As epilepsy treatment becomes more comprehensive and integrates into a “P4 medicine” strategy, it is time to move away from a reactive approach that treats patients after seizures occur and toward a proactive one. This P4 approach—which centres care around the patient and eventually attempts to prevent the onset of epilepsy—is personalized, predictive, preventive, and participatory. Achieving this goal will need switching from the standard anti-seizure medicines to customized treatments targeted at particular etiologies and customizing epilepsy treatments to fit both a given patient and a given syndrome. The current status of this ongoing revolution is presented in this review, with particular attention paid to the rise of the ideas of personalized and precision medicine as well as their implications for clinical practise.

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