An increasing number of infantile epilepsy syndromes have been recognized. However, a significant number of infants (children aged 1–24 months) do not fit into any of the currently defined categories. The majority of patients can attain seizure independence during the first two medication trials. Therefore, pharmaco-resistant individuals are those who cannot achieve an adequate therapeutic response despite multiple treatments. The range of efficacy, safety, and tolerability varies widely, and the diversity of seizures and epilepsies complicates clinical management. Epilepsy is one of the most common neurological disorders, affecting more than 50 million people worldwide and presenting a significant public health challenge.[1] It is characterized by recurrent, unprovoked seizures resulting from abnormal electrical discharges in the brain. The condition is heterogeneous, with varying etiologies, clinical manifestations, and treatment responses. Advances in research have enabled more refined classifications of epilepsy syndromes, including focal, generalized, and pediatric forms such as Lennox– Gastaut syndrome and infantile spasms.[7,10,12] Despite the availability of several antiseizure medications, nearly one-third of patients develop drug- resistant epilepsy, which poses challenges in achieving long-term seizure control and quality of life improvement.[2,3] Current treatment strategies range from pharmacological approaches to non-pharmacological interventions, including ketogenic diets, vagus nerve stimulation, and surgical resection for refractory cases.[1,4,5] Recent studies have emphasized the importance of precision medicine, early diagnosis, and identification of genetic and structural causes to optimize therapeutic outcomes.[3,14] This review discusses the epidemiology, etiology, pathophysiology, diagnosis, and management of epilepsy, with special emphasis on drug resistance and novel treatment approaches. The aim is to provide a comprehensive overview that integrates current evidence and highlights future perspectives for improving patient care and treatment success.