Breaking the resistance - A narrative review of the evolution from traditional drugs to precision therapies in epilepsy

Sep 29, 2026

Uploaded by Mabel

Narrative review examining how epilepsy treatments have evolved from conventional antiseizure medications to precision therapies, with emphasis on treatment-resistant epilepsy and inequities in care. Conventional therapies control seizures in about 70–80% of patients, yet ~30% face drug resistance or intolerable effects. Synthesizing evidence from 120 peer-reviewed articles (2015–2025), the review compares efficacy, safety, mechanisms, and barriers, highlighting emerging options such as cannabidiol, responsive neurostimulation, and gene approaches while addressing persistent global treatment gaps.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Introduction

Background and rationale

Objective

Methods

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Review Breaking the resistance: a narrative review of the evolution from traditional drugs to precision therapies in epilepsy Tirath Patel, AS, BS, MSa ,*, Fathimathul Henna, MBBSb , Ashfaq Ahmad, MBBSc , Ayesha Ahmad, MBBSd , Noor Ul Huda, MBBSe , Syed Aaraiz Ul Hassan, MBBSf , Aiman Muhammad, MBBSg , Amna Javed, MBBSg , Maryem Filal, MBBSh , Arej Iltaf, MBBSg , Aizaz Anwar Khalid, MBBSi , Zoya Riyaz Syeda, MBBSj , Christopher Hanani, DOk , Nikhilesh Anand, MDl Background: Epilepsy is a chronic neurological disorder characterized by recurrent seizures, affecting approximately 50 million individuals globally. While conventional antiseizure medications (ASMs) control seizures in 70–80% of patients, about 30% experience drug resistance or intolerable side effects, necessitating alternative approaches. Objective: To critically compare the efficacy, safety, and accessibility of conventional and emerging therapies for epilepsy, particularly in the context of treatment-resistant cases and global disparities in care. Methods: This narrative review synthesized evidence from 120 peer-reviewed articles published between 2015 and 2025. Literature was retrieved from PubMed, Embase, Cochrane Library, and Scopus using predefined search terms related to epilepsy treatments. Comparative analysis included therapeutic mechanisms, clinical outcomes, and implementation barriers. Results: Conventional treatments such as phenytoin, valproate, levetiracetam, surgical resection, ketogenic diet, and vagus nerve stimulation (VNS) offer 70–80% seizure control. However, emerging therapies are gaining prominence. Cannabidiol (CBD) demonstrates a 30–50% seizure reduction, while responsive neurostimulation (RNS) achieves 50–70% efficacy, especially in drugresistant epilepsy. Despite these advancements, a 75% treatment gap persists in low-income countries due to limited resources, access, and trained personnel. Conclusion: Emerging therapies hold promise for managing refractory epilepsy, yet global disparities limit their reach. Precision medicine strategies must be coupled with efforts to improve access in underserved regions. This review provides practical insights for personalized care and advocates for increased investment in equitable treatment infrastructure. Keywords: antiseizure medications, drug resistance, epilepsy, precision medicine, responsive neurostimulation Introduction Epilepsy, defined as two or more unprovoked seizures, affects approximately 50 million people, around 1% of the global population, with an annual incidence of 50 per 100 000 individuals[1] . The International League Against Epilepsy (ILAE) aDepartment of Surgery, Trinity Medical Sciences University School of Medicine, Kingstown, Saint Vincent and the Grenadines, bDepartment of Medicine, Dubai Medical College for Girls, Dubai, UAE, cDepartment of Medicine, Gomal Medical College, Dera Ismail Khan, Pakistan, dDepartment of Medicine, Khyber Medical University, Peshawar, Pakistan, eDepartment of Medicine, Karachi Medical and Dental College, Karachi, Pakistan, fDepartment of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan, gDepartment of Medicine, Khyber Girls Medical College, Peshawar, Pakistan, hFaculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech, Morocco, iDepartment of Medicine, Peshawar Medical College, Peshawar, Pakistan, jDepartment of Neurology, Khaja Bandanawaz Institute of Medical Sciences, Gulbarga, Karnataka, India, kDepartment of Neurology, Henry Ford Health, Warren, Michigan, USA and lDepartment ofMedical Education, University of Texas Rio Grande Valley, Edinburg, TX, USA Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article. *Corresponding author. Address: Department of Surgery, Trinity Medical Sciences University School of Medicine, P.O. Box 885, Ratho Mill, Kingstown, Saint Vincent and the Grenadines. Tel.: +17047751100. E-mail: [tirath.patel.24@tmsu.edu.vc](

FAQs

What proportion of epilepsy patients achieve seizure control with conventional antiseizure medications (ASMs)?

Conventional ASMs control seizures in approximately 70–80% of patients.

How is drug-resistant epilepsy (DRE) defined in the review?

DRE is described as failure of two appropriately dosed ASMs.

Which emerging therapies show benefits for drug-resistant epilepsy according to the review?

The review highlights cannabidiol (CBD), responsive neurostimulation (RNS), and additional emerging approaches such as diet and gene therapy, with reported improvements in seizure reduction or efficacy.

Sep 29, 2026

Uploaded by Mabel