Introduction and objective: Falls in epilepsy are often framed around seizure-related events, yet fear of falling (FOF) during everyday activities can independently limit participation and reduce quality of life. The aim of the study was to quantify FOF frequency in adults with epilepsy and examine its associations with functional mobility, balance, mood, cognition, and antiseizure medication (ASM) exposure, compared with epilepsy peers without FOF and healthy controls. Materials and methods: In this cross-sectional case-control study, adults with epilepsy were classified as FOF⁺ (n = 37) or FOF⁻ (n = 63) using the Falls Efficacy Scale (FES). Healthy controls (n = 50) were frequency-matched for age, sex, and education. Outcomes included Timed Up and Go (TUG), TUG-Cognitive (TUG-Cog), Berg Balance Scale (BBS), Beck Depression Inventory (BDI), Montreal Cognitive Assessment (MoCA), and ASM duration. Group differences were evaluated using omnibus comparisons across the three groups. Results: Among adults with epilepsy, FOF prevalence was 37% (37/100). FOF⁺ participants had higher FES (82.3 ± 11.2 vs. 65.0 ± 13.1 vs. 48.6 ± 6.7; p < 0.001), slower mobility (TUG 10.5 ± 1.8 vs. 10.3 ± 2.3 vs. 8.5 ± 1.1 s; p < 0.001), greater dual-task cost (TUG-Cog 12.2 ± 2.1 vs. 11.9 ± 0.8 vs. 10.1 ± 1.5 s; p < 0.001), poorer balance (BBS 47.2 ± 3.5 vs. 51.4 ± 2.1 vs. 54.7 ± 5.6; p < 0.001), and more depressive symptoms (BDI 21.7 ± 8.6 vs. 16.5 ± 8.8 vs. 9.7 ± 6.1; p < 0.001). ASM exposure was longer in FOF⁺ than FOF⁻ participants (7.9 ± 4.4 vs. 4.8 ± 3.2 years; p = 0.015). Age of onset did not differ significantly between epilepsy subgroups. MoCA showed a nonsignificant trend across groups (p = 0.07). Conclusions: In non-elderly, ambulatory adults with epilepsy, FOF affected approximately one in three individuals and co-occurred with slower gait, poorer balance, and longer ASM exposure. Brief, clinic-ready screening may help identify patients who could benefit from medication review, balance-oriented rehabilitation, and mood treatment.