Why we urgently need improved epilepsy therapies for adult patients.

Up to a third of patients with epilepsy suffer from recurrent seizures despite therapeutic advances. Current epilepsy treatments are limited by experiential data from treating different types of epilepsy. For example, we lack evidence-based approaches to efficacious multi-drug therapies or identifying potentially serious or disabling adverse events before medications are initiated. Despite advances in neuroscience and genetics, our understanding of epilepsy pathogenesis and mechanisms of treatment-resistance remains limited. For most patients with epilepsy, precision medicine for improved seizure control and reduced toxicity remains a future goal. A third of epilepsy patients suffer from ongoing seizures and even more suffer from adverse effects of treatment. There is a critical need for more effective and safer therapies for epilepsy patients with frequent comorbitidies, including depression, anxiety, migraine, and cognitive impairments, as well as special populations (e.g., women, elderly). Advances from genomic sequencing techniques may identify new genes and regulatory elements that influence both the depth of the epilepsies' roots within brain circuitry as well as ASD resistance. Improved understanding of epilepsy mechanisms, identification of potential new therapeutic targets, and their assessment in randomized controlled trials are needed to reduce the burden of refractory epilepsy. This article is part of the special issue entitled 'New Epilepsy Therapies for the 21st Century - From Antiseizure Drugs to Prevention, Modification and Cure of Epilepsy'.

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Published by Elsevier Ltd.

Déclaration de conflit d'intérêts

Declaration of competing interest Santoshi Billakota has no COI. Kyung-Wha Kim has no COI. Orrin Devinsky serves on the scientific and/or medical advisory boards, and has equity interest and/or receives compensation from Receptor Life Sciences, Privateer Holdings/Tilray, and Egg Rock Holdings/Papa & Barkley. He has also been an investigator and consultant for GW Pharmaceuticals. He has also consulted for Zogenix. He also compensated serves on the scientific and/or medical advisory boards, and has equity interest and/or receives compensation from Tevard, Rettco, Engage Pharmaceuticals, Pairnomix and Empatica.