Breaking the resistance: a narrative review of the evolution from traditional drugs to precision therapies in epilepsy
Year: 2025
Type: review
Abstract: 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 drug-resistant 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.
Source: Annals of Medicine and Surgery
Authors: Tirath Patel, Fathimathul Henna, Ashfaq Ahmad, Ayesha Ahmad, Noor Ul Huda, Syed Aaraiz Ul Hassan, Aiman Muhammad, Amna Javed, Maryem Filal, Arej Iltaf, Aizaz Anwar Khalid, Zoya Riyaz Syeda, Christopher Hanani, Nikhilesh Anand
Institutions: Trinity School of Medicine, Dubai Medical College, Gomal University, Khyber Medical University, Karachi Medical and Dental College, Jinnah Sindh Medical University, Khyber Medical College, Khyber Girls Medical College, Cadi Ayyad University, Henry Ford Health, The University of Texas Rio Grande Valley
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,850
OpenAlex ID: W7106530055