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Social Cognition in Temporal and Frontal Lobe Epilepsy: Systematic Review, Meta-analysis, and Clinical Recommendations. J Int Neuropsychol Soc 2023; 29:205-229. [PMID: 35249578 DOI: 10.1017/s1355617722000066] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Despite the importance of social cognitive functions to mental health and social adjustment, examination of these functions is absent in routine assessment of epilepsy patients. Thus, this review aims to provide a comprehensive overview of the literature on four major aspects of social cognition among temporal and frontal lobe epilepsy, which is a critical step toward designing new interventions. METHOD Papers from 1990 to 2021 were reviewed and examined for inclusion in this study. After the deduplication process, a systematic review and meta-analysis of 44 and 40 articles, respectively, involving 113 people with frontal lobe epilepsy and 1482 people with temporal lobe epilepsy were conducted. RESULTS Our results indicated that while patients with frontal or temporal lobe epilepsy have difficulties in all aspects of social cognition relative to nonclinical controls, the effect sizes were larger for theory of mind (g = .95), than for emotion recognition (g = .69) among temporal lobe epilepsy group. The frontal lobe epilepsy group exhibited significantly greater impairment in emotion recognition compared to temporal lobe. Additionally, people with right temporal lobe epilepsy (g = 1.10) performed more poorly than those with a left-sided (g = .90) seizure focus, specifically in the theory of mind domain. CONCLUSIONS These data point to a potentially important difference in the severity of deficits within the emotion recognition and theory of mind abilities depending on the laterlization of seizure side. We also suggest a guide for the assessment of impairments in social cognition that can be integrated into multidisciplinary clinical evaluation for people with epilepsy.
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2
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Eicher M, Jokeit H. Toward social neuropsychology of epilepsy: a meta-analysis on social cognition in epilepsy phenotypes and a critical narrative review on assessment methods. ACTA EPILEPTOLOGICA 2022. [DOI: 10.1186/s42494-022-00093-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The aim of this review is to (a) characterize social cognition impairments in the domains of emotion recognition (ER) and theory of mind (ToM) in patients with epilepsy and (b) to review assessment tools with a focus on their validity and usability in clinical practice.
Methods
An electronic search for clinical studies investigating social cognition in epilepsy populations vs healthy control subjects (HC) yielded 53 studies for the meta-analysis and descriptive review.
Results
Results suggest that (1) social cognition is significantly impaired in patients with temporal lobe epilepsy (TLE), frontal lobe epilepsy (FLE) and patients with epilepsy not originating within the temporal or frontal lobes including idiopathic generalized epilepsies (eTLE/eFLE); (2) there is no significant difference between eTLE/eFLE and TLE regarding ER, while TLE and FLE patients perform worse than those with eTLE/eFLE, without significant differences between FLE and TLE regarding ToM ability. A descriptive analysis of the most commonly used assessment tools and stimulus material in this field revealed a lack of ecological validity, usability, and economic viability for everyday clinical practice.
Conclusions
Our meta-analysis shows that patients with epilepsy are at a significantly increased risk of deficits in social cognition. However, the underlying multifactorial mechanisms remain unclear. Future research should therefore specifically address the impairment of processing and methodological problems of testing.
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Reisch LM, Wegrzyn M, Mielke M, Mehlmann A, Woermann FG, Bien CG, Kissler J. Face processing and efficient recognition of facial expressions are impaired following right but not left anteromedial temporal lobe resections: Behavioral and fMRI evidence. Neuropsychologia 2022; 174:108335. [PMID: 35863496 DOI: 10.1016/j.neuropsychologia.2022.108335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 07/04/2022] [Accepted: 07/11/2022] [Indexed: 10/17/2022]
Abstract
Anteromedial temporal lobe structures seem to support processing of faces and facial expressions. However, differential effects of unilateral left or right temporal lobe resections (TLR) on face processing, recognition of facial expressions, and on BOLD response to faces in intact brain areas are not yet fully understood. Therefore, we compared 39 patients with unilateral TLR (18 left, 21 right) and 20 healthy controls regarding recognition of facial identity and emotional facial expressions as well as BOLD response to fearful and neutral faces. We found impaired recognition of facial identity following right TLR, which was paralleled by reduced BOLD response to faces irrespective of expression in the right fusiform and lingual gyrus in postsurgical fMRI. Right TLR patients also exhibited subtle impairments of emotion recognition as they needed higher intensity of facial expressions for correct responses in a morphing task. Accuracy of emotion recognition and subjective appraisals of facial expressions did not differ between groups. There was no specific reduction of BOLD response to fearful versus neutral faces in either patient group. Our results underline the specific role of the right anteromedial temporal lobe in processing of faces and facial expressions by showing changes in face processing following right TLR in behavioral as well as imaging data.
