Epilepsy affects millions worldwide, causing seizures and significant neurological, psychological, and social impacts. Traditional antiepileptic drugs (AEDs) help many patients, but about one-third still suffer from drug-resistant epilepsy. Current AEDs mainly suppress excitability through sodium, calcium, or GABA pathways, yet they do not cure the disease and often cause side effects. New therapies, including selective modulators (PRAX-628, QO-83), neuroactive steroids (LPM682000012), gene therapies (AMT-260), and cannabidiol analogues, show promise in overcoming these limits. Advances in AI, pharmacogenomics, and biomarkers are driving a shift toward personalized, effective, and potentially curative treatments.