Neural Epilepsy: A Comprehensive Multi-Scalar Analysis of Pathogenesis, Diagnostics, and Advanced Therapeutics

Epilepsy remains one of the most neurobiologically complex and globally debilitating 
neurological diseases, characterized by an enduring, pathological predisposition to 
generate spontaneous, recurrent seizures. This comprehensive review synthesizes the 
multi-scalar pathophysiology of epileptogenesis—ranging from subcellular ion 
channelopathies, epigenetic reprogramming, and autophagic dysregulation, to the 
macroscopic topological reorganization of thalamocortical neural networks. We detail the 
latest global epidemiological trends and the modernized 2025 International League 
Against Epilepsy (ILAE) classification framework. Furthermore, this paper highlights 
transformative advancements in diagnostic neuroimaging, specifically the integration of 
High-Density Electroencephalography (hd-EEG), the Virtual Epileptic Patient (VEP) 
computational pipeline, and emerging Artificial Intelligence (AI) architectures. Finally, 
we explore the rapidly expanding therapeutic arsenal, detailing novel precision 
neuropharmacology (e.g., cenobamate, fenfluramine, XEN1101), bioelectronic 
neuromodulation, cutting-edge optogenetics, and the overarching shift toward a precision 
medicine framework modeled after advanced oncology.