Epilepsy is one of the most prevalent chronic neurological illnesses. Presently, the provision of symptomatic medicine is the treatment method for epilepsy. The majority of patients can attain seizure independence during the first two medication trials. Therefore, pharmaco-resistant individuals are those who cannot get an adequate therapeutic response. However, the range of efficacy, safety, and tolerability, the diversity of seizures and epilepsies, the frequency of comorbidity, and tolerance associated with the administration of anti-seizure medicines (ASMs) renders medicating these patients rather challenging. Since medicines with different and potentially additive mechanisms of action as well as improved safety and efficacy profiles than first-generation ASMs have been developed, rational polytherapy has become increasingly important in the second, third, and final-generation ASM period. Recent insights into ASM utilization have spotlighted critical clinical and pathogenetic concerns linked to drug-resistant seizures. Pharmacogenetics, elucidating genetic factors influencing drug response, has also emerged as a promising avenue. Additionally, there is a growing interest in non-pharmacological interventions to complement or augment medication strategies.