JCN Open Access ORIGINAL ARTICLE

pISSN 1738-6586 / eISSN 2005-5013 / J Clin Neurol 2021;17(3):393-399 / https://doi.org/10.3988/jcn.2021.17.3.393

Increasing Trends in the Incidence and

Prevalence of Epilepsy in Korea
Ji-Ye Jeona, Hyesung Leeb
Background and Purpose There have been few reports on recent trends in the
Ju-Young Shinb,c, Hye-Jin Moond
occurrence of epilepsy. The aim of this study was to estimate the incidence and prevalence
Seo-Young Leee,f, Jae-Moon Kimg; of epilepsy and analyze their annual trends in Korea over the period 2009–2017.
on behalf of Epidemiology
Methods This nationwide population-based study was carried out using the National
Committee of Korean Epilepsy Health Insurance Service of Korea database. A prevalent case was defined as one of a patient
Society receiving a prescription of anticonvulsants under the diagnostic codes for epilepsy or
a
Department of Neurology, Kyungpook seizure. An inci- dent case was ascertained by confirming the absence of any epilepsy-
National University Chilgok Hospital, related diagnostic codes and anticonvulsant prescription for 2 years or more before the
School of Medicine, Kyungpook National operational definition for a prevalent case was met. Alternative operational definitions for
University, Daegu, Korea
b epilepsy were tested. The tem- poral trends of the incidence and prevalence of epilepsy
School of Pharmacy, Sungkyunkwan
University, Suwon, Korea were analyzed using a Poisson re- gression model, and are expressed as average annual
c
Samsung Advanced Institute for percentage changes (AAPCs).
Health Science & Technology (SAIHST),
Sungkyunkwan University, Seoul, Korea
Results The incidence of epilepsy increased from 28.7/100,000 persons in 2009 to
d
Department of Neurology, Soonchunhyang 35.4/100,000 persons in 2017. The prevalence increased gradually from 3.4/1,000 persons in
University Bucheon Hospital, 2009 to 4.8/1,000 persons in 2017. These increasing trends were more evident among
Soonchunhyang University College of elderly subjects aged ≥75 years and in those who had codes for epilepsy or seizure as an
Medicine, Bucheon, Korea eDepartment of
Neurology, College of Medicine, Kangwon
additional diagnosis. Age stan- dardization revealed a less prominent but still increasing
National University Chuncheon, Korea trend in both incidence (AAPC=0.48%) and prevalence (AAPC=3.11%).
f
Interdisciplinary Graduate Program in
Conclusions There have been increasing trends in both the prevalence and incidence of
Medical Bigdata Convergence, Kangwon
National University, Chuncheon, Korea epilepsy in Korea between 2009 and 2017. This finding appears to be related to societal
g
Department of Neurology, Chungnam aging and the high incidence of symptomatic epilepsy in the elderly population.
National University College of Medicine,
Daejeon, Korea
Key Words epilepsy, epidemiology, incidence, prevalence, trend.

Received August 5, 2020

Revised February 10, 2021
Accepted February 10, 2021 INTRODUCTION
Correspondence
Hye-Jin Moon, MD Epilepsy is the third most common neurological disorder after stroke and dementia,1
Department of affect- ing approximately 70 million patients worldwide.2 A recent meta-analysis of
Neurology,
222 studies reported a point prevalence of epilepsy of 6.38/1,000 persons and a lifetime
Soonchunhyang University Bucheon
Hospital, Soonchunhyang University prevalence of 7.6/1,000 persons. The incidence was 61.44/100,000 person-years.3 The
College of Medicine, 170 Jomaru-ro, prevalence has been reported to lie in the range 10.2–23.3/1,000 persons in developing
Bucheon 14584, Korea
Tel +82-32-621-6569 countries,4-6 and 2.7– 6.2/1,000 persons in developed countries.7-9 The incidence of
Fax +83-32-621-5018 epilepsy is also higher in de- veloping countries than in developed countries.3 In short,
E-mail [email protected]
around 90% of the global burden of epilepsy is carried by developing countries.10
Seo-Young Lee, MD, PhD
Department of Neurology, College
With regard to age-specific occurrence, previous studies have demonstrated a high
of inci- dence of epilepsy in the first year of life and early childhood in both developing and
Medicine, Kangwon National University, devel- oped countries,11 while an increase in the incidence of epilepsy among older people
Interdisciplinary Graduate Program in
Medical Bigdata Convergence, was not- ed in developed countries.12-14
Kangwon National University, How the occurrence of epilepsy changes as a society develops has not been fully
156 Baengnyeong-ro, addressed,
Chuncheon 24289, Korea
Tel +82 33-258-9120 cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-

