A Comprehensive Review of Risk Factors, Etiology, and Pathophysiology of the Epilepsy and Current Treatment, Strategies for Advanced Treatment of Epilepsy with a Novel Approach

About 1% of people worldwide suffer from epilepsy, a chronic neurological condition characterized by prevalent unprovoked seizures brought on by aberrant neuronal hyperexcitability. Its etiology is complex and includes metabolic imbalances, traumatic injuries, infections (like neurocysticercosis), mutations in genes, and structural abnormalities in the brain (like tumors and hippocampus sclerosis). Antiepileptic drugs (AEDs) that target glutamatergic signaling, GABAergic inhibition, and ion channels are still first-line treatments; however, 30% of patients exhibit pharmacoresistance, illustrating the need for more sophisticated approaches. In refractory situations, neuromodulation (such as vagus nerve stimulation), ketogenic diets, and surgical excision are used. Novel therapeutics are being researched as a result of recent developments in pathophysiology research that have highlighted channels including ion channelopathies, neuroinflammatory cascades, and synaptic reorganization. Innovations include prodrug strategies for targeted activation, implantable devices for extending intraparenchymal drug release, and drug delivery systems enabled by nanotechnology (e.g., solid-lipid nanoparticles, intranasal formulations) that boost blood-brain barrier penetration. Treatment personalization is the goal of emerging strategies like genetic/epigenetic biomarkers and hyperosmolar BBB disruption. Drug-resistant epilepsy therapy continuing to present obstacles despite innovations, emphasizing the critical importance of merging precision medicine, multimodal therapy, and patient-specific biomarkers. With the goal to optimize seizure governance and the quality of life for the people who experience them, this review provides some of the current information on the risk factors, molecular mechanisms, therapeutic advancements, and future directions of epilepsy.