J Korean Neurol Assoc.  2021 Nov;39(4):255-269. 10.17340/jkna.2021.4.1.

Practical Drug Treatment Recommendations on the Drug Refractory Epilepsy Patients: 2021 Clinical Guideline Subcommittee for Epilepsy in the Korean Neurological Association

  • 1Department of Neurology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
  • 2Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
  • 3Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
  • 4Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  • 5Department of Neurology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
  • 6Department of Neurology, School of Medicine, Kyungpook National University, Daegu, Korea
  • 7Department of Neurology, Kyungpook National University Hospital, Daegu, Korea
  • 8Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
  • 9Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University School of Medicine, Seoul, Korea


One third of the overall epilepsy population are estimated to be a drug refractory epilepsy (DRE), defined as the patients who failed to control seizure reduction, even tried two or more appropriate antiepileptic drugs (AEDs) trials. Those people need additional AEDs trials or other treatment options (resective surgery, neuromoulation, etc.). Here, we, clinical guideline committee of the Korean Neurological Association (KNA) introduce the recommendations of AEDs treatments including not only old and new AEDs currently available in Korea but also AEDs planned to be launched in the new future for DRE patients with literature review to help efficient decision of the clinician. The authors reviewed literatures and assessed efficacy and tolerability on 12 currently available and four newly introduced/or planned AEDs applied to DRE patients, published from November 2015 to July 2021. Brivaracetam, eslicarbazepine, canabidiol and cenobamate are the four AEDs that are newly introduced or planned to be launched soon. The reviewed articles are publications after November 2015, 2018 American Association of Neurology guideline, new AEDs which were introduced or planned to be launched as of 2021. All AEDs are classified based on the therapeutic rating scheme, generating recommendations. Overall 173 papers have been reviewed and analyzed for recommendation rationales. KNA introduce additional add-on treatment or conversional monotherapy guidelines on the drug refractory focal and generalized epilepsy. We hope these guidelines or recommendations to help clinical decision for the treatment of drug refractory epilepsy patients


Antiseizure medications; Drug refractory epilepsy; Guideline; Recommendation
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