Fax +82 33-258-2103 Com- mercial License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-
E-mail [email protected] commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Copyright © 2021 Korean Neurological Association 393

 JC The Incidence and Prevalence of Epilepsy in Korea

since few studies have focused on time trends in the anticonvulsants for any length of time. Criteria D comprised
incidence and prevalence of epilepsy. The aim of this study 1) at least one visit with a diag- nostic code for epilepsy
was to esti- mate the annual incidence and prevalence of extracted from the code for only pri-
treated epilep- sy in Korea and to identify time trends in
these data between 2009 and 2017.

METHODS
Data sources and study population
Data from the National Health Insurance Service (NHIS)
da- tabase of Korea between 2007 and 2017 were searched.
The NHIS database encompasses the entire population
and all medical facilities in Korea and includes a
comprehensive da- tabase of diagnostic codes that were
assigned according to the tenth revision of the International
Classification of Diseases (ICD-10), laboratory
examinations, medications, surgery, hos- pitalization, and
socioeconomic profiles. The study popula- tion was the
entire unselected Korean population registered in the
NHIS database between 2009 and 2017.

Identification of prevalent and incident cases

Epilepsy was identified using the diagnostic codes for
epilepsy and seizure, and anticonvulsant prescription data.
The diag- nostic codes for epilepsy included G40 (epilepsy),
G41 (status epilepticus), F803 (Landau-Kleffner syndrome),
and R56 (con- vulsion) according to the ICD-10, while
R56.0 (febrile convul- sion) was excluded. Anticonvulsants
included carbamazepine, clobazam, ethosuximide,
gabapentin, lamotrigine, levetirace- tam, oxcarbazepine,
phenobarbital, phenytoin, pregabalin, primidone,
topiramate, vigabatrin, valproate, zonisamide, lacos- amide,
and rufinamide. Clonazepam was excluded because it is
usually administered for nonepileptic conditions such as
tremors, insomnia, or anxiety, and is rarely used as an
anticon- vulsant monotherapy for epilepsy.
Four different operational definitions were used to
identify epilepsy cases in the NHIS database, which are
designated as criteria A–D. Criteria A comprised 1) at least
two visits with one or more diagnostic codes for epilepsy
extracted from among the five diagnostic codes, including
primary, secondary, and additional diagnoses; and 2) the
prescription of anticonvul- sants for at least 180 days.
Criteria B comprised 1) at least two visits with one or more
diagnostic codes for epilepsy extract- ed from among the
five diagnostic codes, including primary, secondary, and
additional diagnoses; and 2) the prescription of
anticonvulsants for any length of time. Criteria C comprised
1) at least one visit with one or more diagnostic codes for
ep- ilepsy extracted from the codes for primary or
secondary di- agnosis, and 2) the prescription of

394 J Clin Neurol 2021;17(3):393-399

 mary diagnosis, and 2) the prescription of anticonvulsants
Jeon JY et JC
groups [Supplementary Table 1 (in the online- only Data
for any length of time. Supplement), Fig. 1A].
A prevalent case was defined as one in which a person
sat- isfied criteria A, B, C, or D within each calendar year.
An in- cident case was one in which a person had neither
epilepsy- related codes nor a prescription of
anticonvulsants for at least 2 years before the operational
definition for a prevalent case was met.
Age-standardized incidence and prevalence rates along
with age- and sex-specific incidence and prevalence rates
were es- timated using criteria A.

