Epilepsy is far more than a neurological disorder- it is a condition that profoundly shapes the social, emotional, and psychological lives of those who live with it. Across the world, people with epilepsy face stigma, misconceptions, and discrimination that often overshadow the clinical aspects of the disease. Despite major advances in diagnosis and treatment, the quality of life (QOL) of people with epilepsy continues to be compromised, especially in developing countries where awareness is low.

Epilepsy: A Condition Often Burdened by Stigma

In many parts of the world, including India, epilepsy continues to be surrounded by myths. Some believe it is caused by witchcraft, evil spirits, or contagion. A previous Indian study found that:

• 15% believed epilepsy to be a form of insanity

• 40% felt children with epilepsy should not attend regular school

• 66% opposed marriage with someone who has epilepsy

Similar patterns have been seen internationally, including in Taiwan, where 31% of respondents felt individuals with epilepsy should not be employed in regular jobs.

Such beliefs significantly shape the emotional and social well-being of patients. Stigma contributes to social withdrawal, depression, poor self-esteem, job discrimination, and reduced marriage prospects, all factors that greatly influence QOL.

About the Study: A Look at Real-life Challenges

This cross-sectional prospective study evaluated 60 adults with epilepsy between 18–56 years at a tertiary-care center. Most participants came from rural and semi-rural regions, where access to specialist neurological care is limited.

Using the QOLIE-89 (Quality of Life in Epilepsy) questionnaire—translated and validated in Kannada and Marathi—the team assessed how epilepsy influences day-to-day functioning across physical, emotional, cognitive, and social domains.

Who Were the Participants?

• 37 males, 23 females

• Mean age: 26.7 years

• The majority are younger than 30 years

• Variety of occupations: skilled workers, homemakers, students, businessmen, professionals.

Epilepsy Characteristics

• Mean duration: 7.44 years

• Seizure types:

  • 38 with generalized tonic-clonic seizures (GTCS)

  • 9 with simple partial seizures

  • 8 with complex partial seizures

  • 5 with juvenile myoclonic epilepsy (JME)

• Treatment pattern:

  • 61.7% on monotherapy

  • 30% on two drugs

  • 8.3% on three or more drugs

Key Findings: What Affects Quality of Life the Most?

1. Age and Quality of Life

While some international studies show older adults have lower energy and physical stamina, this study did not find a negative correlation between age and overall QOL. However, increasing age did impact emotional well-being, bodily pain, memory, and language areas that showed measurable decline.

2. Women Report Significantly Lower QOL

One of the strongest findings was the difference between genders. Female patients had consistently lower scores in:

• Emotional well-being

• Physical activity

• Attention and concentration

• Social support

• Seizure worry

• Bodily pain

• Perceived medication side-effects

The perception of adverse drug effects showed a statistically significant correlation.
These results echo global studies, but cultural expectations, household responsibilities, and stigma may intensify the burden for Indian women.

3. Married Individuals Felt More Burdened

Marriage, ideally a source of support, seemed to add emotional strain for patients with epilepsy. Married patients reported:

• Lower energy

• More fatigue

• Emotional instability

• Greater health discouragement

• Higher social isolation

These differences were statistically significant.
In societies where chronic illness impacts social roles more strictly, marriage can intensify pressure and reduce QOL.

4. Type of Epilepsy Matters

Patients with simple partial seizures had the lowest overall QOL, followed by those with GTCS.  Those with JME and complex partial seizures had better QOL scores. Notably, individuals whose seizures secondarily generalized had:

• Lower health perception

• Reduced energy

• Poor emotional stability

• Higher social isolation

Although differences were not statistically significant, trends were consistent.

5. Long Duration of Epilepsy Leads to Lower QOL

Patients with epilepsy for more than 15 years reported significantly poorer outcomes in:

• Emotional and physical role limitations

• Attention and concentration

• Perceived language problems

These long-term effects likely stem from chronic worry, social hardships, and cumulative medication side effects.

6. More Seizures Are Equal to Lower QOL

While not statistically significant, the trend was unmistakable:
Patients who experienced more than 45 seizures had the lowest QOL scores. They struggled with:

• Physical limitations

• Emotional instability

• Low energy

• Poor social interaction

• Social isolation

Seizure frequency directly shapes confidence, employment opportunities, and independence.

7. Monotherapy Improves Quality of Life

Patients taking a single anti-seizure medication (ASM) scored significantly better than those on two or more drugs.

Those on polytherapy reported:

• Poor health perception

• Low energy

• More side-effects

• Reduced work and social functioning

• Higher seizure worry

Multiple studies worldwide support the idea that monotherapy improves QOL by reducing side effects.

8. Recent Seizures Strongly Reduce QOL

One of the most powerful predictors of poor QOL was having a seizure within the last 10 months. These patients showed:

• Lower emotional stability

• Higher health discouragement

• Greater restrictions on daily activity

These parameters showed statistically significant differences, highlighting that seizure control is one of the most important determinants of a healthy and stable life with epilepsy.

What This Means for Patients and Families

The study highlights several modifiable and non-modifiable factors.
While gender, marital status, or seizure type cannot always be changed, interventions can significantly improve QOL when focused on:

Better seizure control
Every month without a seizure reduces emotional burden and improves overall functioning.

Preferring monotherapy whenever possible
Fewer medications = fewer side effects and better daily experience.

Community education on epilepsy
Reducing stigma improves social participation, mental health, marriage prospects, and employment opportunities.

Counselling and psychological support
Women and married patients—who showed the lowest QOL—may benefit most from structured emotional support.

Long-term follow-up and medication review
Chronic epilepsy requires ongoing medication adjustments and regular evaluation.

Epilepsy is not just a neurological condition—it is a life condition. This study demonstrates that quality of life is shaped more by social and emotional factors than by seizures alone.

Key takeaways include:

• Women and married individuals face greater challenges.

• Longer duration of epilepsy and higher seizure frequency reduce QOL.

• Recent seizures and polytherapy are key modifiable factors.

• Monotherapy improves outcomes.

• Education and awareness can lift decades of stigma and misunderstanding.

With better seizure control, appropriate treatment, and community education, individuals living with epilepsy can lead fulfilling, independent, and dignified lives.