Knowledge of epilepsy in the general population based on two French cities: Implications for stigma Florentina Rafael a , Catherine-Marie Dubreuil a , Francis Burbaud b , Duc Si Tran a , Jean-Pierre Clement a,c , Pierre-Marie Preux a , Philippe Nubukpo a,c, * a Institut de Neurologie Tropicale, Université de Limoges, Limoges, France b Observatoire Régional de la Santé (ORS) du Limousin et Santé Service Limousin, Limoges, France c Service de Psychiatrie, CHU Limoges, Limoges, France article info Article history: Received 22 August 2009 Revised 11 October 2009 Accepted 12 October 2009 Available online 11 November 2009 Keywords: France Epilepsy Stigma Knowledge Culture abstract The objective of this study was to assess the knowledge and attitudes of people living in two French coun- ties. The data were collected from 1777 adults in the general population who were interviewed. Knowl- edge of and attitudes toward epilepsy in these French samples proved largely favorable: 90.6% identified epilepsy as different from a mental disorder or lunacy, and 79.2% correctly identified epilepsy as a brain disorder. The majority agreed with the statements that people with epilepsy should have the opportunity to get married and that children with epilepsy should be allowed to go to school with others. However, gaps in knowledge and erroneous beliefs prevailed, notably among men, old people, and individuals with low levels of education. This study yielded encouraging results. However, further studies are needed to confirm these findings and gain a better understanding of the contribution of French public knowledge to the causative factors generating stigma in France. Ó 2009 Elsevier Inc. All rights reserved. 1. Introduction Epilepsy is a universal disorder that affects nearly 50 million people in the world, including 500,000 in France. Despite this uni- versality and the fact that it is one of the most common neurolog- ical diseases worldwide, epilepsy has long been considered as a curse from the gods, a demonic possession, or a form of lunacy [1–3]. With the development of medical technology, a significant breakthrough in knowledge of epilepsy was achieved both at the diagnostic (with a clear nosography of the various seizures) and therapeutic (chemical and surgical) levels. Despite this revolution in the understanding and care of epilepsy, it remains a disease that sparks fear and rejection [4]. This is not without consequences on people with epilepsy, who are often the victims of the prejudice that results from misunderstanding, discrimination, and exclusion [5,6]. Epilepsy is a stigmatized condition causing familial and social problems, as well as professional disqualifications. The concept of stigma was formulated in 1963 by Goffman as an attribute that marks people as different and which leads to deval- uation [7]. Goffman suggested that stigma can be visible (infirmity, skin color) or invisible (being a recipient of psychiatric counseling). The individuals to whom the stigma is physically visible and recog- nizable may immediately become ‘‘discredited” and their problem is control of the interaction disturbed by the existence of this stig- ma. In contrast, those who carry invisible stigma are potentially ‘‘discreditable” if the stigmatizing features are revealed and their problem becomes the control of information about this stigma. According to this theory, epilepsy constitutes a stigmatizing condi- tion with a dual nature, as the stigma can be visible or invisible. Stigma is commonly identified as one of the greatest burdens of epilepsy and as a burden with the most impact on quality of life [8,9]. It often causes persons with epilepsy more suffering than the attacks themselves. Many authors have shown that attitudes toward persons with epilepsy are influenced by the degree of knowledge of the condi- tion [4,5,10]. Therefore, an understanding of the knowledge, atti- tudes, and practices with respect to epilepsy in a community provides a basis for developing strategies aimed at reducing the misconceptions and social stigma associated with this condition [11]. For the last 10 years, the number of studies evaluating the knowledge, attitudes, and practices with respect to epilepsy has markedly increased, and the progressive emergence of positive public attitudes toward persons with epilepsy in developed coun- tries has already been demonstrated [11]. Studies addressing this issue in developed countries have gen- erally been conducted in the United Kingdom, the United States, 1525-5050/$ - see front matter Ó 2009 Elsevier Inc. All rights reserved. doi:10.1016/j.yebeh.2009.10.014 * Corresponding author. Address: Institut de Neurologie Tropicale, Faculté de Médecine, Université de Limoges, IFR 145 GEIST, EA 3174 NeuroEpidémiologie Tropicale et Comparée, 2 rue du Dr. Marcland, 87025 Limoges, France. Fax: +33 5 55 43 58 21. E-mail addresses: philippe.nubukpo@9online.fr, ient@unilim.fr (P. Nubukpo). Epilepsy & Behavior 17 (2010) 82–86 Contents lists available at ScienceDirect Epilepsy & Behavior journal homepage: www.elsevier.com/locate/yebeh