Being with virtual others: studying social cognition in temporal lobe epilepsy

Temporal lobe epilepsy alters neural responses to human and avatar facial expressions in the face perception network

BACKGROUND AND OBJECTIVE

Although avatars are now widely used in advertisement, entertainment, and business today, no study has investigated whether brain lesions in neurological patients interfere with brain activation in response to dynamic avatar facial expressions. The aim of our event-related fMRI study was to compare brain activation differences in people with epilepsy and controls during the processing of fearful and neutral dynamic expressions displayed by human or avatar faces.

METHODS

Using functional magnetic resonance imaging (fMRI), we examined brain responses to dynamic facial expressions of trained actors and their avatar look-alikes in 16 people with temporal lobe epilepsy (TLE) and 26 controls. The actors' fearful and neutral expressions were recorded on video and conveyed onto their avatar look-alikes by face tracking.

RESULTS

Our fMRI results show that people with TLE exhibited reduced response differences between fearful and neutral expressions displayed by humans in the right amygdala and the left superior temporal sulcus (STS). Further, TLE was associated with reduced response differences between human and avatar fearful expressions in the dorsal pathway of the face perception network (STS and inferior frontal gyrus) as well as in the medial prefrontal cortex.

CONCLUSIONS

Taken together, these findings suggest that brain responses to dynamic facial expressions are altered in people with TLE compared to neurologically healthy individuals-regardless of whether the face is human or computer-generated. In TLE, areas sensitive to dynamic facial features and associated with processes relating to the self and others are particularly affected when processing dynamic human and avatar expressions. Our findings highlight that the impact of TLE on facial emotion processing must be extended to artificial faces and should be considered when applying dynamic avatars in the context of neurological conditions.

The association of psychosocial variables with adherence to antiepileptic drugs in patients with temporal lobe epilepsy

OBJECTIVE

The aim of this study was to explore the association between psychosocial factors and adherence to antiepileptic drugs (AEDs) in patients with temporal lobe epilepsy (TLE).

METHODS

This cross-sectional study was conducted with 123 individuals with TLE, admitted to our epilepsy center from December 2015 to May 2017. The participants completed standardized self-report questionnaires measuring medication adherence, anxiety, depression, and family and social support. Adherence was measured by the 8-item Morisky Medication Adherence Scale (MMAS), and logistic regression was used to examine statistically significant associations of different variables with adherence.

RESULTS

We found a 33.3% rate of poor AED adherence. Moderate-to-severe anxiety (odds ratio (OR)=2.851, 95% confidence interval (CI)=1.138-7.144, P=0.025) and the presence of hippocampal sclerosis (OR=3.098, 95% CI=1.259-7.620, P=0.014) were positively associated with poor adherence to antiepileptic drugs. Social support (OR=0.925, 95% CI=0.863-0.990, P=0.025) was negatively associated with poor adherence. Neither depression nor family support was associated with adherence.

CONCLUSION

One-third of patients with TLE were prone to poor AED adherence, especially individuals with hippocampal sclerosis. Intervention approaches designed to improve AED adherence in patients with TLE should focus on psychosocial factors.

Impaired social cognition in patients with interictal epileptiform discharges in the frontal lobe

BACKGROUND

Patients with epilepsy frequently experience cognitive impairments, including impairments in social cognition. However, there is a lack of direct examinations of the affective and cognitive aspects of social cognition in such patients. The neural correlates remain to be identified. The present study was designed to examine the degree of impairments in different aspects of social cognition including empathy, emotion recognition, and Theory of Mind (ToM) in patients with epilepsy. In addition, we further explored factors related to the impairments, highlighting the specific importance of the frontal region.

