Personalized treatment in the epilepsies: challenges and opportunities

Introduction: 'Personalized' medicine is not a new construct. Indeed, the science of medicine has been historically focused around notions of subgroups and categorization. A few decades ago, the Human Genome Project provided a complete resource of detailed information about the structure, organization, and function of the full set of human genes. This has enabled implementation of the idea that treatments could be targeted to genetically defined subgroups of individuals. Areas covered: We provide an overview of the current pitfalls and opportunities of 'personalized' treatment in epilepsy. Development of targeted therapeutics has been so far mainly by repurposing drugs already available on the market but not necessarily approved for the treatment of epilepsy. Most genomic findings have not yet translated into widespread utilization for therapy. Expert commentary: Genotypic and phenotypic heterogeneity, epigenetic modulation, variable penetrance and expressivity, environmental influence, and posttranslational changes are all factors that increase the complexity of genomic networks and generate pitfalls in the application of the 'personalized' treatment paradigm. Unraveling the multiple layers of biological complexity through new collaborative and computational approaches, and deep and multimodal phenotyping, is becoming fundamental for a better understanding of disease biology and in turn better tailored treatment strategies.