Statistical analyses
The prevalence was calculated by dividing the number of
prev- alent cases by the total population for each calendar
year. The cumulative incidence was calculated by
dividing the num- ber of incident cases by the total
relevant standard popula- tion that excluded patients
already diagnosed with epilepsy. The age-standardized
incidence and prevalence rates were estimated by directly
adjusting to the 2009 Korean population. The annual trends
in prevalence and incidence over time were assessed using
a Poisson regression model and expressed as the average
annual percent change (AAPC), which was cal- culated by
exponentiating the coefficient of the regression. All reported
p values are two-tailed, and p<0.05 was considered
statistically significant. All statistical analyses were performed
using SAS Enterprise Guide 7.1 for Windows (SAS
Institute,
Cary, NC, USA).
This study was approved by the Institutional Review
Board of Sungkyunkwan University (approval number:
2018-06- 006) and NHIS for Bioethics Policy (NHIS-
2018-1-342).

RESULTS
Incidence according to diagnostic criteria, age, and
sex In 2017, the estimated annual cumulative incidence
rates of epilepsy were 35.4/100,000 person-years
according to crite- ria A, 132.9/100,000, 58.1/100,000, and
24.4/100,000 person-
years according to criteria B–D, respectively (Table 1).
The age-specific incidence estimated using criteria A
exhibited a J-shaped curve, being lowest in the fourth
decade of life (30s) and increasing thereafter, with an
explosive increasing trend between the ages of 60 and 94
years. The incidence in 2017 was higher than 100/100,000
persons in males older than 75 years and in females older
than 80 years. Among a total of 18,228 incident patients,
6,063 (33.2%) were 65 years or old- er in 2017. The
incidence was higher in males than in females in most age

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 JC The Incidence and Prevalence of Epilepsy in Korea

Table 1. Annual incidence of epilepsy for different operational definitions

Incidence Age-standardized incidence
Year Criteria A Criteria B Criteria C Criteria D Criteria A AAPC, % p
2009 28.7 (14,258) 86.8 (43,015) 49.4 (24,498) 24.6 (12,213) 28.7
2010 30.7 (15,464) 119.4 (59,997) 64.8 (32,580) 29.3 (14,783) 30.3
2011 28.2 (14,261) 116.0 (58,554) 60.8 (30,716) 27.5 (13,926) 27.5
2012 29.3 (14,882) 119.1 (60,313) 60.7 (30,807) 27.0 (13,715) 28.2
2013 29.8 (15,155) 122.1 (62,082) 59.7 (60,427) 25.1 (12,810) 28.2 0.48 <0.001*
2014 31.1 (15,916) 122.6 (62,560) 57.1 (29,181) 23.1 (11,845) 29.1
2015 30.5 (15,634) 118.6 (60,735) 53.8 (27,593) 22.0 (11,322) 28.1
2016 31.2 (16,080) 121.5 (62,398) 54.5 (28,053) 22.2 (11,461) 28.5
2017 35.4 (18,228) 132.9 (68,358) 58.1 (29,959) 24.4 (12,585) 31.7
Annual incidence of epilepsy per 100,000 persons (numbers of incident cases) as estimated by applying criteria A–D (see main text).
*Statistical significance (p<0.05).
AAPC: average annual percentage change.

200
Male Female All

180
160
Incidence (per 100,000 persons)

140

120

100

80

60

40

0–4 5–9 10–14 15–19 20–24 25–29 30–34 35–39 40–44 45–49 50–54 55–59 60–64 65–69 70–74 75–79 80–84 85–89 ≥90
20 Age (years)
A
0
14
Male Female All
12
Prevalence (per 1,000 persons)

10

0–4 5–9 10–14 15–19 20–24 25–29 30–34 35–39 40–44 45–49 50–54 55–59 60–64 65–69 70–74 75–79 80–84 85–89 ≥90
0 Age (years)
B
Fig. 1. Age-specific incidence (A) and prevalence (B) of epilepsy in 2017. A: Age-specific incidence was lowest in the thirties, explosive increasing
trend from 60 years. B: The prevalence of epilepsy was found to be 10 per 1,000 persons or more in male aged 70 to 89. Both incidence and
preva- lence were higher in male than female in most age groups.

