The post-transcriptional modification of mammalian transcripts in the central nervous system by adenosine-to-inosine RNA editing is an important mechanism for the generation of molecular diversity, and serves to regulate protein function through recoding of genomic information. As the molecular players and an increasing number of edited targets are identified and characterized, adenosine-to-inosine modification serves as an exquisite mechanism for customizing channel function within diverse biological niches. Here, we review the mechanisms that could regulate adenosine-to-inosine RNA editing and the impact of dysregulation in clinical conditions.