Feature Article: Novel treatments for Epilepsy: Progress in the treatment of epilepsy over the last years
Over the past five years, epilepsy treatment has progressed remarkably, not only due to innovations in medical technology, and new medications, but also due to a deeper understanding of the mechanisms that are involved in epilepsy.
These developments are especially meaningful for the roughly 30% of patients who have drug-resistant epilepsy, offering new hope for seizure control and improved quality of life. Here’s a look at some of the key developments in the last five years.
One major stride has been the enhancement and increasing adoption of neuromodulation techniques. An implantable device, Responsive Neurostimulation (RNS), pioneered by NeuroPace, has gained traction as a sophisticated tool for drug-resistant focal epilepsy. This implantable device monitors brain activity and delivers targeted electrical pulses to disrupt seizure onset. It adapts to individual patterns which is key. Long-term data published in recent years show that about 75% of patients achieve at least a 50% reduction in seizures after nine years, with some experiencing longer seizure-free periods. Furthermore, improvements like the nSight Platform (2023) have made RNS more user-friendly for clinicians, improving its precision and accessibility.
Minimally invasive surgical options have also advanced in recent years. Laser Interstitial Thermal Therapy (LITT), or laser ablation, has become a preferred alternative to traditional open surgery. Using MRI-guided lasers to precisely target and destroy seizure-causing brain tissue, LITT reduces recovery time and complications. Centers like UChicago Medicine report that 80- 90% of their epilepsy surgeries now use this technique, with patients often achieving seizure freedom or significant reduction in seizure frequency. Improved imaging and robotic assistance have further boosted its efficacy and safety.
On the pharmacological front, new antiseizure medications (ASMs) have emerged, expanding the pharmacological toolkit epileptologists can choose from. Cenobamate (Xcopri), approved by the FDA in 2019, has had very positive results for many patients. Clinical trials indicate that up to 20% of patients with refractory focal seizures achieve seizure freedom which is a monumental achievement. It is thought that it has been such a gamechanger due to its dual mechanism—modulating sodium channels and GABA receptors—which takes a novel approach.
Similarly, cannabidiol (CBD) formulations like Epidiolex, approved in 2018 but increasingly studied and optimized since, have proven effective for rare epilepsies like Dravet and Lennox- Gastaut syndromes, with ongoing research exploring broader applications.
In addition, gene therapy has progressed significantly in recent years with exceptional potential.
In 2023, NeuroPace launched the NAUTILUS trial to explore neuromodulation for idiopathic generalized epilepsy, while other efforts, like the STK-001 antisense oligonucleotide for Dravet syndrome, aim to correct genetic underpinnings by upregulating sodium channel function in GABAergic neurons. These therapies, still in clinical trials as of 2025, signal a shift toward addressing epilepsy’s root causes rather than just its symptoms.
Artificial intelligence (AI) and machine learning are now mentioned on a daily basis with regard to all sorts of fields and topics. As could be expected AI has also entered the Epilepsy field and as such, has begun impacting and improving diagnostics and treatment planning. Tools like
EpiScalp, an AI-driven EEG analysis platform, have improved seizure detection accuracy, potentially reducing misdiagnoses by up to 70%. Integrating AI with closed-loop systems like RNS could enable real-time seizure prediction and personalized stimulation, a development actively researched since 2021, and which is being followed eagerly by epilepsy specialists.
Finally, the ketogenic diet and its variants have seen renewed interest, supported by studies showing seizure reduction in both children and adults with refractory epilepsy. Combined with advances in neuromodulation and pharmacology, this non-invasive option complements the high-tech landscape.
These breakthroughs—spanning devices, drugs, and diagnostics—reflect a dynamic evolution in epilepsy care in just the last five years. While challenges like cost, accessibility, and long-term efficacy remain, we are moving closer to a future where seizures are not just managed but potentially prevented or cured.
