Advances and Challenges in Understanding and Treating Epilepsy: A Concise Review

Abstract

Epilepsy is a chronic brain disorder characterized by recurrent and unprovoked seizures. The uncontrolled, abnormal, paroxysmal discharge of neurons in the brain initiates seizures, which are clinical manifestations of epilepsy. The International League Against Epilepsy (ILAE) classified seizures into three categories: focal, generalized, and unknown-onset seizures, based on clinical characteristics and affected brain regions. Treatment for epilepsy primarily involves anti-seizure medications (ASMs) that help stabilize the electrical signals in the brain. However, 30% of patients appear to be refractory to treatment. ASMs effectively control seizures but do not influence epileptogenesis, the silent seizure-free period from brain injury to the first unprovoked seizure. The exact mechanism of epileptogenesis remains controversial. Consequently, advancements in treatment could stem from a deeper understanding of epilepsy's underlying pathophysiology. Besides, there is a critical need for new pharmaceuticals that are both safe and effective in preventing epilepsy progression and improving patients' quality of life. This article reviews epilepsy and epileptogenesis pathophysiology, the recent classification of seizure types, current treatment strategies, and animal models used to better understand epilepsy. Additionally, it discusses the emerging research directions for antiepileptogenic drugs, highlighting recent advancements aimed at addressing the limitations of current ASMs and offering new insights into epilepsy treatments.