Objective To investigate the current status and needs of epilepsy management among patients and primary healthcare workers in rural Northwest China, providing data support for the development of an intelligent medical assistant tailored for rural epilepsy care. Methods A questionnaire survey was conducted from March 22 to April 22, 2025, targeting patients (or their caregivers) and healthcare workers in eight regions of the Shaanxi Rural Epilepsy Prevention and Management Project. The patient/caregiver questionnaire covered basic information, disease-related information, and functional needs; the healthcare worker questionnaire included basic information, job responsibilities, and functional suggestions. Questionnaires were distributed via the Wenjuanxing platform. Python was used for descriptive statistics and correlation analysis. Results A total of 1 154 valid patient/caregiver questionnaires (response rate 59.45%) and 337 valid healthcare worker questionnaires (response rate 100%) were collected. The main difficulties reported by patients/caregivers were psychological stress (58.75%), financial burden (47.05%), and lack of disease knowledge (38.82%). 87.09% of respondents expressed willingness to use an intelligent assistant, with the highest demand for psychological support (56.33%), medication reminders (52.51%), and condition monitoring (45.06%). The primary difficulties reported by healthcare workers were poor patient adherence (75.96%), insufficient professional training (62.62%), and ineffective communication (55.79%). 87.83% of healthcare workers were willing to use an intelligent assistant and expected it to feature patient information management (92.58%), remote follow-up (77.15%), and condition monitoring (74.48%) to improve work efficiency. Conclusion Patients and healthcare workers in rural Northwest China show high acceptance and clear demand for an intelligent medical assistant for epilepsy. Future development should prioritize core modules such as medication management, health education, and psychological support, adopting a minimalist design to enhance the accessibility and effectiveness of long-term epilepsy management.