive treatment using radiofrequency or lasers, as at major centers in the United States and Europe, is also being performed actively.
Access to treatment has also improved considerably. Epilepsy surgery infrastructure in Korea was once confined to Seoul and Busan, with waits of one to two years, but the situation has improved as specialized medical institutions offering detailed evaluation and surgery have opened outside university hospitals.
From February 2026, magnetoencephalography (MEG), which helps identify the seizure focus, was also switched to essential health insurance coverage.
St. Peter's Hospital opened its center in April last year around Hong Seung-bong, Director of the Epilepsy & Sleep Center, and built a fast-track system that provides continuous care from diagnosis through treatment.
It is the largest facility of its kind in Korea, with seven video-EEG monitoring rooms and state-of-the-art equipment, reading magnetoencephalography studies and performing an average of more than 60 video-EEG studies a month.
Center Director Hong Seung-bong holds the record for administering cenobamate to the most patients in Korea, and has contributed to expanding infrastructure by leading the introduction of the emergency drug 'Buccolam' to Korea and by working with Japanese specialists to create a short-term surgical training program for Korean neurosurgeons.
Next-generation research to find new treatment strategies is also active. 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.
SoVarGen, a KAIST faculty startup, also developed an RNA drug for the treatment of intractable epilepsy and signed a technology transfer agreement worth about 770 billion won with a global pharmaceutical company.
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 specialized centers being established, the diagnostic and treatment environment is changing rapidly,” adding, “If advances in research combining a variety of medications and surgical methods deliver results such as long-term seizure control and cure, it will be possible to offer ‘a life without seizures’ to many more patients.”
Meanwhile, the Epilepsy & Sleep Center at St. Peter's Hospital has been running an Epilepsy Support Center under its own resources since July 2020. Through an epilepsy helpline it provides free counseling on the treatment of intractable epilepsy, referral to social welfare services and counseling on emotional problems such as depression, and it has handled about 24,000 consultations to date.
Epilepsy, which affects about 50 million people worldwide and about 360,000 in Korea, is a major chronic brain disorder counted along with stroke and dementia as one of the three main neurological diseases.
More than 20,000 new patients are diagnosed each year, and it can develop at any age, from 0 to 100.
Because infrastructure for treating intractable epilepsy is lacking, however, it still tends to be seen as a condition managed mainly with drugs to control seizures. 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, predicted, "As Korea's epilepsy diagnosis and treatment infrastructure continues to expand, the range of treatment options will widen further."
In the past, epilepsy treatment focused on suppressing seizures as a first line of care using antiseizure drugs.
Patients with drug-resistant epilepsy, who account for about 30% of all cases, have had a particularly hard time, as their seizures remain difficult to control even on two or more drugs.
Recent treatment trends, however, are shifting beyond simply reducing seizures toward active treatment strategies that maintain long seizure-free periods, improve patients' quality of life and ultimately help them return to social life.
The most striking change is the arrival of third-generation drugs. New agents with mechanisms that set them apart from existing second-generation drugs are entering use one after another.
‘Cenobamate’, developed by the Korean company SK Biopharmaceuticals and under health insurance reimbursement review, is showing excellent results in drug-resistant epilepsy and other conditions.
‘Brivaracetam’ formulations, whose insurance coverage took full effect in July, reduce side effects such as depression and personality change and help maintain stable blood levels.
Surgical techniques have also become more precise and sophisticated. Detailed evaluation using stereo-EEG electrode implantation (SEEG) with the Kymero surgical robot is now possible, raising cure rates for intractable epilepsy.
When curative surgery is difficult, patient-tailored procedures such as deep brain stimulation (DBS) and vagus nerve stimulation (VNS) are emerging as alternatives, and minimally invasive treatment using radiofrequency or lasers, as at major centers in the United States and Europe, is also being performed actively.
Access to treatment has also improved considerably. Epilepsy surgery infrastructure in Korea was once confined to Seoul and Busan, with waits of one to two years, but the situation has improved as specialized medical institutions offering detailed evaluation and surgery have opened outside university hospitals.
From February 2026, magnetoencephalography (MEG), which helps identify the seizure focus, was also switched to essential health insurance coverage.
St. Peter's Hospital opened its center in April last year around Hong Seung-bong, Director of the Epilepsy & Sleep Center, and built a fast-track system that provides continuous care from diagnosis through treatment.
It is the largest facility of its kind in Korea, with seven video-EEG monitoring rooms and state-of-the-art equipment, reading magnetoencephalography studies and performing an average of more than 60 video-EEG studies a month.
Center Director Hong Seung-bong holds the record for administering cenobamate to the most patients in Korea, and has contributed to expanding infrastructure by leading the introduction of the emergency drug 'Buccolam' to Korea and by working with Japanese specialists to create a short-term surgical training program for Korean neurosurgeons.
Next-generation research to find new treatment strategies is also active. 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.
SoVarGen, a KAIST faculty startup, also developed an RNA drug for the treatment of intractable epilepsy and signed a technology transfer agreement worth about 770 billion won with a global pharmaceutical company.
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 specialized centers being established, the diagnostic and treatment environment is changing rapidly,” adding, “If advances in research combining a variety of medications and surgical methods deliver results such as long-term seizure control and cure, it will be possible to offer ‘a life without seizures’ to many more patients.”
Meanwhile, the Epilepsy & Sleep Center at St. Peter's Hospital has been running an Epilepsy Support Center under its own resources since July 2020. Through an epilepsy helpline it provides free counseling on the treatment of intractable epilepsy, referral to social welfare services and counseling on emotional problems such as depression, and it has handled about 24,000 consultations to date.