OBJECTIVE: We examined people with epilepsy (PWE) regarding presenteeism, an aspect of reduced work productivity due to health-related issues despite physical presence, with a focus on epilepsy treatment and psychosocial factors. METHODS: We used data from 32,000 participants aged 16-83 years old that were obtained through a 2024 nationwide internet survey. The Work Functioning Impairment Scale, which measures "presenteeism," was used to compare participants with and without a history of epilepsy. Odds ratios for presenteeism were calculated using univariable and multivariable analyses with two models based on sociodemographic and health-related variables. Propensity score matching was applied to equate groups with and without epilepsy in health-related variables. RESULTS: Among 29,268 participants with valid responses, those with current epilepsy (n = 351) and in remission (n = 429) exhibited significantly higher presenteeism (p <
0.0001) and psychological distress (p <
0.0001) versus participants without epilepsy (n = 28,488). Multivariable analysis confirmed current epilepsy was independently associated with higher presenteeism (odds ratio: 2.61
95 % confidence interval: 2.05-3.33, p <
0.0001) in the sociodemographic model. After propensity score matching of 277 non-epilepsy and epilepsy participants, presenteeism remained significantly higher in current epilepsy patients versus those without (44.0 % vs. 28.2 %, p <
0.0001). When further adjusted for psychological disorders, the difference in presenteeism became negligible (46.2 % vs. 44.0 %, p = 0.716). SIGNIFICANCE: This cross-sectional study confirms significant presenteeism in PWE, which persists even in remission cases. This suggests that multiple causal conditions, rather than epileptic activity itself, affect presenteeism. As the epilepsy effect on presenteeism substantially decreases when accounting for psychological disorders, addressing these disorders may promote social productivity in PWE.