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Affiliation(s)
- Lea Marie Reisch
- Department of Psychology, Bielefeld University, Bielefeld, Germany; Department of Epileptology (Krankenhaus Mara), Bielefeld University, Campus Bielefeld-Bethel, Bielefeld, Germany.
| | - Martin Wegrzyn
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Malena Mielke
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | | | - Friedrich G Woermann
- Department of Epileptology (Krankenhaus Mara), Bielefeld University, Campus Bielefeld-Bethel, Bielefeld, Germany
| | - Christian G Bien
- Department of Epileptology (Krankenhaus Mara), Bielefeld University, Campus Bielefeld-Bethel, Bielefeld, Germany
| | - Johanna Kissler
- Department of Psychology, Bielefeld University, Bielefeld, Germany
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Qi L, Zhao J, Zhao P, Zhang H, Zhong J, Pan P, Wang G, Yi Z, Xie L. Theory of mind and facial emotion recognition in adults with temporal lobe epilepsy: A meta-analysis. Front Psychiatry 2022; 13:976439. [PMID: 36276336 PMCID: PMC9582667 DOI: 10.3389/fpsyt.2022.976439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/16/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Mounting studies have investigated impairments in social cognitive domains (including theory of mind [ToM] and facial emotion recognition [FER] in adult patients with temporal lobe epilepsy (TLE). However, to date, inconsistent findings remain. METHODS A search of PubMed, Web of Science, and Embase databases was conducted until December 2021. Hedges g effect sizes were computed with a random-effects model. Meta-regressions were used to assess the potential confounding factors of between-study variability in effect sizes. RESULTS The meta-analysis included 41 studies, with a combined sample of 1,749 adult patients with TLE and 1,324 healthy controls (HCs). Relative to HCs, adult patients with TLE showed large impairments in ToM (g = -0.92) and cognitive ToM (g = -0.92), followed by medium impairments in affective ToM (g = -0.79) and FER (g = -0.77). Besides, no (statistically) significant differences were observed between the magnitude of social cognition impairment in adult with TLE who underwent and those who did not undergo epilepsy surgery. Meta-regressions exhibited that greater severity of executive functioning was associated with more severe ToM defects, and older age was associated with more severe FER defects. CONCLUSIONS Results of this meta-analysis suggest that adult patients with TLE show differential impairments in the core aspects of social cognitive domains (including ToM and FER), which may help in planning individualized treatment with appropriate cognitive and behavioral interventions.
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Affiliation(s)
- Liang Qi
- Department of Neurosurgery, The Affiliated Huai'an Hospital of Xuzhou Medical University, The Second People's Hospital of Huai'an, Huaian, China
| | - Jing Zhao
- Department of Central Laboratory, The Sixth Affiliated Hospital of Nantong University, Yancheng Third People's Hospital, Yancheng, China
| | - PanWen Zhao
- Department of Central Laboratory, The Sixth Affiliated Hospital of Nantong University, Yancheng Third People's Hospital, Yancheng, China
| | - Hui Zhang
- Department of Central Laboratory, The Sixth Affiliated Hospital of Nantong University, Yancheng Third People's Hospital, Yancheng, China
| | - JianGuo Zhong
- Department of Neurology, The Sixth Affiliated Hospital of Nantong University, Yancheng Third People's Hospital, Yancheng, China
| | - PingLei Pan
- Department of Central Laboratory, The Sixth Affiliated Hospital of Nantong University, Yancheng Third People's Hospital, Yancheng, China.,Department of Neurology, The Sixth Affiliated Hospital of Nantong University, Yancheng Third People's Hospital, Yancheng, China
| | - GenDi Wang
- Department of Neurology, The Sixth Affiliated Hospital of Nantong University, Yancheng Third People's Hospital, Yancheng, China
| | - ZhongQuan Yi
- Department of Central Laboratory, The Sixth Affiliated Hospital of Nantong University, Yancheng Third People's Hospital, Yancheng, China
| | - LiLi Xie
- Department of Neurology, The Sixth Affiliated Hospital of Nantong University, Yancheng Third People's Hospital, Yancheng, China
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Mikula B, Lencsés A, Borbély C, Demeter G. Emotion recognition and theory of mind after temporal lobe epilepsy surgery: A systematic review. Seizure 2021; 93:63-74. [PMID: 34710833 DOI: 10.1016/j.seizure.2021.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 09/13/2021] [Accepted: 10/04/2021] [Indexed: 01/14/2023] Open
Abstract
In order to navigate in our complex social world successfully, it is crucial to maintain and practice cognitive skills that are dedicated to adaptive social functioning. Emerging evidence suggests that besides deficits in declarative memory, executive functions, and language, impairments in social cognition (SC, e.g., emotion recognition, theory of mind) are also present in temporal lobe epilepsy (TLE). The organic and psycho-social consequences of epilepsy surgery might have additional implications regarding this deficit. Here we qualitatively synthesize longitudinal and cross-sectional findings on SC after TLE surgery. A literature search using PubMed and Scopus identified 275 potential articles. Studies were eligible if they (1) included patients with a diagnosis of TLE, (2) included a healthy comparison group, (3) reported original research, (4) were published in peer-reviewed journals and in English language, (5) reported the intervention of epilepsy surgery. Articles that (1) were case studies, (2) did not focus on SC abilities, (3) used interviews or self-report questionnaires to examine SC functions were excluded. A total of 16 original studies assessing emotion recognition (ER) and/or theory of mind (ToM) matched our criteria. The literature suggests that neither ER nor ToM abilities change after surgery: post-surgery patients show similar impairment patterns to pre-surgery patients. Nevertheless, individual improvement or decline could be masked by group comparisons and results should be considered in light of methodological heterogeneity among studies.
