Early trials of antisense oligonucleotide (ASO) treatments for rare genetic epilepsies show promise in reducing seizures, but high costs pose challenges. ASOs have grown from a single N-of-1 study in 2019 to involve over two dozen patients, with some trials reporting significant seizure reductions. Despite promising results, the high cost of ASO treatments, potentially in the millions, raises concerns about accessibility. Neurologists emphasize the need for genetic screening at birth to identify patients early and streamline the development of these gene-based therapies.