Patients with epilepsy often experience an unsatisfactory quality of life because of a variety of epilepsy-related psychosocial factors, such as stigma and psychiatric comorbidity.
Stigma adversely affects patients with epilepsy, especially those with difficult-to-control seizures, and particularly in developing, resource-poor countries. Perceived and enacted stigma impact on nearly all everyday activities of persons with epilepsy, such as attending school, driving, working, enjoying recreational activities, establishing social relationships, and obtaining insurance. Even patients who are seizure-free and well informed about their disorder may experience unemployment and underemployment, driving restrictions, difficulty obtaining life and health insurance, and social stigmatization.
Psychiatric comorbidity is common in patients with epilepsy. The most frequent associated psychiatric condition is depression, occurring in 10–20% of patients with controlled seizures and up to 60% of patients with medically intractable epilepsy. Depression is underdiagnosed and undertreated in patients with epilepsy, in part because of the largely unjustified concern that all antidepressant drugs could exacerbate seizures. Undertreatment is a major problem, because suicide is a frequent cause of death in patients with epilepsy, occurring up to 10 times more frequently than in the general population.
Up to 25% of patients with epilepsy have anxiety, most commonly in the form of a generalized anxiety disorder. The severity of anxiety may not correlate with seizure frequency. Ironically, severe anxiety may develop after a patient with epilepsy becomes seizure-free. Apart from having an anxiety disorder, living with fear is common among people with epilepsy and is often reported as ‘the worst thing about having epilepsy’ (Fisher et al., 2000a, 2000b). Specific fears include dying from a seizure, public embarrassment, losing employment, and being involved in an automobile accident.