Epilepsy is one of the most common chronic neurological disorders, affecting people of all ages and imposing a substantial burden on patients, families, and health systems worldwide. Over the past two decades, the therapeutic landscape of epilepsy has expanded considerably, moving beyond traditional antiseizure medications toward precision medicine, targeted neurostimulation, and dietary and surgical interventions for drug-resistant cases. This article reviews current evidence on the epidemiology, classification, pathophysiology, and diagnostic approach to epilepsy, with particular emphasis on modern pharmacological and non-pharmacological treatment strategies, including newer antiseizure medications, ketogenic dietary therapy, epilepsy surgery, neurostimulation techniques, and emerging precision-medicine approaches.
Epilepsy is a chronic neurological disorder characterized by an enduring predisposition to generate recurrent, unprovoked epileptic seizures, along with the associated neurobiological, cognitive, psychological, and social consequences of this condition. It is among the most common serious neurological disorders worldwide, affecting individuals across all age groups, socioeconomic backgrounds, and geographic regions. Despite substantial advances in diagnosis and treatment, a significant proportion of patients continue to experience seizures despite adequate pharmacological therapy, underscoring the need for continued research into more effective and individualized therapeutic strategies.
Epidemiology and Classification
Epilepsy affects a substantial proportion of the global population, with the highest burden observed in low- and middle-income countries, where access to diagnosis and treatment remains limited. The International League Against Epilepsy (ILAE) has established a widely used classification framework that categorizes seizures according to their onset (focal, generalized, or unknown) and epilepsy syndromes according to etiology, which may be structural, genetic, infectious, metabolic, immune, or unknown. Accurate classification is essential, as it directly informs the selection of appropriate antiseizure therapy.
Pathophysiology
The pathophysiology of epilepsy involves an imbalance between excitatory and inhibitory neurotransmission within cortical and subcortical neuronal networks. Abnormal synchronization of neuronal firing, alterations in ion channel function, and disruption of gamma-aminobutyric acid (GABA)-mediated inhibitory signaling are central mechanisms underlying seizure generation. Genetic mutations affecting ion channels and neurotransmitter receptors have been identified in a growing number of epilepsy syndromes, contributing to the emerging field of precision medicine in epilepsy care.
Diagnosis
The diagnosis of epilepsy is primarily clinical, based on a detailed history of seizure semiology, often supplemented by eyewitness accounts. Electroencephalography (EEG) remains a cornerstone diagnostic tool, providing evidence of epileptiform activity and assisting in syndrome classification. Magnetic resonance imaging (MRI) is essential for identifying structural abnormalities, such as hippocampal sclerosis, cortical dysplasia, or tumors, which may serve as the underlying substrate for seizures. In selected cases, video-EEG monitoring, genetic testing, and metabolic screening may be warranted to establish a precise diagnosis.
Pharmacological Treatment
Antiseizure medications (ASMs) remain the first-line treatment for the majority of patients with epilepsy. Older-generation agents, including valproate, carbamazepine, and phenytoin, remain widely used and effective for many seizure types, though they are associated with notable drug interactions and adverse effect profiles. Newer-generation ASMs, such as levetiracetam, lamotrigine, lacosamide, perampanel, and brivaracetam, offer improved tolerability and more favorable pharmacokinetic profiles, with fewer drug-drug interactions. Selection of an appropriate ASM depends on seizure type, epilepsy syndrome, patient age, comorbidities, and potential for teratogenicity in women of childbearing potential.
Approximately one-third of patients with epilepsy do not achieve adequate seizure control despite trials of two or more appropriately selected and adequately dosed ASMs, a condition termed drug-resistant epilepsy. These patients warrant early referral to specialized epilepsy centers for consideration of non-pharmacological treatment options.
Non-Pharmacological Treatment
Epilepsy Surgery
For patients with drug-resistant focal epilepsy and a clearly identified epileptogenic zone, resective surgery can achieve seizure freedom in a substantial proportion of carefully selected candidates, particularly in cases of temporal lobe epilepsy associated with hippocampal sclerosis. Comprehensive presurgical evaluation, including video-EEG monitoring, neuroimaging, and neuropsychological assessment, is essential to identify appropriate surgical candidates and minimize postoperative risk.