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Affiliation(s)
- Bernadett Mikula
- Department of Cognitive Science, Budapest University of Technology and Economics, Budapest, Hungary.
| | - Anita Lencsés
- Department of Cognitive Science, Budapest University of Technology and Economics, Budapest, Hungary
| | - Csaba Borbély
- National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary
| | - Gyula Demeter
- Department of Cognitive Science, Budapest University of Technology and Economics, Budapest, Hungary; Rehabilitation Department of Brain Injuries, National Institute of Medical Rehabilitation, Budapest, Hungary
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Bertini C, Starita F, Passamonti C, Santoro F, Zamponi N, Michelucci R, Scarpazza C. Fear‐specific enhancement of tactile perception is disrupted after amygdala lesion. J Neuropsychol 2019; 14:165-182. [DOI: 10.1111/jnp.12178] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 11/13/2018] [Indexed: 01/20/2023]
Affiliation(s)
- Caterina Bertini
- Center for Studies and Research in Cognitive Neuroscience University of Bologna Italy
- Department of Psychology University of Bologna Italy
| | - Francesca Starita
- Center for Studies and Research in Cognitive Neuroscience University of Bologna Italy
- Department of Psychology University of Bologna Italy
| | - Claudia Passamonti
- Regional Center for Pediatric Epilepsy Department of Neuropsychiatry Ospedali Riuniti Ancona Italy
| | - Francesca Santoro
- Unit of Neurology IRCCS – Institute of Neurological Sciences of Bologna Bellaria Hospital Bologna Italy
| | - Nelia Zamponi
- Regional Center for Pediatric Epilepsy Department of Neuropsychiatry Ospedali Riuniti Ancona Italy
| | - Roberto Michelucci
- Unit of Neurology IRCCS – Institute of Neurological Sciences of Bologna Bellaria Hospital Bologna Italy
| | - Cristina Scarpazza
- Center for Studies and Research in Cognitive Neuroscience University of Bologna Italy
- Department of Psychology University of Bologna Italy
- Department of General Psychology University of Padova Italy
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7
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Facial emotion perception in patients with epilepsy: A systematic review with meta-analysis. Neurosci Biobehav Rev 2017; 83:212-225. [PMID: 29045812 DOI: 10.1016/j.neubiorev.2017.10.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 10/13/2017] [Accepted: 10/13/2017] [Indexed: 11/21/2022]
Abstract
Facial emotion perception is a fundamental social competency relying on a specialised, yet distributed, neural network. This review aimed to determine whether patients with epilepsy have facial emotion perception accuracy impairments overall, or for a subset of emotions (anger, disgust, happiness, sadness, fear, and surprise), and the relationship to epilepsy type, demographic/treatment variables, and brain organisation. Database searches used PRISMA guidelines with strict inclusion/exclusion criteria. Thirty included studies assessed patients with temporal lobe (TLE; n=709), frontocentral (FCE; n=22), and genetic generalised (GGE; n=48) epilepsy. Large deficits emerged in patients with epilepsy compared to controls (n=746; Hedges' g=0.908-1.076). Patients with TLE were significantly impaired on all emotions except surprise; patients with GGE were significantly impaired in anger, disgust, and fear perception. Meta-regression of patients with TLE revealed younger age at testing was associated with lower accuracy. This review provides evidence for marked global deficits of emotion perception in epilepsy, with differential emotion-specific impairment patterns in patients with TLE and GGE.
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8
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Richard AE, Scheffer IE, Wilson SJ. Features of the broader autism phenotype in people with epilepsy support shared mechanisms between epilepsy and autism spectrum disorder. Neurosci Biobehav Rev 2017; 75:203-233. [DOI: 10.1016/j.neubiorev.2016.12.036] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 12/15/2016] [Accepted: 12/20/2016] [Indexed: 12/29/2022]
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Bora E, Meletti S. Social cognition in temporal lobe epilepsy: A systematic review and meta-analysis. Epilepsy Behav 2016; 60:50-57. [PMID: 27179192 DOI: 10.1016/j.yebeh.2016.04.024] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 03/26/2016] [Accepted: 04/10/2016] [Indexed: 12/29/2022]
Abstract
OBJECTIVE There is increasing evidence suggesting that social cognitive abilities are impaired in temporal lobe epilepsy (TLE), the most common form of focal epilepsies. METHODS In this meta-analysis, 31 studies investigating theory of mind (ToM) and facial emotion recognition performances of 1356 patients with TLE (351 postsurgery) and 859 healthy controls were included. RESULTS Patients with TLE had significant deficits in ToM (d = 0.73–0.89) and recognition of facial emotions. There were no significant differences in severity of social cognitive deficits between patients with TLE with or without medial temporal lobectomy. Earlier onset of seizures was associated with ToM impairment. Right-sided TLE was associated with more severe deficits in recognition of fear, sadness, and disgust. CONCLUSIONS Social cognitive information processing is impaired in TLE, and the potential role of these deficits in functional impairment needs to be further investigated.
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Affiliation(s)
- Emre Bora
- The Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, VIC, Australia.
| | - Stefano Meletti
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Neurology Unit, NOCSAE Hospital, AUSL Modena, Italy
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10
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Korczyn AD, Schachter SC, Amlerova J, Bialer M, van Emde Boas W, Brázdil M, Brodtkorb E, Engel J, Gotman J, Komárek V, Leppik IE, Marusic P, Meletti S, Metternich B, Moulin CJA, Muhlert N, Mula M, Nakken KO, Picard F, Schulze-Bonhage A, Theodore W, Wolf P, Zeman A, Rektor I. Third International Congress on Epilepsy, Brain and Mind: Part 1. Epilepsy Behav 2015; 50:116-37. [PMID: 26276417 PMCID: PMC5256665 DOI: 10.1016/j.yebeh.2015.06.044] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 06/24/2015] [Indexed: 12/12/2022]
Abstract
Epilepsy is both a disease of the brain and the mind. Here, we present the first of two papers with extended summaries of selected presentations of the Third International Congress on Epilepsy, Brain and Mind (April 3-5, 2014; Brno, Czech Republic). Epilepsy in history and the arts and its relationships with religion were discussed, as were overviews of epilepsy and relevant aspects of social cognition, handedness, accelerated forgetting and autobiographical amnesia, and large-scale brain networks.