MATERIALS AND METHODS

After 24-hour EEG monitoring, 53 patients with epilepsy were administered a neuropsychological battery of tests for basic intelligence assessment and then were tested with the Interpersonal Reactive Index, the "Yoni" task, the Emotion Recognition Test, the Reading the Mind in the Eyes test, and other neuropsychological tests. The clinical variables potentially affecting the ability to accomplish these tests were taken into account. We divided the patients into those having frontal lobe interictal epileptiform discharges (group with frontal IEDs) and those with seizures originating outside the frontal or temporal lobes (group with extrafrontal IEDs). Sixty healthy individuals served as controls.

RESULTS

The group with frontal IEDs achieved the most severe deficits in emotion recognition, ToM, and cognitive empathy, while affective empathy was intact. Moreover, the performance scores of empathy in the group with frontal IEDs were selectively correlated with their executive function scores, which are believed to be associated with orbitofrontal functioning. In contrast, patients with epilepsies not originating from the frontal or temporal lobes may also be at risk of impairments in social cognition, albeit to a lesser extent.

CONCLUSIONS

The preliminary findings suggest that patients with epilepsy, especially those having frontal lobe interictal epileptiform discharges, have associated general social cognition deficits. At the clinical level, these results are in line with previous findings regarding social cognition and the importance of the prefrontal area in the integration of cognition and affect. At the theoretical level, our findings also provide evidence for the functional independence of cognitive from affective aspects of empathy.

Working memory retrieval differences between medial temporal lobe epilepsy patients and controls: a three memory layer approach

Multi-store models of working memory (WM) have given way to more dynamic approaches that conceive WM as an activated subset of long-term memory (LTM). The resulting framework considers that memory representations are governed by a hierarchy of accessibility. The activated part of LTM holds representations in a heightened state of activation, some of which can reach a state of immediate accessibility according to task demands. Recent neuroimaging studies have studied the neural basis of retrieval information with different states of accessibility. It was found that the medial temporal lobe (MTL) was involved in retrieving information within immediate access store and outside this privileged zone. In the current study we further explored the contribution of MTL to WM retrieval by analyzing the consequences of MTL damage to this process considering the state of accessibility of memory representations. The performance of a group of epilepsy patients with left hippocampal sclerosis in a 12-item recognition task was compared with that of a healthy control group. We adopted an embedded model of WM that distinguishes three components: the activated LTM, the region of direct access, and a single-item focus of attention. Groups did not differ when retrieving information from single-item focus, but patients were less accurate retrieving information outside focal attention, either items from LTM or items expected to be in the WM range. Analyses focused on items held in the direct access buffer showed that consequences of MTL damage were modulated by the level of accessibility of memory representations, producing a reduced capacity.

Differential role of the Mentalizing and the Mirror Neuron system in the imitation of communicative gestures

Successful social interaction requires recognising the intention of another person's communicative gestures. At a neural level, this process may involve neural activity in different systems, such as the mentalizing system (MS) and the mirror neuron system (MNS). The aim of the present study was to explore the neural correlates of communicative gestures during observation and execution of these gestures. Twenty participants watched video clips of an actor executing social gestures (S), non-social gestures (NS) and meaningless gestures (ML). During fMRI data acquisition, participants were asked to observe (O) and subsequently to execute (E) one of two tasks: imitate the gesture presented (IMI) or perform a motor control task (CT). For the contrast IMI>CT we found activations in the core areas of the MNS [inferior parietal lobule (IPL) and inferior frontal cortex, the posterior part of pars opercularis], as well as in areas related to the MS [superior temporal sulcus (STS) and middle cingulate cortex]. For S>NS, we found activations in the left medial orbitofrontal cortex (mOFC), right superior frontal cortex and middle cingulate cortex. The interaction of stimulus condition (S vs NS) and task (IMI vs CT) revealed activation in the right IPL. For the interaction between observation vs execution (O vs E), task (IMI vs CT) and stimulus condition (S vs NS) we found activation in the right mOFC. Our data suggest that imitation is differentially processed in the MNS as well as in the MS. The activation in IPL is enhanced during the processing of social gestures most likely due to their communicative intention. The activation of IPL together with medial frontal areas may contribute to mentalizing processes. The interaction in the mOFC suggests an involvement of self-referential processes in the processing of social gesture.

