Status epilepticus (SE) is one of the most serious neurologic emergencies. SE is a condition that encompasses a broad range of semiologic subtypes and heterogeneous etiologies. The treatment of SE primarily involves the management of the underlying etiology and the use of antiepileptic drug therapy to rapidly terminate seizure activities. The Drug Committee of the Korean Epilepsy Society performed a review of existing guidelines and literature with the aim of providing practical recommendations for antiepileptic drug therapy. This article is one of a series of review articles by the Drug Committee and it summarizes staged antiepileptic drug therapy for SE. While evidence of good quality supports the use of benzodiazepines as the first-line treatment of SE, such evidence informing the administration of second- or third-line treatments is lacking; hence, the recommendations presented herein concerning the treatment of established and refractory SE are based on case series and expert opinions. The choice of antiepileptic drugs in each stage should consider the characteristics and circumstances of each patient, as well as their estimated benefit and risk to them. In tandem with the antiepileptic drug therapy, careful searching for and treatment of the underlying etiology are required.

Background and Purpose There have been few reports on recent trends in the occurrence of epilepsy. The aim of this study was to estimate the incidence and prevalence of epilepsy and analyze their annual trends in Korea over the period 2009–2017. Methods This nationwide population-based study was carried out using the National Health Insurance Service of Korea database. A prevalent case was defined as one of a patient receiving a prescription of anticonvulsants under the diagnostic codes for epilepsy or seizure. An incident case was ascertained by confirming the absence of any epilepsy-related diagnostic codes and anticonvulsant prescription for 2 years or more before the operational definition for a prevalent case was met. Alternative operational definitions for epilepsy were tested. The temporal trends of the incidence and prevalence of epilepsy were analyzed using a Poisson regression model, and are expressed as average annual percentage changes (AAPCs). Results The incidence of epilepsy increased from 28.7/100,000 persons in 2009 to 35.4/100,000 persons in 2017. The prevalence increased gradually from 3.4/1,000 persons in 2009 to 4.8/1,000 persons in 2017. These increasing trends were more evident among elderly subjects aged ≥75 years and in those who had codes for epilepsy or seizure as an additional diagnosis. Age standardization revealed a less prominent but still increasing trend in both incidence (AAPC=0.48%) and prevalence (AAPC=3.11%). Conclusions There have been increasing trends in both the prevalence and incidence of epilepsy in Korea between 2009 and 2017. This finding appears to be related to societal aging and the high incidence of symptomatic epilepsy in the elderly population.

Objectives: Vestibular epilepsy refers to epilepsy in which vertigo is the sole or main symptom of a seizure. However, epilepsy is rarely considered as a differential diagnosis in patients complaining of dizziness. Here, we reviewed ten cases of vestibular epilepsy and analyzed the dizziness complained by the patient.Methods: In this study, the medical records of dizziness patients with epileptic discharges observed on electroencephalogram were retrospectively analyzed. Patients who had other obvious causes of dizziness, lacked a description of dizziness, or were not taking antiseizure medications were excluded. We finally recruited 10 patients, and investigated their dizziness characteristic, brain imaging tests, electroencephalograms, and blood test findings.Results: Patients with vestibular epilepsy usually felt dizzy abruptly while not moving, and often complained of dizziness in the form of spinning around or becoming dazed. Dizziness was short, usually between a few seconds and a few minutes, and the frequency of occurrence was variable, so there was no consistent trend. There were no abnormal findings in blood tests. In brain imaging test, most patients did not show significant abnormalities. The electroencephalographic abnormalities of the patients were mainly observed in the temporal lobe, and the dizziness they complained of improved when they started taking antiseizure medications.Conclusions: If a patient with dizziness complains of dizziness that occurs suddenly and lasts for a short time, early electroencephalogram should be considered to prevent the diagnosis of epilepsy from being overlooked or delayed.