Neurostimulation
Neurostimulation techniques offer alternative options for patients who are not candidates for resective surgery. Vagus nerve stimulation (VNS) involves intermittent electrical stimulation of the vagus nerve and has demonstrated efficacy in reducing seizure frequency across a range of epilepsy syndromes. Responsive neurostimulation (RNS) and deep brain stimulation (DBS), particularly targeting the anterior nucleus of the thalamus, represent more recently developed approaches that provide targeted, closed-loop or continuous stimulation to disrupt seizure activity.
Dietary Therapy
The ketogenic diet, a high-fat, low-carbohydrate dietary regimen, has demonstrated efficacy in reducing seizure frequency, particularly in children with drug-resistant epilepsy and specific genetic epilepsy syndromes. Modified variants, including the modified Atkins diet and low glycemic index treatment, offer more palatable alternatives with comparable efficacy in select populations.
Precision Medicine and Emerging Therapies
Advances in genetic testing have enabled the identification of specific gene mutations underlying certain epilepsy syndromes, opening the door to targeted therapeutic approaches. For example, patients with SCN1A-related Dravet syndrome may benefit from specific ASMs while avoiding sodium channel blockers that can worsen seizures. Cannabidiol has received regulatory approval for the treatment of seizures associated with Dravet syndrome, Lennox-Gastaut syndrome, and tuberous sclerosis complex, representing a notable advance in targeted therapy for these historically difficult-to-treat conditions.
Discussion
The management of epilepsy has evolved substantially from a one-size-fits-all pharmacological approach toward an individualized treatment paradigm that integrates seizure type, underlying etiology, genetic findings, and patient-specific factors. While newer-generation ASMs have improved tolerability, drug-resistant epilepsy remains a significant clinical challenge, highlighting the importance of timely referral to specialized epilepsy centers for consideration of surgical, neurostimulation, or dietary interventions. Continued research into the genetic and molecular underpinnings of epilepsy holds promise for further expanding precision-medicine approaches and improving long-term outcomes for patients with this complex and heterogeneous disorder.
Conclusion
Epilepsy remains a common and clinically heterogeneous neurological disorder requiring individualized management. Modern therapeutic approaches, encompassing newer pharmacological agents, epilepsy surgery, neurostimulation, dietary therapy, and precision-medicine strategies, have considerably broadened the treatment options available to patients, particularly those with drug-resistant disease. Early and accurate diagnosis, coupled with timely referral to specialized epilepsy care when appropriate, remains essential for optimizing seizure control and improving patients’ quality of life.
Conflict of Interest
The author declares no conflict of interest.
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J.J. Campbell (1976 – ?) is old enough to know better. He’s been widely published over the years, most recently at The Beatnik Cowboy, Drinkers Only, Mad Swirl, Yellow Mama and Night Owl Narrative. His latest book, to live your dreams, published by Whiskey City Press, is available at Amazon by going here: https://a.co/d/0bwkUIkX
Doctor of Sciences in Philology of ANAS, Professor Ramazan Gafarli
Lady of ladies, Burla Khatun of our poetry, long live.
Pride
What a beautiful name Burla Khatun is,
A symbol of courage, zeal, and chastity.
To keep this image alive,
To promote our country,
She never rests, she always writes,
She watches over it, makes it prosperous,
The cover of my pen.
I will separate the strands from my hair,
I will put a new string on the saz,
If the mizrab is a silk string,
The sound will spread naturally,
I will play the shur in the war,
I will go out in front of the army,
I will look straight into the enemy’s eyes.
I am a Turkish girl, my forehead is open,
I have a history, a nation, a great woman,
On earth, faithful to the covenant,
The voice of truth belongs to me,
Remember, O Muslim,
The book “Quran”, the anthem “Azan”,
I will spread freedom.
Elmaya Jabbarova was born in Azerbaijan. She is poet, writer, translator. Her poems from 2019 to date were published in the regional and foreign newspapers, magazines, books, Web pages, and anthologies. She has been awarded many certificates diplomas, medals. She is Department manager of Hekari newspaper of Azerbaijan. She is a honorary member of the Writers of Kazakhstan and Kyrgyzstan. World Association of People’s Creators, Honorary member of the International Academy of Literature, Art, Culture and Social Sciences of Uzbekistan. She is an Academic. Appointed Coordinator, Secretary General of Azerbaijan, Argentina. She is presented in the book Famous Personalities MultiArt – 5, Argentina. She was a member World Poetic Fraternity. She was awarded the title of Global Poet of 2023; 2024. She was awarded the title of World Poet Laureate from Azerbaijan as one of 55 poets selected by Pentasi B Friendship Poetry for 2025.