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Affiliation(s)
- Amos D Korczyn
- Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Steven C Schachter
- Consortia for Improving Medicine with Innovation and Technology, Harvard Medical School, Boston, MA, USA.
| | - Jana Amlerova
- Department of Neurology, Charles University, 2nd Faculty of Medicine, Motol University Hospital, Prague, Czech Republic
| | - Meir Bialer
- Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Walter van Emde Boas
- Department of EEG, Dutch Epilepsy Clinics Foundation (SEIN), Heemstede, The Netherlands; Epilepsy Monitoring Unit, Dutch Epilepsy Clinics Foundation (SEIN), Heemstede, The Netherlands
| | - Milan Brázdil
- Masaryk University, Brno Epilepsy Center, St. Anne's Hospital and School of Medicine, Brno, Czech Republic; Central European Institute of Technology (CEITEC), Brno, Czech Republic
| | - Eylert Brodtkorb
- Department of Neurology and Clinical Neurophysiology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Jean Gotman
- Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Vladmir Komárek
- Department of Paediatric Neurology, Charles University, 2nd Faculty of Medicine, Motol University Hospital, Prague, Czech Republic
| | - Ilo E Leppik
- MINCEP Epilepsy Care, University of Minnesota, Minneapolis, MN, USA; College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
| | - Petr Marusic
- Department of Neurology, Charles University, 2nd Faculty of Medicine, Motol University Hospital, Prague, Czech Republic
| | - Stefano Meletti
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Chris J A Moulin
- Laboratory for the Study of Learning and Development, University of Bourgogne, Dijon, France
| | - Nils Muhlert
- School of Psychology and Cardiff University Brain Research Imaging Centre, Cardiff University, Cardiff, Wales, UK
| | - Marco Mula
- Epilepsy Group, Atkinson Morley Regional Neuroscience Centre, St. George's Hospital, London, UK; Institute of Medical and Biomedical Sciences, St. George's University of London, London, UK
| | - Karl O Nakken
- National Centre for Epilepsy, Oslo University Hospital, Norway
| | - Fabienne Picard
- Department of Neurology, University Hospital and Medical School of Geneva, Switzerland
| | | | - William Theodore
- Clinical Epilepsy Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Peter Wolf
- Danish Epilepsy Centre Filadelfia, Dianalund, Denmark; Department of Clinical Medicine, Neurological Service, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Adam Zeman
- University of Exeter Medical School, St. Luke's Campus, Exeter, UK
| | - Ivan Rektor
- Masaryk University, Brno Epilepsy Center, St. Anne's Hospital and School of Medicine, Brno, Czech Republic; Central European Institute of Technology (CEITEC), Brno, Czech Republic
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Monti G, Meletti S. Emotion recognition in temporal lobe epilepsy: A systematic review. Neurosci Biobehav Rev 2015; 55:280-93. [DOI: 10.1016/j.neubiorev.2015.05.009] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 04/30/2015] [Accepted: 05/08/2015] [Indexed: 11/25/2022]
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12
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Selective amygdalohippocampectomy versus standard temporal lobectomy in patients with mesiotemporal lobe epilepsy and unilateral hippocampal sclerosis: post-operative facial emotion recognition abilities. Epilepsy Res 2015; 111:26-32. [DOI: 10.1016/j.eplepsyres.2015.01.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 12/16/2014] [Accepted: 01/09/2015] [Indexed: 11/20/2022]
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13
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Right mesial temporal lobe epilepsy impairs empathy-related brain responses to dynamic fearful faces. J Neurol 2015; 262:729-41. [PMID: 25572160 DOI: 10.1007/s00415-014-7622-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 12/17/2014] [Accepted: 12/19/2014] [Indexed: 12/30/2022]
Abstract
Unilateral mesial temporal lobe epilepsy (MTLE) has been associated with reduced amygdala responsiveness to fearful faces. However, the effect of unilateral MTLE on empathy-related brain responses in extra-amygdalar regions has not been investigated. Using functional magnetic resonance imaging, we measured empathy-related brain responses to dynamic fearful faces in 34 patients with unilateral MTLE (18 right sided), in an epilepsy (extra-MTLE; n = 16) and in a healthy control group (n = 30). The primary finding was that right MTLE (RMTLE) was associated with decreased activity predominantly in the right amygdala and also in bilateral periaqueductal gray (PAG) but normal activity in the right anterior insula. The results of the extra-MTLE group demonstrate that these reduced amygdala and PAG responses go beyond the attenuation caused by antiepileptic and antidepressant medication. These findings clearly indicate that RMTLE affects the function of mesial temporal and midbrain structures that mediate basic interoceptive input necessary for the emotional awareness of empathic experiences of fear. Together with the decreased empathic concern found in the RMTLE group, this study provides neurobehavioral evidence that patients with RMTLE are at increased risk for reduced empathy towards others' internal states and sheds new light on the nature of social-cognitive impairments frequently accompanying MTLE.
