Ramadan fasting, a religious practice observed by Muslims worldwide, involves abstaining from food, drink, and other specified activities from dawn to sunset. For patients with epilepsy (PWE), fasting during Ramadan presents unique challenges due to potential disruptions in medication schedules, changes in sleep patterns, and alterations in diet, which can influence seizure control. This literature review synthesizes current research on the impact of Ramadan fasting on seizure frequency, quality of life (QoL), and physiological changes in PWE. The review also examines existing clinical guidelines for managing epilepsy during Ramadan and identifies significant gaps in the literature that warrant further investigation. Through a systematic search of three electronic databases, namely PubMed, ScienceDirect, and Google Scholar, relevant studies were identified and analyzed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review reveals a complex relationship between fasting and epilepsy, with some patients experiencing stable or improved seizure control, while others face increased seizure risk. Medication adherence, sleep disruption, and individual patient characteristics are critical in determining outcomes. The findings underscore the importance of personalized care strategies for PWE who wish to fast during Ramadan, including pre-Ramadan consultations, tailored medication regimens, and ongoing monitoring throughout the fasting period. Despite the progress made in understanding the effects of Ramadan fasting on epilepsy, significant gaps remain. The review highlights the need for future studies to assess the long-term impact of fasting, research on diverse patient populations, and the development of evidence-based clinical guidelines. Addressing these gaps is essential to improve the management of epilepsy during Ramadan and ensure that patients can safely observe their religious practices while maintaining optimal seizure control.