AI, the ‘jinn’ which has come out of Aladdin’s Lamp, is no doubt the triumph of human mind. It has opened the flood gates of knowledge, and conquered time and space, and brought mankind to the enviable position of a great victor. But, it is fraught with grave risks because it poses the greatest danger to human mind only. Moreover, it appears the machine has taken all the credit pushing man, for whose benefit it was created, to a secondary position. The master does not trust his own mind, what commands to give. Man is being reduced to a non-entity now, his brain laid aside, and the AI is doing all the work. A washing machine doing the chores of a housewife is a great help. Making chapatis would also do. If the AI assists us, it is acceptable. But, if AI starts feeding us, while we are lying on our bed, it would be a bad day for man. Assistance enhances our powers, but replacement dismantles us. That is nothing short of a disaster for mankind.
The business world has acquired AI as a blessing, and got rid of millions of workers, who are now on the roads, looking for jobs. One major achievement/danger of the modern times is that AI has started making human fakes. In fact, it has created a fake factory, and men are thrilled by its powers to create AI babies, and then, once you give the perfect order, it responds and creates what you want. A young man’s thrill at such creations can be appreciated, but, when older men indulge in these thrills, there is definitely a cause for worry, because, now these fakes will be misused to create an imaginary world, like the world of the celluloid where even murders carry no responsibility.
It is scary to imagine what AI can do although, behind it, we find our own human mind. The ‘Jinn’ is remembered for good deeds, but in case of AI, we are not certain, what is going to happen to mankind. What good it can do, and what good it has done, everything is in a fluid state, and in a state of absolute uncertainty. If AI, like the ‘Jinn’ works on our command, it is for man to realize what command to give. In itself, AI has no existence, nor any power, either to create or to destroy.
If the ‘Jinn’ has come out, I propose certain ideas which can make this ‘Jinn’ perform to perfection, and for the betterment of mankind. I think, as awakened sections of humanity, we should realize where things have gone wrong, and how they can be put back into order.
AI and Social Activism
The AI can be harnessed for social activism. But for this, the scientists who are creating this Ultra-Culture have to be given a Refresher Course in Social Idealism. They need to be told that Science is a welfare discipline, and its powers cannot be used to abridge human happiness in any way. In fact, they need to be given training is Social Ethics emphasising the fact that science cannot be ethically neutral. And this idea has to be injected into the minds of the people working at the helm. Neither entertainment, nor business, should be the ideal of any scientific advancement. It is the wellbeing of humanity, and arming mankind with more and more powers, so that they could improve their living style, ultimately leading to greater happiness of the greater number. For this, we need to have an education which is ethically committed. International Academy of Ethics believes in changing the very Alphabet of human studies, such as E for Ethics, C for Compassion and K for Kindness and so on. And while leaving colleges, the students should be required to give a solemn declaration that they will not allow their knowledge to be misused to bring any harm to cosmic society.
From an Amusement Park to Social Activism
AI is working as most significant defining power in society already. But it is being used as a wilful amusement park where people come for mental acrobatics. But it has to take the next step now, and assume the role of a Social Awakener. And Man must rise up to his role as the Master of this Recreated Universe. AI has to focus on things which were left undone by man while he was busy in marching forward.
The revered river of India, the Ganges, remains polluted, and the Govt has made great efforts to cleanse its waters. Why not we press in AI to start cleaning the rivers of the world?
AI should work to reduce the radiations from electronic towers, or remove their toxicity, so that bird life could be saved.
The AI can help raise underground water levels in states where these are going down.
AI can de-escalate pollution levels in cities like New Delhi, Kolkata etc.
In a state like Punjab and Haryana, where stubble is burnt at the cost of human heath, it can find out some ways to tackle these issues.