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The affective value of faces in patients achieving long-term seizure freedom after temporal lobectomy. Epilepsy Behav 2014; 36:97-101. [PMID: 24892756 DOI: 10.1016/j.yebeh.2014.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 04/30/2014] [Accepted: 05/05/2014] [Indexed: 11/23/2022]
Abstract
We investigated different aspects of facial expression evaluation in a homogeneous cohort of 42 seizure-free patients with 5 or more years of follow-up after temporal lobectomy (TL), with the aim of further characterizing the impairment in emotion and social cognition among patients. A group of healthy subjects matched for sex, age, and education served as controls. Four tasks of facial expression evaluation were used: (a) facial expression recognition, (b) rating of the intensity of facial expression, and (c) rating of valence (pleasantness) and (d) rating of arousal induced by facial expressions. Patients had a worse performance in the recognition task for all negative emotions, while no differences in intensity ratings were found. They also reported lower arousal ratings than controls for faces showing fear, anger, disgust, and neutral expressions, as well as lower valence ratings for all facial expressions except those showing happiness. Longer epilepsy duration before TL was negatively associated with ratings of arousal and intensity and positively associated with valence ratings for fearful facial expressions. This study showed that patients who become seizure-free after TL present long-term deficits in several aspects of facial expression evaluation. Longitudinal, prospective studies are needed to evaluate if social cognition improves or declines after TL.
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15
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Amlerova J, Cavanna AE, Bradac O, Javurkova A, Raudenska J, Marusic P. Emotion recognition and social cognition in temporal lobe epilepsy and the effect of epilepsy surgery. Epilepsy Behav 2014; 36:86-9. [PMID: 24892754 DOI: 10.1016/j.yebeh.2014.05.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Revised: 04/26/2014] [Accepted: 05/01/2014] [Indexed: 10/25/2022]
Abstract
The abilities to identify facial expression from another person's face and to attribute mental states to others refer to preserved function of the temporal lobes. In the present study, we set out to evaluate emotion recognition and social cognition in presurgical and postsurgical patients with unilateral refractory temporal lobe epilepsy (TLE). The aim of our study was to investigate the effects of TLE surgery and to identify the main risk factors for impairment in these functions. We recruited 30 patients with TLE for longitudinal data analysis (14 with right-sided and 16 with left-sided TLE) and 74 patients for cross-sectional data analysis (37 with right-sided and 37 with left-sided TLE) plus 20 healthy controls. Besides standard neuropsychological assessment, we administered an analog of the Ekman and Friesen test and the Faux Pas Test to assess emotion recognition and social cognition, respectively. Both emotion recognition and social cognition were impaired in the group of patients with TLE, irrespective of the focus side, compared with healthy controls. The performance in both tests was strongly dependent on the intelligence level. Beyond intelligence level, earlier age at epilepsy onset, longer disease duration, and history of early childhood brain injury predicted social cognition problems in patients with TLE. Epilepsy surgery within the temporal lobe seems to have neutral effect on patients' performances in both domains. However, there are a few individual patients who appear to be at risk of postoperative decline, even when seizure freedom is achieved following epilepsy surgery.
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Affiliation(s)
- Jana Amlerova
- Department of Neurology, Charles University in Prague, 2nd Faculty of Medicine, University Hospital Motol, Prague, Czech Republic
| | - Andrea E Cavanna
- Department of Neuropsychiatry, BSMHFT and University of Birmingham, UK; Institute of Neurology, University College London, UK; School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Ondrej Bradac
- Department of Neurosurgery, Charles University in Prague, 1st Faculty of Medicine, Central Military Hospital, Prague, Czech Republic
| | - Alena Javurkova
- Department of Psychology, University Hospital Motol, Prague, Czech Republic
| | | | - Petr Marusic
- Department of Neurology, Charles University in Prague, 2nd Faculty of Medicine, University Hospital Motol, Prague, Czech Republic; Department of Neurosurgery, Charles University in Prague, 1st Faculty of Medicine, Central Military Hospital, Prague, Czech Republic.
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16
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Ambiguous emotion recognition in temporal lobe epilepsy: the role of expression intensity. COGNITIVE AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2014; 13:452-63. [PMID: 23430725 DOI: 10.3758/s13415-013-0153-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The lateralization of emotion processing is currently debated and may be further explored by examining facial expression recognition (FER) impairments in temporal lobe epilepsy (TLE). Furthermore, there is also debate in the literature whether FER deficits in individuals with TLE are more pronounced in the right than in the left hemisphere. Individuals with TLE were tested with an FER task designed to be more sensitive than those classically used to shed light on this issue. A total of 25 right- and 32 left-TLE patients, candidates for surgery, along with controls, underwent an FER task composed of stimuli shown not only at full-blown intensities (100 %), but also morphed to lower-intensity display levels (35 %, 50 %, and 75 %). The results showed that, as compared to controls, right-TLE patients showed deficits in the recognition of all emotional categories. Furthermore, when considering valence, right-TLE patients were impaired only in negative emotion recognition, but no deficits for positive emotions were highlighted in left-TLE patients. Finally, only the right-TLE patients' impairment was found to be related to the age of epilepsy onset. Our work demonstrates that the FER deficits in TLE span multiple emotional categories and show manifestations dependent on the laterality of the epileptic focus. Taken together, our findings provide the strongest evidence for the right-hemisphere model, but they also partially support the valence model. We suggest that current models are not exhaustive at explaining emotional-processing cerebral control, and further that multistep models should be developed.
