Epilepsy is a chronic neurological disorder caused by abnormal neuronal discharges in the brain, affecting a large population worldwide. Approximately one-third of patients develop drug-resistant epilepsy, posing significant challenges in clinical management. Recent evidence highlights the involvement of gut microbiota (gastrointestinal microbiome, GM) in epilepsy pathogenesis and progression through the gut-brain axis. Patients with epilepsy exhibit marked alterations in the composition and function of gut microbiota, which may influence the disease process via immune, neuroendocrine, and metabolic pathways. Interventions targeting the gut microbiota have emerged as a promising therapeutic strategy. This review summarizes recent advances in the field and discusses the potential applications and challenges of microbiota-based interventions, aiming to provide new insights for epilepsy treatment.