Epilepsy is a common chronic brain disorder, with approximately 30% of patients being resistant to conventional anti-epileptic drugs, necessitating precision medicine strategies for individualized treatment. This article systematically reviews the key advances and future directions in the precision treatment of epilepsy, , with its core framework built on three main pillars. First, targeted therapies based on genetic etiology serves as the cornerstone of precision medicine. By using genetic diagnostics to identify pathogenic mutations (such as in SCN1A and KCNQ2), treatment strategies can be tailored with channel modulators, receptor antagonists, or ketogenic diets that address the underlying causes. Second, pharmacogenomics aids in the personalized selection of conventional anti-epileptic drugs by analyzing key genes such as CYP2C9 and HLA-B*15:02, effectively predicting therapeutic efficacy and preventing severe adverse reactions. Third, for drug-resistant epilepsy, precision surgical techniques and neuromodulation methods accurately localize the epileptogenic focus, providing effective intervention options for patients. In the future, integrating multi-omics data, developing of novel targeted therapies, and overcoming clinical translation bottlenecks will be crucial in making precision treatments accessible to a broader patient population.