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Milesi V, Cekic S, Péron J, Frühholz S, Cristinzio C, Seeck M, Grandjean D. Multimodal emotion perception after anterior temporal lobectomy (ATL). Front Hum Neurosci 2014; 8:275. [PMID: 24839437 PMCID: PMC4017134 DOI: 10.3389/fnhum.2014.00275] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Accepted: 04/14/2014] [Indexed: 11/30/2022] Open
Abstract
In the context of emotion information processing, several studies have demonstrated the involvement of the amygdala in emotion perception, for unimodal and multimodal stimuli. However, it seems that not only the amygdala, but several regions around it, may also play a major role in multimodal emotional integration. In order to investigate the contribution of these regions to multimodal emotion perception, five patients who had undergone unilateral anterior temporal lobe resection were exposed to both unimodal (vocal or visual) and audiovisual emotional and neutral stimuli. In a classic paradigm, participants were asked to rate the emotional intensity of angry, fearful, joyful, and neutral stimuli on visual analog scales. Compared with matched controls, patients exhibited impaired categorization of joyful expressions, whether the stimuli were auditory, visual, or audiovisual. Patients confused joyful faces with neutral faces, and joyful prosody with surprise. In the case of fear, unlike matched controls, patients provided lower intensity ratings for visual stimuli than for vocal and audiovisual ones. Fearful faces were frequently confused with surprised ones. When we controlled for lesion size, we no longer observed any overall difference between patients and controls in their ratings of emotional intensity on the target scales. Lesion size had the greatest effect on intensity perceptions and accuracy in the visual modality, irrespective of the type of emotion. These new findings suggest that a damaged amygdala, or a disrupted bundle between the amygdala and the ventral part of the occipital lobe, has a greater impact on emotion perception in the visual modality than it does in either the vocal or audiovisual one. We can surmise that patients are able to use the auditory information contained in multimodal stimuli to compensate for difficulty processing visually conveyed emotion.
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Affiliation(s)
- Valérie Milesi
- Swiss Center for Affective Sciences, University of Geneva Geneva, Switzerland ; Neuroscience of Emotion and Affective Dynamics Laboratory, Department of Psychology, Faculty of Psychology and Educational Sciences, University of Geneva Geneva, Switzerland
| | - Sezen Cekic
- Swiss Center for Affective Sciences, University of Geneva Geneva, Switzerland ; Neuroscience of Emotion and Affective Dynamics Laboratory, Department of Psychology, Faculty of Psychology and Educational Sciences, University of Geneva Geneva, Switzerland
| | - Julie Péron
- Swiss Center for Affective Sciences, University of Geneva Geneva, Switzerland ; Neuroscience of Emotion and Affective Dynamics Laboratory, Department of Psychology, Faculty of Psychology and Educational Sciences, University of Geneva Geneva, Switzerland
| | - Sascha Frühholz
- Swiss Center for Affective Sciences, University of Geneva Geneva, Switzerland ; Neuroscience of Emotion and Affective Dynamics Laboratory, Department of Psychology, Faculty of Psychology and Educational Sciences, University of Geneva Geneva, Switzerland
| | - Chiara Cristinzio
- Swiss Center for Affective Sciences, University of Geneva Geneva, Switzerland ; Neuroscience of Emotion and Affective Dynamics Laboratory, Department of Psychology, Faculty of Psychology and Educational Sciences, University of Geneva Geneva, Switzerland ; Laboratory for Neurology and Imaging of Cognition, Department of Neurology and Department of Neuroscience, Medical School, University of Geneva Geneva, Switzerland
| | - Margitta Seeck
- Epilepsy Unit, Department of Neurology, Geneva University Hospital Geneva, Switzerland
| | - Didier Grandjean
- Swiss Center for Affective Sciences, University of Geneva Geneva, Switzerland ; Neuroscience of Emotion and Affective Dynamics Laboratory, Department of Psychology, Faculty of Psychology and Educational Sciences, University of Geneva Geneva, Switzerland
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Szaflarski JP, Allendorfer JB, Heyse H, Mendoza L, Szaflarski BA, Cohen N. Functional MRI of facial emotion processing in left temporal lobe epilepsy. Epilepsy Behav 2014; 32:92-9. [PMID: 24530849 DOI: 10.1016/j.yebeh.2014.01.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Revised: 01/15/2014] [Accepted: 01/20/2014] [Indexed: 11/19/2022]
Abstract
Temporal lobe epilepsy (TLE) may negatively affect the ability to recognize emotions. This study aimed to determine the cortical correlates of facial emotion processing (happy, sad, fearful, and neutral) in patients with well-characterized left TLE (LTLE) and to examine the effect of seizure control on emotion processing. We enrolled 34 consecutive patients with LTLE and 30 matched healthy control (HC) subjects. Participants underwent functional MRI (fMRI) with an event-related facial emotion recognition task. The seizures of seventeen patients were controlled (no seizure in at least 3months; LTLE-sz), and 17 continued to experience frequent seizures (LTLE+sz). Mood was assessed with the Beck Depression Inventory (BDI) and the Profile of Mood States (POMS). There were no differences in demographic characteristics and measures of mood between HC subjects and patients with LTLE. In patients with LTLE, fMRI showed decreased blood oxygenation level dependent (BOLD) signal in the hippocampus/parahippocampus and cerebellum in processing of happy faces and increased BOLD signal in occipital regions in response to fearful faces. Comparison of groups with LTLE+sz and LTLE-sz showed worse BDI and POMS scores in LTLE+sz (all p<0.05) except for POMS tension/anxiety (p=0.067). Functional MRI revealed increased BOLD signal in patients with LTLE+sz in the left precuneus and left parahippocampus for "fearful" faces and in the left periarcheocortex for "neutral" faces. There was a correlation between the fMRI and Total Mood Disturbance in the left precuneus in LTLE-sz (p=0.019) and in LTLE+sz (p=0.018). Overall, LTLE appears to have a relatively minor effect on the cortical underpinnings of facial emotion processing, while the effect of seizure state (controlled vs. not controlled) is more pronounced, indicating a significant relationship between seizure control and emotion processing.
