Objective To explore the relationship between the marital quality and psychological stress in patients with epilepsy. Methods In the paired-case control study, 40 adult married epilepsy out-patients and 40 normal controls were investigated with Enrich Marital Inventory, self-rating depression scale (SDS), self-rating anxiety scale (SAS), and psycho-social stress scale (PSS) to analyze the marital quality and the psychological stress of the two groups. Results The marital satisfaction, personality issues, conflict resolution, financial management, and leisure activities of the patients scored significantly lower than those of the controls (P<0.05). The scores of SAS, SDS, stress emotion reaction (SER), stress physical reaction (SPR) and negative coping (NC) were significantly higher in patients than in controls (P<0.01). The scores of positive coping (PC) was significantly lower in patients than in controls (P<0.01). The total scores of marital quality were negatively correlated with epileptic seizure type, total SDS and SAS scores, while positively correlated with the scores of PC and social support. In addition, regression analysis showed that three factors were involved, including depression (β=-1.324), epileptic seizure type (β=-31.771) and family support (β=5.192). Conclusion The marital quality of patients with epilepsy is lower than that of the controls. The patients suffer significant anxiety, depression and stress, whose marital quality is closely related with epileptic seizure type, anxiety, depression, social support and coping style.