Perceived stigma in drug-resistant epilepsy: Association with vagus nerve stimulation and disease burden

Stigma is an important psychosocial problem in patients with drug-resistant epilepsy (DRE). Although vagus nerve stimulation (VNS) may improve seizure control, its association with perceived stigma remains unclear. This study evaluated the relationship between VNS and perceived stigma in patients with DRE.

In this single-center cross-sectional study, 70 patients with DRE were enrolled, including 35 patients with implanted VNS and 35 without VNS. Perceived stigma was assessed using the Stigma Scale for Epilepsy, and the individual impact of epilepsy was evaluated using the Personal Impact of Epilepsy Scale (PIES). Multivariable regression analysis was performed to identify factors independently associated with perceived stigma.

Patients with VNS had significantly higher total stigma scores and higher social isolation, discrimination, insufficiency, and false beliefs subscale scores (all p ≤ 0.003). Moderate-to-high stigmatization was more frequent in the VNS group (p < 0.001). VNS treatment was remained associated with higher stigma scores in multivariable regression analysis. Patients in the VNS group had a younger age at epilepsy onset, longer disease duration, and used a greater number of antiseizure medications (all p ≤ 0.003). Total PIES and seizure effect scores were also higher in patients with VNS (p = 0.039 and p = 0.025, respectively). PIES scores showed significant positive correlations with stigma subscale and total stigma scores.

Patients with DRE treated with VNS appear to experience a greater burden of perceived stigma. The persistence of this association after adjustment for demographic and clinical factors suggests that psychosocial aspects of VNS treatment warrant greater attention.