The approach to epilepsy care has transformed in the last 30 years, with more 
and better anti-epileptic medications, improved cerebral imaging and increased 
surgical options. Alongside this, developments in neuroscience and molecular 
genetics have furthered the understanding of epileptogenesis. Future 
developments in pharmacogenomics hold the promise of antiepileptic drugs matched 
to specific genotypes. Despite this rapid progress, one-third of epilepsy 
patients remain refractory to medication, with their seizures impacting upon 
day-to-day activity, social well-being, independence, economic output and 
quality of life. International genome collaborations, such as HapMap and the 
Welcome Trust Case-Control Consortium single nucleotide polymorphism (SNP) 
mapping project have identified common genetic variations in diseases of major 
public health importance. Such genetic signposts should help to identify at-risk 
populations with a view to producing more effective pharmaceutical treatments. 
Neurological disorders, despite comprising one-fifth of UK acute medical 
hospital admissions, are surprisingly under-represented in these projects. 
Epilepsy is the commonest serious neurological disorder worldwide. Although 
physically, psychologically, socially and financially disabling, it rarely 
receives deserved attention from physicians, scientists and governmental bodies. 
As outlined in this article, research into epilepsy genetics presents unique 
challenges. These help to explain why the identification of its complex genetic 
traits has lagged well behind other disciplines, particularly the efforts made 
in neuropsychiatric disorders. Clinical beginnings must underpin any genetic 
understanding in epilepsy. Success in identifying genetic traits in other 
disorders does not make the automatic case for genome-wide screening in 
epilepsy, but such is a desired goal. The essential clinical approach of 
accurately phenotyping, diagnosing and interpreting the dynamic nature of 
epilepsy remains fundamental to harvesting its potential translational outcomes.