[약업신문]New alternatives are needed for epilepsy. Even with many drugs, the effect is insignificant. About 30%

Recent domestic research results suggest that the introduction of a new anticonvulsant option for epilepsy is required.

In fact, looking at the results of a recent survey of epilepsy treatment experts (n=108) in Korea who had experience in prescribing anticonvulsants by the Drug Committee of the Korean Epilepsy Society, experts who responded to the questionnaire (n=90) were Also, the proportion of patients who failed to control seizures was 26.9% of the patients treated, confirming that it was similar to the proportion of patients with drug-refractory epilepsy (30%).

Lack of effect (57.4%), adverse reaction (20.4%), and compliance (18.6%) were cited as the cause of the seizure control failure. In particular, the response to the lack of drug efficacy was the type of hospital, clinical experience, region, and specialty. Consistently, regardless of knowledge, it showed the unmet need of medical staff to expand options for anti-epileptic drugs.

According to the results of analysis of the National Health Insurance data from 2009 to 2017 by the Epidemiological Committee of the Korean Epilepsy Society, the incidence of epilepsy in Korea increased from 28.7 per 100,000 in 2009 to 35.4 per 100,000 in 2017, and the prevalence was The number increased from 3.4 out of 1,000 in 2009 to 4.8 out of 1,000 in 2017.

The incidence and prevalence of epilepsy patients in Korea have steadily increased over the past 8 years. Comparing by age group, the incidence rate (Average Annual Percentage Change, AAPC 15.49%) increased remarkably in the elderly aged 75 years or older, and there were more males than females regardless of age.

Epilepsy, one of the three major brain diseases, is a disease in which seizures occur repeatedly through various causes and complex onset processes. The causes of epilepsy are very diverse, and an accident with a head injury may be an acquired cause of epilepsy. Seizures, which are the main symptoms, occur suddenly when brain cells in a specific brain region are temporarily overexcited or their inhibitory power is weakened, resulting in a loss of balance and loss of control.

An important point is that among epilepsy patients, the proportion of patients who do not respond to existing drug treatment is also significant. Epilepsy is primarily treated with drugs, and seizures can be controlled through anticonvulsants with a mechanism suitable for the patient. However, if seizures are not controlled even with two or more drugs, it is classified as ‘drug-refractory epilepsy’, which is a severe intractable disease, and it is reported that about 30% of epilepsy patients in Korea fall under this category.

Professor Seo Dae-won of Samsung Medical Center, who conducted the expert survey, said, “More than half (54.5%) of the experts who participated in the survey expected that seizure control would be possible if a new anticonvulsant drug was added to patients with drug-refractory epilepsy. When adding drugs to patients who have failed treatment despite taking 5 or more drugs, the mechanism of action of the drug is considered first. points,” he said.

According to Clinical Epilepsy published by the Korean Epilepsy Society, currently used anticonvulsants inhibit or block ion channels to modulate the excitability of nerve cells (modulation of ion channels), or enhance the action of inhibitory neurotransmitters ( It is classified into four mechanisms: enhancement of inhibitory neurotransmission, attenuation of excitatory neurotransmission, and regulation of neurotransmitter secretion.

As such, the need for more delicate consideration in the selection of drugs for patients with intractable epilepsy is a major topic of discussion in overseas guidelines. The American Academy of Neuroscience separates treatment guidelines for newly diagnosed epilepsy patients and drug-refractory epilepsy patients. According to the guidelines, the selection of anticonvulsants in patients with drug-refractory epilepsy requires consideration of seizure and syndrome type, patient age, concomitant medications, and anti-seizure medication (ASM) tolerability, safety, and efficacy.

Professor Seo said, “In the case of patients with intractable epilepsy, as the number of drugs taken increases, there are many concerns in terms of side effects and compliance. Therefore, when new anticonvulsant options are continuously introduced, try using them in combination with existing drugs and, if they are effective, we can expect to reduce the number of drugs taken.” Considering the drug treatment tendency for epilepsy that requires a drug combination, the range of mechanisms of action that can be actually selected is not wide.”