Editing Epilepsy (section)

==Society and culture==
{{See also|List of people with epilepsy}}Epilepsy has significant social and cultural implications that vary across regions and contexts. People with epilepsy may experience social stigma, legal restrictions, economic disadvantage, and barriers to education and employment. Public perceptions of the condition are shaped by cultural beliefs, media portrayals, and the level of awareness in a given society. Efforts by advocacy groups and international organizations aim to improve public understanding, reduce stigma, and promote access to care. Social consequences such as educational exclusion, unemployment, and social isolation further compound the impact on quality of life. Despite the availability of effective antiseizure medications and cost-effective treatment strategies, a large treatment gap persists in many countries, underscoring the need for strengthened health systems and public health interventions.

===Stigma===
[[Social stigma]] is commonly experienced by people with epilepsy worldwide, and it can have economic, social, and cultural consequences.<ref name="WHO2023" /><ref name="Boer2010">{{cite journal |vauthors=de Boer HM |date=December 2010 |title=Epilepsy stigma: moving from a global problem to global solutions |journal=Seizure |volume=19 |issue=10 |pages=630–636 |doi=10.1016/j.seizure.2010.10.017 |pmid=21075013 |doi-access=free}}</ref> Misconceptions about the condition — including beliefs that it is contagious, a form of madness, or caused by supernatural forces — persist in many communities. In parts of Africa, including Tanzania and Uganda, epilepsy is sometimes associated with spirit possession, witchcraft, or poisoning, and is incorrectly believed to be contagious.<ref name="Jil1999" /> Similar stigmatizing beliefs have been reported in other regions, such as India and China, where epilepsy may be cited as grounds for denying marriage.<ref name="WHO2012" /> In the United Kingdom, epilepsy was legally considered valid grounds for annulling a marriage until 1971.<ref name="Nel2012" />

Stigma can also affect how people respond to a diagnosis. Some individuals with epilepsy may deny having had seizures, fearing discrimination.<ref name="Nel2012" /> A 2024 cross-sectional study found that 64.8% of relatives of people with epilepsy reported experiencing moderate levels of stigma, which was associated with more negative attitudes toward the condition. Greater stigma was observed among relatives of patients with more frequent seizures or poor medication adherence.<ref>{{cite journal |last1=Erkal |first1=Emre |last2=Kiyak |first2=Emine |last3=Uren |first3=Yavuz |last4=Milanlioglu |first4=Aysel |date=October 2024 |title=Determination of stigma and attitude in relatives of patients with epilepsy |journal=Seizure: European Journal of Epilepsy |volume=121 |pages=64–69 |doi=10.1016/j.seizure.2024.07.022 |pmid=39089140}}</ref>

Negative perceptions of epilepsy can also affect educational opportunities and academic outcomes.<ref name="Jacoby2007">{{Cite journal |last=Jacoby |first=Ann |last2=Austin |first2=Joan K. |date=2007 |title=Social stigma for adults and children with epilepsy |url=https://onlinelibrary.wiley.com/doi/10.1111/j.1528-1167.2007.01391.x |journal=Epilepsia |language=en |volume=48 |issue=s9 |pages=6–9 |doi=10.1111/j.1528-1167.2007.01391.x |issn=1528-1167}}</ref> Children with epilepsy are at increased risk of underachievement in school due to a combination of neurological factors, m edication side effects, and the effects of social exclusion.<ref>{{Cite journal |last=Camfield |first=Carol S. |last2=Camfield |first2=Peter R. |date=2007 |title=Long‐term social outcomes for children with epilepsy |url=https://onlinelibrary.wiley.com/doi/10.1111/j.1528-1167.2007.01390.x |journal=Epilepsia |language=en |volume=48 |issue=s9 |pages=3–5 |doi=10.1111/j.1528-1167.2007.01390.x |issn=0013-9580}}</ref> These challenges can lead to long-term disadvantages in learning and social development. In some cases, students are placed in special education classes regardless of their actual cognitive abilities or excluded from school activities out of fear of seizures.

In adulthood, stigma can result in reduced employment opportunities and workplace discrimination. Adults with epilepsy are more likely to be unemployed or underemployed than the general population, a disparity often driven by employer concerns about safety, productivity, or liability.<ref name="Jacoby2007" /> Disclosure of an epilepsy diagnosis in job applications or interviews may lead to discrimination, although nondisclosure can limit access to workplace accommodations.

