Epilepsy presents challenges in seizure management and cognitive deficits despite medical advancements. Virtual reality (VR) technology has emerged as a promising tool in epilepsy care, offering innovative approaches beyond traditional therapies. This narrative review explores current trends, challenges in implementation, and future directions of VR applications in epilepsy management. Systematic searches of PubMed, MEDLINE, PsycINFO, and Google Scholar identified relevant studies from 2000 to February 2024. Key findings highlight VR’s potential in stress reduction, seizure prediction, cognitive training, and patient education. VR environments provide immersive experiences that alleviate stress and anxiety associated with epilepsy, potentially improving patient well-being. Moreover, VR-based biofeedback systems show promise in enhancing seizure prediction through real-time physiological data monitoring, aiding in early intervention strategies. Cognitive deficits, such as impaired memory and attention, significantly impact daily functioning in epilepsy patients. VR-based cognitive training programs offer tailored interventions to address these deficits, promoting neuroplasticity and functional independence. However, challenges such as photosensitivity risks and variability in VR technology must be addressed to ensure safe and effective implementation. The review explores the need for standardized protocols and longitudinal studies to validate VR’s efficacy across diverse patient populations. Future research should explore advanced VR technologies and focus on integrating VR into clinical practice to optimize epilepsy management strategies.