396 J Clin Neurol 2021;17(3):393-399

 Jeon JY et JC
Annual trend of incidence
patients aged 45–69 years [Fig. 3A, Supplementary Table 1
The incidence of epilepsy according to criteria A increased
(in the online-only Data Supplement)].
from 28.7/100,000 persons in 2009 to 35.4/100,000
persons in 2017 (Table 1). The incidence estimated using
Prevalence according to diagnostic criteria,
criteria B also increased, but was relatively stable when
age, and sex
estimated us- ing criteria C or D. The age-standardized
In 2017, the prevalence rates of epilepsy were 4.8/1,000
incidence accord- ing to criteria A increased
per- sons according to criteria A, 6.7/1,000, 4.3/1,000, and
(AAPC=0.48%, p<0.001) (Fig. 2A, Table 1). Increasing
2.8/1,000 persons according to criteria B–D, respectively
trends were observed for both sexes [Fig. 2A,
(Table 2). The age-specific prevalence increased until the
Supplementary Table 1 (in the online-only Data Supple-
ninth decade of life (80s), with a plateau from the third to
ment)]. The age-specific incidence exhibited a remarkable
fourth decades. In 2017, the prevalence of epilepsy was
tendency to increase (AAPC increased by up to 15.49%) in
10/1,000 persons or more in males aged 70–94 years. The
the elderly population (age 75 years or older), but
total number of prevalent pa- tients in that year was
increased only slightly (AAPC=1.63–2.87%) in patients
249,878 according to criteria A, among whom 62,514
aged 10–34 years, and decreased slightly (AAPC=-1.6%
(25.0%) were older than 65 years. Sex-specif-
to -0.84%) in

40.0 6.0
Incidence (per 100,000 persons)

35.0
Prevalence (per 1,000 persons)

5.0
30.0

25.0
4.0

20.0

3.0
15.0

10.0 Male Female All Male Female All

2.0
5.0
0.0 0.0
2009 2010 2011 2012 2013 2014 2015 2016 2017 1.0 2009 2010 2011 2012 2013 2014 2015 2016 2017
Year Year
A B
Fig. 2. Annual trend of age-standardized incidence (A) and age-standardized prevalence (B) of epilepsy. Increasing trends of age-standardized in-
cidence and prevalence were observed in both sexes.

10.0
120.0 0–4 years10–19 years45–74 years 0–4 years10–19 years45–74 years
9.0
5–9 years20–44 years≥75 years 5–9 years20–44 years≥75 years
8.0
7.0
100.0 6.0
Prevalence (per 1,000 people)

5.0
Incidence (per 100,000 people)

80.0 4.0
3.0
2.0
60.0
1.0
0.0
40.0

20.0

0.0

2009 2010 2011 2012 2013 2014 2015 2016 2017 2009 2010 2011 2012 2013 2014 2015 2016 2017
Year Year
A B
Fig. 3. Annual trend of incidence (A) and prevalence (B) of epilepsy according to age. A: Age-specific incidence was a remarkable increasing ten-
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 JC The Incidence and Prevalence of Epilepsy in Korea
dency in 75 years or older. B: The prevalence tended to increase from the age of 9, the rate of increase has increased significantly since the age of 75.

398 J Clin Neurol 2021;17(3):393-399

 Jeon JY et JC
Table 2. Annual prevalence of epilepsy for different operational definitions
Prevalence Age-standardized prevalence
Year Criteria A Criteria B Criteria C Criteria D Criteria A AAPC, % p
2009 3.4 (170,730) 4.5 (225,556) 3.5 (174,583) 2.4 (119,674) 3.4
2010 3.7 (187,056) 5.3 (269,076) 4.0 (199,285) 2.6 (131,602) 3.7
2011 3.9 (195,125) 5.5 (277,104) 4.0 (202,479) 2.6 (132,128) 3.8
2012 4.0 (203,075) 5.7 (289,541) 4.1 (208,262) 2.7 (133,953) 3.9
2013 4.2 (213,484) 5.9 (302,879) 4.2 (213,042) 2.7 (135,820) 4.0 3.11 <0.001*
2014 4.4 (223,357) 6.1 (311,874) 4.2 (215,057) 2.7 (135,832) 4.2
2015 4.4 (228,614) 6.1 (315,236) 4.1 (213,016) 2.7 (137,190) 4.2
2016 4.6 (237,514) 6.4 (328,541) 4.2 (217,280) 2.7 (138,767) 4.3
2017 4.8 (249,878) 6.7 (347,411) 4.3 (225,459) 2.8 (145,462) 4.5
Prevalence of epilepsy per 1,000 persons (number of prevalent cases) as estimated by applying criteria A–D (see main text).
*Statistical significance (p<0.05).

ic prevalence was higher in males than in females in all age total population of Korea has gradually increased, to exceed
groups [Fig. 1B, Supplementary Table 2 (in the online-only 14% in 2017, indi-
Data Supplement)].