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Affiliation(s)
- Jerzy P Szaflarski
- Department of Neurology, UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA; Center for Imaging Research, University of Cincinnati Academic Health Center, Cincinnati, OH, USA; Department of Neurology, University of Cincinnati Academic Health Center, Cincinnati, OH, USA.
| | - Jane B Allendorfer
- Department of Neurology, UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA; Center for Imaging Research, University of Cincinnati Academic Health Center, Cincinnati, OH, USA; Department of Neurology, University of Cincinnati Academic Health Center, Cincinnati, OH, USA
| | - Heidi Heyse
- Department of Neurology, University of Cincinnati Academic Health Center, Cincinnati, OH, USA; Department of Psychiatry, University of Cincinnati Academic Health Center, Cincinnati, OH, USA
| | - Lucy Mendoza
- Department of Neurology, University of Cincinnati Academic Health Center, Cincinnati, OH, USA
| | - Basia A Szaflarski
- Department of Neurology, UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nancy Cohen
- Department of Neurology, UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
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Cantalupo G, Meletti S, Miduri A, Mazzotta S, Rios-Pohl L, Benuzzi F, Pisani F, Tassinari CA, Cossu G. Facial emotion recognition in childhood: the effects of febrile seizures in the developing brain. Epilepsy Behav 2013; 29:211-6. [PMID: 23994831 DOI: 10.1016/j.yebeh.2013.07.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 07/04/2013] [Accepted: 07/07/2013] [Indexed: 01/16/2023]
Abstract
It has been documented that anteromedial temporal lobe dysfunction can cause impairment in emotional intelligence. In particular, medial temporal lobe epilepsy (MTLE) is associated with disorders in emotion recognition from facial expressions. About one-third of patients with MTLE experienced febrile seizures (FSs) during childhood. In the present study, we investigated facial emotion recognition ability in a group of 38 school-aged children with antecedent FSs and in an age- and sex-matched control group. Children with abnormal general visuoperceptual abilities were excluded. Children with FSs showed lower recognition scores versus controls in both matching (28.64 vs 33.47; p<.0001) and labeling (21.25 vs 23.03; p=.001) facial emotions. Our findings support the hypothesis that FSs can be associated during childhood with a dysfunction within the neural network subserving the processing of facial expressions of the basic emotions.
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Affiliation(s)
- Gaetano Cantalupo
- Child Neuropsychiatry Unit, Department of Neuroscience, University-Hospital of Parma, Via Gramsci 14, Parma, Italy; Department of Life and Reproduction Sciences, University of Verona, P.le Scuro 10, Verona, Italy.
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Korczyn AD, Schachter SC, Brodie MJ, Dalal SS, Engel J, Guekht A, Hecimovic H, Jerbi K, Kanner AM, Landmark CJ, Mares P, Marusic P, Meletti S, Mula M, Patsalos PN, Reuber M, Ryvlin P, Štillová K, Tuchman R, Rektor I. Epilepsy, cognition, and neuropsychiatry (Epilepsy, Brain, and Mind, part 2). Epilepsy Behav 2013; 28:283-302. [PMID: 23764496 PMCID: PMC5016028 DOI: 10.1016/j.yebeh.2013.03.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2013] [Indexed: 12/13/2022]
Abstract
Epilepsy is, of course, not one disease but rather a huge number of disorders that can present with seizures. In common, they all reflect brain dysfunction. Moreover, they can affect the mind and, of course, behavior. While animals too may suffer from epilepsy, as far as we know, the electrical discharges are less likely to affect the mind and behavior, which is not surprising. While the epileptic seizures themselves are episodic, the mental and behavioral changes continue, in many cases, interictally. The episodic mental and behavioral manifestations are more dramatic, while the interictal ones are easier to study with anatomical and functional studies. The following extended summaries complement those presented in Part 1.
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Affiliation(s)
- Amos D. Korczyn
- Sackler School of Medicine, Tel Aviv University, Ramat Aviv 69978, Israel
| | - Steven C. Schachter
- Center for Integration of Medicine and Innovative Technology, Harvard Medical School, Boston, MA, USA
| | | | - Sarang S. Dalal
- Zukunftskolleg & Department of Psychology, University of Konstanz, Germany
- Lyon Neuroscience Research Center (CRNL), INSERM U1028, CNRS UMR5292, University Lyon I, Brain Dynamics and Cognition Team, Lyon, France
| | | | - Alla Guekht
- Russian National Research Medical University, Moscow City Hospital No. 8 for Neuropsychiatry, Moscow, Russia
| | - Hrvoje Hecimovic
- Zagreb Epilepsy Center, Department of Neurology, University Hospital, Zagreb, Croatia
| | - Karim Jerbi
- Lyon Neuroscience Research Center (CRNL), INSERM U1028, CNRS UMR5292, University Lyon I, Brain Dynamics and Cognition Team, Lyon, France
| | - Andres M. Kanner
- Department of Neurology, University of Miami, Miller School of Medicine, Miami FL, USA
| | - Cecilie Johannessen Landmark
- Department of Pharmacy and Biomedical Science, Oslo, Norway
- Akershus University College of Applied Sciences, Oslo, Norway
| | - Pavel Mares
- Institute of Physiology, Academy of Sciences of the Czech Republic, Prague, Czech Republic
| | - Petr Marusic
- Department of Neurology, Charles University in Prague, 2nd Faculty of Medicine, Motol University Hospital, Prague, Czech Republic
| | - Stefano Meletti
- Department of Biomedical Sciences, Metabolism, and Neuroscience, University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Mula
- Amedeo Avogadro University, Novara, Italy
| | - Philip N. Patsalos
- Department of Clinical and Experimental Epilepsy, UCL-Institute of Neurology, London and Epilepsy Society, Chalfont St Peter, UK
