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Blood–brain barrier (BBB) breakdown in epilepsy drives seizure susceptibility in a positive feedback loop, and is seen by some as a biomarker of epileptogenesis.

Antiseizure medications act on neuronal signaling, targeting ion channels, synaptic vesicle proteins, and neurotransmitter receptors at inhibitory and excitatory synapses.

Monotherapy is the preferred first-line treatment for epilepsy, with alternative or add-on therapy considered if seizures persist. Treatment choices should balance benefits, tolerability, and the risk of adverse effects or drug interactions.

The epilepsy treatment gap shows major global inequalities, with inadequate treatment far more common in lower-income countries.

Epilepsy is linked to several major comorbidities – including sleep, cardiac, cognitive, and mood disorders – through complex and sometimes bidirectional relationships that influence diagnosis and treatment.

People with epilepsy have a higher risk of several psychiatric comorbidities, including depression, anxiety, and psychotic disorders, which may occur around or between seizures.