Stigma as social comorbidity in epilepsy.

Empirical evidence confirms both the pervasiveness and the significant impact of stigma among people with epilepsy (PWE). Despite being one of the most extensively studied neurological disorders, epilepsy continues to carry a disproportionate social burden across cultures and historical periods. Stigma is not only a psychological consequence but also a chronic social determinant of health that negatively affects quality of life, social participation, and long-term outcomes. Recent research highlights the multidimensional nature of epilepsy-related stigma, including internalized, enacted, and intersectional forms, and its interaction with emotional, relational, and structural factors. While seizure control remains a central goal of clinical care, it rarely eliminates the social and psychological consequences of stigma. We propose conceptualizing epilepsy-related stigma as a "social comorbidity": a chronic, co-evolving social condition that exacerbates disability, constrains life opportunities, and requires targeted interventions beyond conventional biomedical treatment. Addressing stigma effectively demands integrated strategies that combine psychosocial support, community engagement, policy reform, and public education, aiming to facilitate genuine social recovery and inclusion for PWE. Recognizing stigma as a social comorbidity reframes epilepsy care and research, emphasizing that clinical gains alone are insufficient without addressing the enduring social and relational consequences of the disorder.