癫痫是一种慢性神经系统疾病，药物难治性癫痫占比高且伴随多种共患病，传统治疗效果有限。本文聚焦神经-免疫动态交互在癫痫中的作用，系统阐述其核心机制：癫痫发作引发血脑屏障结构功能异常，促使外周免疫细胞浸润，激活小胶质细胞、星形胶质细胞等释放促炎因子，形成恶性循环，同时剖析了多个关键通路的调控作用。诊断方面，梳理了体液与组织类神经-免疫生物标志物，以及多模态影像、单细胞测序等新型诊断技术的应用。治疗上，总结了靶向促炎通路、调节胶质细胞、干预肠道菌群及细胞治疗等免疫调节策略，以及新型抗癫痫药物的研发方向。此外，本文还指出了免疫细胞功能、炎症因果关系等研究争议，以及动物模型局限、临床转化障碍等挑战。最后提出了多组学整合、人工智能应用及新型递送技术等发展方向，为药物难治性癫痫精准诊疗提供了新范式，助力癫痫治疗从对症控制向病因干预转型。

Epilepsy is a chronic neurological disorder often complicated by drug resistance and comorbidities, with limited benefits from conventional therapies. This review explores the role of neuro-immune interactions in epilepsy, detailing a core mechanism where seizures disrupt the blood-brain barrier, enabling immune cell infiltration and activating glial cells to release pro-inflammatory factors, thus perpetuating a vicious cycle. Key signaling pathways are also discussed. The article surveys diagnostic advances, including neuro-immune biomarkers and technologies like multimodal imaging and single-cell sequencing. For treatment, immunomodulatory strategies—such as targeting inflammation, modulating glial cells or gut microbiota, and cell therapies—as well as the development of novel anti-seizure medications​ are summarized. Current challenges involve controversies over immune cell functions and inflammatory causality, as well as limitations in animal models and clinical translation. Future directions like multi-omics integration, artificial intelligence, and novel delivery systems are highlighted, offering a new paradigm for precise, etiology-targeted therapy in drug-resistant epilepsy.