Sustained neural activity to gaze and emotion perception in dynamic social scenes

To understand social interactions, we must decode dynamic social cues from seen faces. Here, we used magnetoencephalography (MEG) to study the neural responses underlying the perception of emotional expressions and gaze direction changes as depicted in an interaction between two agents. Subjects viewed displays of paired faces that first established a social scenario of gazing at each other (mutual attention) or gazing laterally together (deviated group attention) and then dynamically displayed either an angry or happy facial expression. The initial gaze change elicited a significantly larger M170 under the deviated than the mutual attention scenario. At around 400 ms after the dynamic emotion onset, responses at posterior MEG sensors differentiated between emotions, and between 1000 and 2200 ms, left posterior sensors were additionally modulated by social scenario. Moreover, activity on right anterior sensors showed both an early and prolonged interaction between emotion and social scenario. These results suggest that activity in right anterior sensors reflects an early integration of emotion and social attention, while posterior activity first differentiated between emotions only, supporting the view of a dual route for emotion processing. Altogether, our data demonstrate that both transient and sustained neurophysiological responses underlie social processing when observing interactions between others.

Remote effects of hippocampal sclerosis on effective connectivity during working memory encoding: a case of connectional diaschisis?

Accumulating evidence suggests a role for the medial temporal lobe (MTL) in working memory (WM). However, little is known concerning its functional interactions with other cortical regions in the distributed neural network subserving WM. To reveal these, we availed of subjects with MTL damage and characterized changes in effective connectivity while subjects engaged in WM task. Specifically, we compared dynamic causal models, extracted from magnetoencephalographic recordings during verbal WM encoding, in temporal lobe epilepsy patients (with left hippocampal sclerosis) and controls. Bayesian model comparison indicated that the best model (across subjects) evidenced bilateral, forward, and backward connections, coupling inferior temporal cortex (ITC), inferior frontal cortex (IFC), and MTL. MTL damage weakened backward connections from left MTL to left ITC, a decrease accompanied by strengthening of (bidirectional) connections between IFC and MTL in the contralesional hemisphere. These findings provide novel evidence concerning functional interactions between nodes of this fundamental cognitive network and sheds light on how these interactions are modified as a result of focal damage to MTL. The findings highlight that a reduced (top-down) influence of the MTL on ipsilateral language regions is accompanied by enhanced reciprocal coupling in the undamaged hemisphere providing a first demonstration of "connectional diaschisis."

Recognition profile of emotions in natural and virtual faces

Background

Computer-generated virtual faces become increasingly realistic including the simulation of emotional expressions. These faces can be used as well-controlled, realistic and dynamic stimuli in emotion research. However, the validity of virtual facial expressions in comparison to natural emotion displays still needs to be shown for the different emotions and different age groups.

Methodology/Principal Findings

Thirty-two healthy volunteers between the age of 20 and 60 rated pictures of natural human faces and faces of virtual characters (avatars) with respect to the expressed emotions: happiness, sadness, anger, fear, disgust, and neutral. Results indicate that virtual emotions were recognized comparable to natural ones. Recognition differences in virtual and natural faces depended on specific emotions: whereas disgust was difficult to convey with the current avatar technology, virtual sadness and fear achieved better recognition results than natural faces. Furthermore, emotion recognition rates decreased for virtual but not natural faces in participants over the age of 40. This specific age effect suggests that media exposure has an influence on emotion recognition.

Conclusions/Significance

Virtual and natural facial displays of emotion may be equally effective. Improved technology (e.g. better modelling of the naso-labial area) may lead to even better results as compared to trained actors. Due to the ease with which virtual human faces can be animated and manipulated, validated artificial emotional expressions will be of major relevance in future research and therapeutic applications.