Epilepsy is a neurological disorder caused by abnormal neuronal discharges, affecting approximately 50 million people worldwide. Recent research has highlighted the role of microglia, the resident immune cells of the central nervous system, in the pathophysiology of epilepsy. This article reviews the inflammatory polarization of microglia and their dual role in epilepsy, including the proinflammatory damage of M1 microglia and the anti-inflammatory protective effects of M2 microglia based on the latest findings. Additionally, the article discusses the interplay between microglial polarization and other cellular functions, such as pyroptosis, autophagy, mitochondrial dysfunction, and ferroptosis. However, the exact role of the interactions between different microglial functions and their complex associations with other brain cells in the pathological mechanism of epilepsy remains unclear. By summarizing the latest research progress on microglial polarization in the pathophysiology of epilepsy, this article highlights its therapeutic implications and potential challenges, providing insights for future research.