=== Economic impact ===
Epilepsy is associated with a substantial economic burden at both the individual and societal levels. Direct costs include expenses related to diagnosis, treatment, and long-term management, such as antiseizure medications and hospitalizations. Indirect costs may arise from lost productivity, unemployment, and premature death. In many countries, especially those with limited health infrastructure, individuals with epilepsy and their families often bear the majority of healthcare expenses out of pocket. A 2021 modeling study estimated the total global cost of epilepsy at approximately $119.27&nbsp;billion annually, based on per capita cost projections applied to an estimated 52.51 million people living with epilepsy worldwide, while accounting for the treatment gap.<ref>{{Cite journal |last=Begley |first=Charles |last2=Wagner |first2=Ryan G |last3=Abraham |first3=Annette |last4=Beghi |first4=Ettore |last5=Newton |first5=Charles |last6=Kwon |first6=Churl Su |last7=Labiner |first7=David |last8=Winkler |first8=Andrea S. |date=2022 |title=The global cost of epilepsy: A systematic review and extrapolation |url=https://onlinelibrary.wiley.com/doi/10.1111/epi.17165 |journal=Epilepsia |language=en |volume=63 |issue=4 |pages=892–903 |doi=10.1111/epi.17165 |issn=0013-9580}}</ref> The treatment gap — referring to the proportion of people with epilepsy who do not receive appropriate care — remains high in low- and middle-income countries, exacerbating the economic burden through avoidable seizures, injuries, and emergency care.
Seizures result in direct economic costs of about one billion dollars in the United States.<ref name="AFP2012" /> Epilepsy resulted in economic costs in Europe of around 15.5&nbsp;billion euros in 2004.<ref name="National Clinical Guideline 21_28" /> In India, epilepsy is estimated to result in costs of US$1.7&nbsp;billion or 0.5% of the GDP.<ref name="WHO2012" /> It is the cause of about 1% of emergency department visits (2% for emergency departments for children) in the United States.<ref name="pmid21109099">{{cite journal | vauthors = Martindale JL, Goldstein JN, Pallin DJ | title = Emergency department seizure epidemiology | journal = Emergency Medicine Clinics of North America | volume = 29 | issue = 1 | pages = 15–27 | date = February 2011 | pmid = 21109099 | doi = 10.1016/j.emc.2010.08.002 }}</ref>

=== Driving and legal restrictions ===
{{See also|Epilepsy and driving}}
Those with epilepsy are at about twice the risk of being involved in a [[motor vehicular collision]] and thus in many areas of the world are not allowed to drive or only able to drive if certain conditions are met.<ref name=Drive2012/> Diagnostic delay has been suggested to be a cause of some potentially avoidable motor vehicle collisions since at least one study showed that most motor vehicle accidents occurred in those with undiagnosed non-motor seizures as opposed to those with motor seizures at epilepsy onset.<ref>{{cite journal | vauthors = Pellinen J, Tafuro E, Yang A, Price D, Friedman D, Holmes M, Barnard S, Detyniecki K, Hegde M, Hixson J, Haut S, Kälviäinen R, French J | title = Focal nonmotor versus motor seizures: The impact on diagnostic delay in focal epilepsy | journal = Epilepsia | volume = 61 | issue = 12 | pages = 2643–2652 | date = December 2020 | pmid = 33078409 | doi = 10.1111/epi.16707 }}</ref> In some places physicians are required by law to report if a person has had a seizure to the licensing body while in others the requirement is only that they encourage the person in question to report it themselves.<ref name=Drive2012/> Countries that require physician reporting include Sweden, Austria, Denmark and Spain.<ref name=Drive2012/> Countries that require the individual to report include the UK and New Zealand, and physicians may report if they believe the individual has not already.<ref name=Drive2012/> In Canada, the United States and Australia the requirements around reporting vary by province or state.<ref name=Drive2012/> If seizures are well controlled most feel allowing driving is reasonable.<ref name=Epi2279/> The amount of time a person must be free from seizures before they can drive varies by country.<ref name=Epi2279/> Many countries require one to three years without seizures.<ref name=Epi2279/> In the United States the time needed without a seizure is determined by each state and is between three months and one year.<ref name=Epi2279>{{cite book|title=Epilepsy: a comprehensive textbook|year=2008|publisher=Wolters Kluwer Health/Lippincott Williams & Wilkins|location=Philadelphia|isbn=978-0-7817-5777-5|page=2279|url=https://books.google.com/books?id=6Kq4Zt2KOpcC&pg=PA2279|edition=2nd| veditors = Engel J, Pedley TA }}</ref>

