Impact of medical and surgical treatment on stigma among people with epilepsy: A systematic review

OBJECTIVE: The stigma surrounding epilepsy affects medication adherence, psychosocial well-being, and quality of life. While medical and surgical interventions aim for seizure control, their impact on stigma remains unclear. We appraised published literature examining the relationship between epilepsy treatment and stigma. METHODS: We conducted a systematic review across PubMed, Embase, PsycINFO, Web of Science, and Scopus to identify studies examining how epilepsy treatment affects stigma among people with epilepsy. We included studies providing quantitative assessments of stigma in relation to medical treatment or surgical interventions. Given the heterogeneity of study designs and outcomes, we synthesized data narratively. Risk of bias was evaluated using the Joanna Briggs Institute Critical Appraisal Tools. This systematic review is registered on PROSPERO (CRD42024526560). RESULTS: Ten studies were analyzed: seven on medical treatment (three cross-sectional, three cohort studies, and one randomized trial) and three on surgical interventions (cohort studies). Medical treatments also yielded mixed results, with stigma reductions linked to improved seizure control and psychosocial outcomes. Surgical interventions were frequently associated with reduced stigma; however, findings vary with some data indicating that stigma does not significantly decrease following epilepsy surgery. Studies from low- and middle-income countries reported persistent stigma driven by limited access and cultural barriers. SIGNIFICANCE: Evidence suggests surgical treatment may reduce perceived stigma among people with epilepsy, though it is based on limited studies. Outcomes of medical treatment vary significantly, as they are influenced by seizure control, psychosocial support, and healthcare access. Further research is required to fully elucidate the relationships between treatment interventions, stigma, and different socio-economic contexts.