Annual trend of prevalence

The prevalence increased every year from 2009 to 2017,
re- gardless of the operational criteria used to identify
epilepsy. The age-standardized prevalence according to
criteria A also increased during that period (AAPC=3.11%,
p<0.001) (Ta- ble 2). An increasing prevalence was
observed for both sexes [Fig. 2B, Supplementary Table 2 (in
the online-only Data Sup- plement)]. Annual trends
showed that the prevalence was slightly decreased with
each year in patients aged 0–9 years, whereas the
prevalence tended to increase over the studied time
period from the age of 10 years, showing a strong in-
crease after an age of 75 years [Fig. 3B, Supplementary
Table 2 (in the online-only Data Supplement)].

DISCUSSION
This study found increasing trends in both the incidence
and prevalence of treated epilepsy over a 9-year period from
2009, reaching 35.4/100,000 person and 4.8/1,000 persons,
respec- tively, in 2017, as estimated from data in the NHIS
data. The incidence of epilepsy increased year on year,
although this tendency was less prominent after age
standardization. The increasing tendency of incidence in
the elderly was promi- nent, while it was relatively static
in the other age groups.

Cause of the increase in epilepsy

The increases in the incidence and prevalence of epilepsy
in Korea reported here appear to be related to various
factors. Ageing of the population is the primary reason.
According to resident registration population by census,
the proportion of people older than 65 years relative to the

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 JC The Incidence and Prevalence of Epilepsy in Korea
cating that Korea is now an aged society.15 In addition,
there has been an improvement in the survival rate for
people with epilepsy, which would contribute to the
increasing prevalence of the disease, together with the
improved survival of those with stroke and dementia. The
Cardiovascular Health Study found that the prevalence of
epilepsy increased from 3.7% to 5.4% during a 14-year
follow-up period, and confirmed that a history of stroke
was associated with a higher risk of devel- oping
epilepsy.16 Moreover, the reported prevalence of seizures in
patients with dementia is high (10–22%).17 Therefore, an
increase in the elderly population and an increase in
those with chronic central nervous system illness could
have con- tributed to the increases observed in both the
incidence and prevalence of epilepsy in Korea.
A reduction in the treatment gap may also have
contribut- ed to the increased incidence and prevalence
of treated epi- lepsy, as well as the actual increase in the
occurrence of epi- lepsy.18 The treatment gap reportedly
exceeds 75% in low- income countries while it is less
than 10% in high-income countries, with lower rates
being observed in urban areas. The treatment gap was
reported to decrease over time in many countries
irrespective of educational intervention, although there
are currently no data on the treatment gap for epilepsy in
Korea.18

Identification of epilepsy in administrative data

Several operational definitions have been used to identify
in- dividuals with epilepsy in the NHIS database. Criteria
that in- clude an anticonvulsant prescription for 180 days or
more can increase specificity by excluding cases of acute
symptomatic seizure and unconfirmed epilepsy under
therapeutic trial con- ditions, but can also increase the
false-negative rate by miss- ing patients with nonadherent
epilepsy and patients who died within 180 days. If the
criteria include additional diagnostic codes for detecting
epilepsy patients, the sensitivity increas- es as a result of
the inclusion of more symptomatic epilepsy;

400 J Clin Neurol 2021;17(3):393-399

 Jeon JY et JC
however, the false-positive rate could be increased by another potential lim- itation. According to a recent
includ- ing those who were treated for pain but who were systematic review,27 adminis- trative data can accurately
coded as epilepsy or seizure for reimbursement. Meanwhile, identify people with epilepsy us-
if only the primary diagnosis is included (criteria D), many
people with symptomatic epilepsy would be excluded.
Previous reports used criteria C for 200919 and criteria D
for 200720 to estimate the prevalence of epilepsy in Korea.
The results of the present study demonstrate that the
tendency toward increasing in- cidence and prevalence of
epilepsy seen when applying cri- teria A and B, but not
when applying criteria C and D suggests that the incidence
and prevalence of symptomatic epilepsy are increasing,
while those for primary epilepsy are stable.