Those with epilepsy or seizures are typically denied a pilot license.<ref>{{cite book| vauthors = Bor R |title=Aviation Mental Health: Psychological Implications for Air Transportation|year=2012|publisher=Ashgate Publishing|isbn=978-1-4094-8491-2|page=148|url=https://books.google.com/books?id=bS98mtcqRdUC&pg=PA148 }}</ref>
* In Canada if an individual has had no more than one seizure, they may be considered after five years for a limited license if all other testing is normal.<ref name="Ca2013">{{cite web|title=Seizure Disorders|url=http://www.tc.gc.ca/eng/civilaviation/publications/tp13312-2-neurology-seizure-2179.htm|work=Transport Canada|publisher=Government of Canada|access-date=29 December 2013|url-status=dead|archive-url=https://web.archive.org/web/20131230232523/http://www.tc.gc.ca/eng/civilaviation/publications/tp13312-2-neurology-seizure-2179.htm|archive-date=30 December 2013}}</ref> Those with febrile seizures and drug related seizures may also be considered.<ref name="Ca2013" />
* In the United States, the [[Federal Aviation Administration]] does not allow those with epilepsy to get a commercial pilot license.<ref>{{cite book| vauthors = Wilner AN |title=Epilepsy 199 answers: a doctor responds to his patients' questions|year=2008|publisher=Demos Health|location=New York|isbn=978-1-934559-96-3|page=52|url=https://books.google.com/books?id=_yVGV1_FP4wC&pg=RA1-PT52|edition=3rd|url-status=live|archive-url=https://web.archive.org/web/20160517061331/https://books.google.com/books?id=_yVGV1_FP4wC&pg=RA1-PT52|archive-date=17 May 2016}}</ref> Rarely, exceptions can be made for persons who have had an isolated seizure or febrile seizures and have remained free of seizures into adulthood without medication.<ref>{{cite web|title=Guide for Aviation Medical Examiners|url=http://www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide/app_process/exam_tech/item46/amd/nc/|work=Federal Aviation Administration|access-date=29 December 2013|url-status=live|archive-url=https://web.archive.org/web/20131017045628/http://www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide/app_process/exam_tech/item46/amd/nc/|archive-date=17 October 2013}}</ref>
* In the United Kingdom, a full [[national private pilot license]] requires the same standards as a professional driver's license.<ref name="Caa2013">{{cite web|title=National PPL (NPPL) Medical Requirements|url=http://www.caa.co.uk/default.aspx?catid=49&pagetype=90&pageid=12133|work=Civil Aviation Authority|access-date=29 December 2013|url-status=live|archive-url=https://web.archive.org/web/20131016233956/http://www.caa.co.uk/default.aspx?catid=49&pagetype=90&pageid=12133|archive-date=16 October 2013}}</ref> This requires a period of ten years without seizures while off medications.<ref>{{cite web|title=For Medical Practitioners: At a glance Guide to the current Medical Standards of Fitness to Drive|url=https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/258991/aagv1.pdf|access-date=29 December 2013|author=Drivers Medical Group|pages=8|year=2013|url-status=live|archive-url=https://web.archive.org/web/20131230235214/https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/258991/aagv1.pdf|archive-date=30 December 2013}}</ref> Those who do not meet this requirement may acquire a restricted license if free from seizures for five years.<ref name="Caa2013" />

=== Advocacy and support organizations ===
There are organizations that provide support for people and families affected by epilepsy. The ''Out of the Shadows'' campaign, a joint effort by the World Health Organization, the ILAE and the [[International Bureau for Epilepsy]], provides help internationally.<ref name=WHO2012/> In the United States, the [[Epilepsy Foundation]] is a national organization that works to increase the acceptance of those with the disorder, their ability to function in society and to promote research for a cure.<ref name=EFA>{{cite web|title=Epilepsy Foundation of America – EFA|url=http://healthfinder.gov/FindServices/Organizations/Organization.aspx?code=HR0238|website=Healthfinder.gov|publisher=[[US Department of Health and Human Services]]|access-date=28 July 2014|date=28 April 2011|url-status=live|archive-url=https://web.archive.org/web/20140716080153/http://healthfinder.gov/FindServices/Organizations/Organization.aspx?code=HR0238|archive-date=16 July 2014}}</ref> The Epilepsy Foundation, some hospitals, and some individuals also run support groups in the United States.<ref>{{cite book | veditors = Engel J, Pedley TA |title=Epilepsy: a comprehensive textbook|date=2008|publisher=Wolters Kluwer Health/Lippincott Williams & Wilkins |location=Philadelphia |isbn=978-0-7817-5777-5 |page=2245 |edition=2nd |url=https://books.google.com/books?id=6Kq4Zt2KOpcC&pg=PA2245}}</ref> In Australia, the [[Epilepsy Foundation of Victoria|Epilepsy Foundation]] provides support, delivers education and training and funds research for people living with epilepsy.

International Epilepsy Day (World Epilepsy Day) began in 2015 and occurs on the second Monday in February.<ref>{{cite journal | vauthors = Aleem MA | title = World epilepsy day | journal = Epilepsia | volume = 56 | issue = 2 | pages = 168 | date = February 2015 | pmid = 25404065 | doi = 10.1111/epi.12814 }}</ref><ref>{{cite journal | vauthors = Perucca E | title = Commentary: why an international epilepsy day? | journal = Epilepsia | volume = 56 | issue = 2 | pages = 170–171 | date = February 2015 | pmid = 25403985 | doi = 10.1111/epi.12813 | doi-access = free }}</ref>

[[Purple Day]], a different world-wide epilepsy awareness day for epilepsy, was initiated by a nine-year-old Canadian named Cassidy Megan in 2008, and is every year on 26 March.<ref>{{cite magazine|url=https://time.com/5215273/purple-day-epilepsy-awareness-day/|title=People Are Wearing Purple Today for Epilepsy Awareness Day. Here's What That Is|magazine=[[Time (magazine)|Time]]|date=26 March 2018| vauthors = Carr F |access-date=18 April 2018}}</ref>