Over the past decade, advances in genetics, neuroimaging and EEG have made it possible to identify the etiology of epilepsy earlier. At the same time, advances in the study of experimental models of epilepsy have led to a better understanding of the underlying mechanisms of this disease and to the identification of therapies that specifically target them. We are now seeing the impact of these advances in our daily clinical practice. It is therefore time for a paradigm shift in the treatment of epilepsy, moving from a reactive attitude, treating patients after the onset of epilepsy marked by the onset of seizures, to a more proactive attitude more broadly integrated into a « 4P medicine » type approach (personalized, predictive, preventive and participatory). This approach places patients at the center of their own care and ultimately aims to prevent the onset of epilepsy. This will be achieved by tailoring epilepsy treatments not only to a given syndrome but also to a given patient, moving from generic anticonvulsant treatments to personalized treatments designed to target the specific etiology of a given patient. In this review, we present the current status of this ongoing revolution, highlighting the impact on clinical practice.