Comparison with studies in other countries

The overall incidence of epilepsy in Korea (28.7–
35.4/100,000 person-years) was comparable to that in other
developed coun- tries, including the United States and
Europe (16–57/100,000 person-years), and Asia (24–
97/100,000 person-years).21-23 The incidence and prevalence
of epilepsy vary depending upon the study population,
the method used to identify cases, and the diagnostic
accuracy.11 The present study has demonstrat- ed that the
number of patients with epilepsy varies with the
operational definition used to identify cases, even when us-
ing the same data source.
In this study, the incidence of epilepsy was lower in chil-
dren than in the elderly. The few epidemiological studies
of epilepsy in children found that the incidence was
higher in developing countries than in developed
countries. In addi- tion, a community-based study in the
United Kingdom found that the incidence of epilepsy
appears to increase with increas- ing socioeconomic
deprivation.24,25 The present study found a J-shaped curve
for incidence according to age in 2017. A similar pattern
was shown in a study conducted in the Unit- ed States,14
which found that both the incidence and preva- lence of
epilepsy were higher in males than in females in most age
groups. This is consistent with a meta-analysis finding that
the epilepsy was more common in males than in females.26

Strengths and limitations of the study

This study is one of the very few to analyze the time trends
of certain the epidemiological parameters of epilepsy.
Moreover, this is the first to report on the incidence of
epilepsy in Korea. It was an unbiased, population-based
study carried out using nationwide data.
One of the limitations of this study is that it was based
on administrative data. The estimations of incidence and
prev- alence did not include people with untreated
epilepsy. The validity of the operational definitions is

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 JC The Incidence and Prevalence of Epilepsy in Korea
ing operational definitions that combine disease codes 3. Fiest KM, Sauro KM, Wiebe S, Patten SB, Kwon CS, Dykeman J, et
with antiepileptic drugs (AEDs). In a previous Korean
study using NHIS data, the positive predictive value for
epilepsy identi- fied using the criterion of one or more
AED prescription with a diagnostic code representing
epilepsy or seizure was 0.81 in 2009.19 Stricter criteria
were used in the present study in order to increase the
specificity, and several alternative crite- ria were tested to
overcome this limitation.

Conclusions
The incidence and prevalence of epilepsy increased in
Korea between 2009 and 2017. These increasing trends
appear to be attributable to the increasing number of
elderly and symp- tomatic patients with epilepsy.
Accurate diagnosis and prop- er treatment of epilepsy in
the elderly will become a more im- portant issue in the
future.

Supplementary Materials
The online-only Data Supplement is available with this
arti- cle at https://doi.org/10.3988/jcn.2021.17.3.393.

Author Contributions
Conceptualization: Hye-Jin Moon, Seo-Young Lee. Data curation: Hye-
Jin Moon, Ji-Ye Jeon. Formal analysis: Ji-Ye Jeon, Hyesung Lee, Ju-
Young Shin. Funding acquisition: Hye-Jin Moon, Seo-Young Lee.
Investigation: Hye-Jin
Moon, Seo-Young Lee. Methodology: Hye-Jin Moon, Seo-Young
Lee. Project administration: Hye-Jin Moon. Resources: Hye-Jin
Moon, Seo- Young Lee. Software: Hyesung Lee, Ju-Young Shin.
Supervision: Jae-Moon Kim. Validation: Hye-Jin Moon, Hyesung Lee.
Visualization: Ji-Ye Jeon. Writing—original draft: Ji-Ye Jeon. Writing
—review & editing: Hye-Jin Moon, Seo-Young Lee, Hyesung Lee.

ORCID iDs
Ji-Ye Jeon https://orcid.org/0000-0003-1111-3521
Hyesung Lee https://orcid.org/0000-0001-6556-9984
Ju-Young Shin https://orcid.org/0000-0003-1010-7525
Hye-Jin Moon https://orcid.org/0000-0002-6109-7171
Seo-Young Lee https://orcid.org/0000-0001-5319-1777
Jae-Moon Kim https://orcid.org/0000-0002-5035-9877

Conflicts of Interest
The authors have no potential conflicts of interest to disclose.

Acknowledgements This work was supported by the

Soonchunhyang University Research Fund and a grant from the
Korean Neurological Association (KNA-18- MI-11).

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