AI can run the engines of buses, and cars, and even aeroplanes, and trains, without using any type of fuel. This is a great challenge for AI-ans so that it could usher in a new world order which is based on AI fuel.
These are only a few suggestions which might look like an overkill. But, we should have faith in the human mind. If AI can be used for Deep Fakes and causing fear in human minds, we just need to change its direction, just change its posture, all its powers can be used for the good of mankind too.
DR JERNAIL S ANAND
Dr. Jernail S. Anand, with 200 books to his credit [20 epics] is a Chandigarh-based polymath, and a vital architect of the 21st century ethical literature whose seminal work ‘Lustus: The Prince of Darkness’ challenges the moral complacency of our era. Founding President of the International Academy of Ethics, and Laureate of Charter of Morava [Serbia], Seneca [Italy], Franz Kafka [Germany, Ukraine, Czech Rep] and Maxim Gorky [Russia], his name is inscribed on the Poets’ Rock in Serbia. He is an Honorary Member of the Serbian Writers Association, Belgrade. Anand has built a poetics that unites ethics, Vedic spirituality, social critique, and the philosophy of meaning. Anand presents an articulated perspective on poetry as an instrument of planetary consciousness. A moral philosopher, professor, and international speaker, Anand has devoted much of his research to the ethical dimension of language, to the responsibility of the individual within a globalised society, and to the relationship between matter, consciousness, and transcendence. Email: anandjs55@yahoo.com.
I admire shelters. A roof’s worth ten thousand lines
of free verse at least. Actually, I envy them.
Their walls, their warmth, the way a lock and a key connect.
When they’re done, there’s color on curtains,
on quilts, on cheeks, as well as on the rooms.
I write a poem. There are no word stains.
And the housed always look the part –
the brushed hair, the steady gait, the calmness in the stare.
The unhoused blend in. The worst that can happen to me
is to be picked out in a crowd.
And the housed sell their time. The homeless are lucky
if they can give theirs away.
Best of all, the housed hang their photos on walls.
When the homeless hang, a silence has to be sent for.
LIVING ON THE STREETS
Dawn is at its most primeval –
time moves on from despair into defiance –
a figure on the street corner –
eyes cast down but spine still upright.
If it weren’t for the rising sun,
this shadowed soul would have no rival.
The lull is misleading. Not while hunger scurries
through the alleys below. Eyes and ears miss nothing.
They’re always in the struggle.
Hands twitch like trigger fingers.
Breath rises and falls against the cold air.
The body is about to endure.
It has strength enough for the weaknesses beneath.
RENEWAL
Shower and shave.
The chin is smooth.
The skin is clean.
None of it is brand new
but what can you expect?
Some grime rubs off,
a certain firmness
keeps its cool around the bone.
But no sponge, no blade,
is worth a damn
against the years.
Not even a hug
and the words,
“You’re still the man
I married”
or three chords strummed
on an old guitar
and a verse of
“Tangled Up In Blue.”
But I still pop into
the bathroom each morning,
make a pretense of preparing myself
for the day, the world.
I figure I can fool both of them
into thinking it’s someone else,
younger, fitter,
more dashing and handsome
than three movie stars
and a boy band.
But I’m older than I was
the last time I did this.
And sure,
as the cliché would have it,
deep down, I’m wiser.
But wisdom’s just another word
for knowing the joke’s on you.
Why not? I need a good laugh.
IDENTITY
Usually I’m nothing much.
But sometimes…
hey, I admit it, I’m great.
But mostly I’m a pinch of salt
somewhere in the Atlantic.
Or a drop of rain
in a downpour.
Or a molecule.
But then there’s moments when
I’m not just the molecule,
I’m the entire thing.
Most of the time,
when I’m around,
you don’t know I’m there.
To be honest,
I hardly know I’m there either.
I can be so insignificant,
I’m next to non-existent.
But I have it in me
to be existence.
Or, at least,
where it goes from here.
What I am,
I have no idea.
Unless I’m an idea.
Then I know.
John Grey is an Australian poet, US resident, recently published in Midnight Mind, Willow Review and the Pennsylvania Literary Journal. Latest books, “Bittersweet”, “Subject Matters” and “Between Two Fires” are available through Amazon. Work upcoming in the MacGuffin, Touchstone and Willow Review.
