Epilepsy is a common brain disorder, characterized by spontaneous recurrent seizures, with associated neuropsychiatric and cognitive comorbidities and increased mortality. Although people at risk can often be identified, interventions to prevent the development of the disorder are not available. Moreover, in at least 30% of patients, epilepsy cannot be controlled by current antiseizure medications (ASMs). As a result of considerable progress in epilepsy genetics and the development of novel disease models, drug screening technologies and innovative therapeutic modalities over the past 10 years, more than 200 novel epilepsy therapies are currently in the preclinical or clinical pipeline, including many treatments that act by new mechanisms. Assisted by diagnostic and predictive biomarkers, the treatment of epilepsy is undergoing paradigm shifts from symptom-only ASMs to disease prevention, and from broad trial-and-error treatments for seizures in general to mechanism-based treatments for specific epilepsy syndromes. In this Review, we assess recent progress in ASM development and outline future directions for the development of new therapies for the treatment and prevention of epilepsy.

癫痫是一种常见的脑部疾病，其特征是自发性反复发作，伴有相关的神经精神和认知合并症以及死亡率增加。尽管通常可以识别出处于危险中的人，但无法采取干预措施来预防这种疾病的发展。此外，目前的抗癫痫药物 (ASM) 无法控制至少 30% 的癫痫患者。过去 10 年来，由于癫痫遗传学取得了长足进展，以及新疾病模型、药物筛选技术和创新治疗方式的发展，目前有超过 200 种新的癫痫疗法处于临床前或临床研发阶段，其中包括许多可发挥作用的治疗方法。通过新机制。在诊断和预测生物标志物的辅助下，癫痫的治疗正在经历范式转变，从仅针对症状的 ASM 转向疾病预防，从针对一般癫痫发作的广泛试错治疗转向针对特定癫痫综合征的基于机制的治疗。在这篇综述中，我们评估了 ASM 发展的最新进展，并概述了治疗和预防癫痫新疗法的未来发展方向。