Epilepsy is a neurological disorder characterized by recurrent, unprovoked seizures, affecting millions of people globally. Despite advances in diagnostic tools, early detection and personalized treatment remain challenging. Recently, circulating microRNAs (miRNAs), small non-coding RNA molecules involved in gene regulation, have emerged as promising biomarkers for various forms of epilepsy. This article reviews the potential role of circulating miRNAs in epilepsy, focusing on their diagnostic, prognostic, and treatment-monitoring capabilities. Studies have identified specific miRNAs, such as miR-146a, miR-199a, and miR-134, that are differentially expressed in different epilepsy forms, including temporal lobe epilepsy, genetic epilepsies, drug-resistant epilepsy, and status epilepticus. These miRNAs are implicated in critical processes such as neuroinflammation, neuronal excitability, and synaptic plasticity. Technological advancements in miRNA detection, such as quantitative PCR and next-generation sequencing, have enabled the identification of miRNA profiles in blood, serum, and cerebrospinal fluid. While circulating miRNAs hold great potential for non-invasive monitoring of epilepsy, further research and validation are required to standardize detection methods and assess their clinical utility. Ultimately, miRNA-based biomarkers could improve the diagnosis, prognosis, and treatment of epilepsy, leading to more personalized and effective therapeutic strategies.