Epilepsy is a common neurological disorder characterized by recurrent unprovoked seizures resulting from abnormal electrical activity in the brain. Magnetic Resonance Imaging (MRI) plays a pivotal role in identifying structural brain abnormalities that contribute to epileptogenesis and assists in diagnosis, treatment planning, and prognostic evaluation. Aim: The present study aims to assess structural brain changes in patients with epilepsy using Magnetic Resonance Imaging (MRI). The objectives are to evaluate cortical and subcortical abnormalities, identify the etiological factors responsible for seizures, determine syndrome-specific structural alterations, assess the diagnostic utility of different MRI sequences, examine the role of MRI as a non-invasive imaging modality, and analyze the distribution of structural changes according to patients' age, sex, and duration of epilepsy. Materials and Methods: This retrospective observational study included 100 patients with epilepsy selected from 120 MRI records after applying predefined inclusion and exclusion criteria. MRI examinations performed between 1st January 2019 and 1st June 2019 were analyzed. MRI findings were reviewed using conventional sequences, including T1-weighted, T2-weighted, FLAIR, Diffusion-Weighted Imaging (DWI), Susceptibility-Weighted Imaging (SWI), and post-contrast imaging where available. Cortical thickness measurements were obtained using CAT12 software, and structural changes were compared across different epilepsy syndromes. Results: The majority of patients belonged to the 5–15 years age group (38%), with a male predominance (57%). Generalized tonic-clonic seizures were the most common seizure type (38%), while Idiopathic Generalized Epilepsy (60%) was the predominant epilepsy syndrome. MRI detected diverse structural abnormalities, including hippocampal involvement, ischemic lesions, traumatic changes, vascular malformations, and developmental abnormalities. Mesial temporal lobe epilepsy demonstrated characteristic ipsilateral hippocampal changes, whereas quantitative cortical thickness analysis revealed syndrome-specific alterations involving the medial temporal, frontal, and parietal cortices. Conclusion: MRI is an effective, non-invasive imaging modality for identifying structural brain abnormalities in epilepsy. High-resolution MRI combined with quantitative cortical and subcortical analysis improves lesion detection, facilitates syndrome classification, and supports appropriate clinical management and surgical planning in patients with epilepsy.