There is a paucity of literature regarding the optimal selection of combination antiseizure medications (ASMs) for drug-resistant epilepsy (DRE). The aim of this scoping review is to evaluate current evidence related to "rational polytherapy" among adults with DRE. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-SCr) guidelines, PubMed, ProQuest, CINAHL, and Cochrane databases were searched using DRE-and polytherapy-related keywords. The exclusion criteria applied included: non-English; non-human studies; non-research studies; participants less than 18 years; status epilepticus; ASM monotherapy; and certain ASMs. In Covidence, two researchers independently reviewed articles for inclusion at each phase, with a third resolving conflicts. Data were extracted, with quality appraisal using the Mixed Methods Appraisal Tool (MMAT). Of the 6477 studies imported for screening, 33 studies were included. Clinical, humanistic, and economic outcomes were reported by 26, 12, and one study, respectively.Common efficacy-related clinical outcomes included ≥50% reduction in seizure frequency (n = 14), seizure freedom (n = 14), and percent reduction in seizure frequency (n = 8). Common humanistic outcomes included quality of life (n = 4), medication adherence (n = 2), sleep-related outcomes (n = 2), and physician and patient global assessments (n = 2). The economic study reported quality-adjusted life years. The median MMAT score was 80 (range: 60-100). Two studies referenced the standard definition of DRE, whereas five studies did not specifically define DRE. Gaps in the literature include limited generalizability, minimal reports in pregnancy, and lack of optimal ASM combinations, among others. Strengths of the evidence include addressing a variety of outcomes. Inconsistent definitions of DRE, small sample sizes, and heterogeneity among studies limit the ability to draw meaningful conclusions. Optimal combinations of ASMs for rational polytherapy for DRE is unclear.

Background: There is no objective and standardized tool for stratification of high-alert medications (HAMs) that reflect each institution's practice of medication management, drug utilization in the institution, and patient safety protocols in the Korean hospital settings. We aimed to develop the Korean version of the high-alert medication stratification tool (K-HAMST) and assess its content validity and reliability.Methods: Ten clinical pharmacists from multi-site hospitals completed a two-round Delphi survey to assess the content validity of the translated High-Alert Medication Stratification Tool-Revised. Content validity was demonstrated using the item content validity index and scale content validity index (S-CVI). An expert meeting was conducted to revise the tool to accommodate the clinical practice and workflow in Korea based on the results of the content validity index. Reliability was assessed by calculating the risk scores for 37 HAMs and 37 control medications. The interrater reliability of each medication was assessed using the Kendall's coefficient of concordance (W). Results:The initial S-CVI was 0.71. After revision, the final S-CVI of the K-HAMST was 0.92, indicating that the tool has content validity. The HAM scores ranged from 3 to 8 (n=37; median [interquartile {IQR},[4][5]), whereas the control medication scores ranged from 1 to 2 (n=37; median [IQR], 1 [1-1]). The Kendall's coefficient of concordance (W) was 0.57, indicating moderate agreement between raters (p<0.001). Conclusion:The K-HAMST is a valid and reliable tool for assessing and evaluating HAMs in hospital settings.