“A new anticonvulsant drug should be introduced to treat drug-refractory epilepsy”

26.9% of patients treated by epilepsy specialists in Korea are ‘drug-refractory patients’ who cannot control their seizures even with two or more drugs .

Recently, the Pharmacology Committee of the Korean Epilepsy Society (hereinafter referred to as the ‘Society’) announced the results of a survey conducted on 108 domestic epilepsy treatment experts who had experience in prescribing anticonvulsants.

Epilepsy, one of the three major brain diseases, is a disease in which seizures occur repeatedly through various causes and complex onset processes. Seizures, the main symptom of epilepsy, occur suddenly when brain cells in a specific brain region are temporarily over-excited or have weakened inhibitory power, resulting in a loss of balance and loss of control.

The incidence and prevalence of epilepsy patients in Korea have steadily increased over the past 8 years. According to the results of analysis of the National Health Insurance data from 2009 to 2017 by the epidemiological committee of the Society, the incidence of epilepsy in Korea increased from 28.7 per 100,000 in 2009 to 35.4 per 100,000 in 2017. It increased from 3.4 out of 1,000 to 4.8 out of 1,000 in 2017.

Comparing by age group, the incidence rate increased markedly in the elderly aged 75 years and older, and there were more men than women regardless of age.

The problem is that a significant proportion of patients with epilepsy do not respond to existing drug treatments.

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 known that about 30% of epilepsy patients in Korea fall under this category.

In fact, similar results were found in the survey results of the Society’s Drug Committee. The proportion of patients who failed to control seizures even with two drugs was 26.9% of the patients treated, which was confirmed similar to the known drug-refractory epilepsy rate of 30%.

‘Lack of effect (57.4%)’, ‘adverse reaction (20.4%)’, and ‘compliance (18.6%)’ were cited as the cause of the seizure control failure. It appeared consistently regardless of the type of treatment, clinical experience, region, or expertise, indicating the unmet need of medical staff for expanding anti-epileptic treatment options.

In addition, 91.1% of respondents ranked ‘mechanism of action’ as a priority factor when adding drugs to drug-refractory patients who cannot control seizures even with 5 or more drugs, and ‘expert opinion’ and ‘clinical experience ‘, ‘thesis’, and ‘guidelines’ in the order of consideration.

Professor Seo Dae-won of Samsung Medical Center who conducted this 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 failed treatment despite taking 5 or more drugs, the mechanism of action of the drug was considered first. points,” he said.

According to the clinical epilepsy published by the Society, currently used anticonvulsants ▲ control the excitability of nerve cells by inhibiting or blocking ion channels ▲ Strengthening the action of inhibitory neurotransmitters ▲ Weakening excitatory neurotransmission ▲ Neurotransmitters It is classified into four mechanisms, including regulating the secretion of

In particular, 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 patients with epilepsy and patients with drug-refractory epilepsy. , concomitant drugs, ASM (Anti-Seizure Medication) tolerability, safety and efficacy should be considered.

In this regard, the professor said, “In the case of patients with refractory epilepsy, as the number of drugs taken increases, there are many concerns about side effects and compliance. If there is a drug, we can expect even the possibility of reducing the number of drugs taken.”

Professor Seo added, “Currently, there are about 18 domestic anticonvulsants that are covered, but the range of mechanisms of action that can be actually selected is not wide considering the drug combination for each patient and the tendency of drug treatment for epilepsy.”