Epilepsy is a disease with diverse etiology; however, greater than 70%–80% of epileptic syndromes are thought to be associated with some genetic abnormality. Because of our fast-expanding genetic knowledge in epilepsy, we are approaching a new era of clinical management. We have an increased understanding of the underlying pathogenesis of genetic epilepsy as well as novel targets for precision therapies. Gene therapy, including gene transfer therapy, gene silencing, and gene editing, are promising new approaches to genetic epilepsy which have the potential to treat more than just the seizure manifestation of these devastating disorders. This chapter briefly reviews the role of genetic testing in epilepsy and introduces the application of gene therapy to genetic epilepsy syndromes as well as epileptogenesis more broadly.