| | - Markus Reuber
- Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Sheffield, UK
| | - Philippe Ryvlin
- Service de neurologie fonctionnelle et d’épileptologie, Hôpital Neurologique, HCL TIGER, CRNL, INSERM U1028, UMR-CNRS 5292, Université Lyon-1, Lyon, France
| | - Klára Štillová
- Masaryk University, Brno Epilepsy Center, St. Anne’s Hospital and School of Medicine, and Central European Institute of Technology (CEITEC), Brno, Czech Republic
| | - Roberto Tuchman
- Autism and Neurodevelopment Program, Miami Children’s Hospital Dan Marino Center, Departments of Neurology and Psychiatry, Herbert Wertheim College of Medicine, Florida International University, FL, USA
| | - Ivan Rektor
- Masaryk University, Brno Epilepsy Center, St. Anne’s Hospital and School of Medicine, and Central European Institute of Technology (CEITEC), Brno, Czech Republic
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Tanaka A, Akamatsu N, Yamano M, Nakagawa M, Kawamura M, Tsuji S. A more realistic approach, using dynamic stimuli, to test facial emotion recognition impairment in temporal lobe epilepsy. Epilepsy Behav 2013; 28:12-6. [PMID: 23648274 DOI: 10.1016/j.yebeh.2013.03.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 03/19/2013] [Accepted: 03/23/2013] [Indexed: 11/24/2022]
Abstract
To explore potentially impaired social functioning in patients with mesial temporal lobe epilepsy (MTLE), we evaluated facial emotion recognition (FER) using dynamic facial stimuli. We evaluated FER in 88 patients with MTLE, including 25 posttemporal lobectomy (PTL) patients, when they watched videos of actors expressing the six basic emotions of happiness, sadness, anger, fear, surprise, and disgust. Thirty-two healthy subjects were examined as controls. The relationships between task, performance, and neurophysiological and radiological variables potentially affecting the ability to recognize moving facial emotions were examined by multivariate analysis. Both the patients with MTLE and the PTL subset demonstrated significantly impaired FER compared with healthy controls. Of the six emotions, they showed impaired recognition of sadness, fear, and disgust. Facial emotion recognition was impaired in patients with chronic MTLE, particularly those with bilateral damage. Failure to recognize emotional expressions, particularly fear, disgust, and sadness, may contribute to difficulties in social functioning and relationship building.
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Affiliation(s)
- Akihiro Tanaka
- Department of Neurology, University of Occupational and Environmental Health School of Medicine, Kitakyusyu, Japan.
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Changes in functional integration with the non-epileptic temporal lobe of patients with unilateral mesiotemporal epilepsy. PLoS One 2013; 8:e67053. [PMID: 23818976 PMCID: PMC3688582 DOI: 10.1371/journal.pone.0067053] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 05/14/2013] [Indexed: 11/19/2022] Open
Abstract
Purpose To investigate epilepsy-induced changes in effective connectivity between the non-epileptic amygdalo-hippocampal complex (AHC) and the rest of the brain in patients with unilateral mesiotemporal lobe epilepsy (MTLE) associated with hippocampal sclerosis (HS). Methods Thirty-three patients with unilateral MTLE associated with HS (20 females, mean age: 36 years, 19 left HS) and 33 adult controls matched for age and gender underwent 18F-Fluorodeoxyglucose positron emission tomography (FDG-PET). Right-HS patients' FDG-PET data were flipped to obtain a left–epileptic–focus–lateralized group of patients. Voxels of interest (VOI) were selected within the cytoarchitectonic probabilistic maps of the non-epileptic AHC (probability level = 100%, SPM8 Anatomy toolbox v1.7). Patients and controls were compared using VOI metabolic activity as covariate of interest to search for epilepsy-induced changes in the contribution of the non-epileptic AHC to the level of metabolic activity in other brain areas. Age, gender, duration of epilepsy, seizure type and frequency were used as covariates of no-interest for connectivity analyses. Key findings Significant decrease in effective connectivity was found between the non-epileptic AHC and ventral prefrontal cortical areas bilaterally, as well as with the temporal pole and the posterior cingulate cortex contralateral to HS. Significant increase in connectivity was found between the non-epileptic AHC and midline structures, such as the anterior cingulate and dorsal medial prefrontal cortices, as well as the temporo-parietal junction bilaterally. Connectivity analyses also revealed a preserved positive connectivity between the non-epileptic and the epileptic AHC in the patients' group. Significance This study evidences epilepsy-induced changes in connectivity between the non-epileptic AHC and some limbic and default mode network areas. These changes in connectivity probably account for emotional, cognitive and decision-making impairments frequently observed in MTLE patients. The preserved neurometabolic connectivity between the non-epileptic and the epileptic AHC in MTLE patients is pivotal to explain the epilepsy-induced changes found in this study.
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Xi C, Zhu Y, Zhu C, Song D, Wang Y, Wang K. Deficit of theory of mind after temporal lobe cerebral infarction. Behav Brain Funct 2013; 9:15. [PMID: 23607361 PMCID: PMC3646669 DOI: 10.1186/1744-9081-9-15] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 04/12/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous studies have indicated that the temporal lobe is involved in theory of mind (ToM). However, little attention has been paid to ToM in patients with cerebral infarction. In this study, we investigated the ability of ToM in patients with temporal lobe cerebral infarction (TLCI) using a variety of tests. METHODS In the study, 19 patients with TLCI and 20 healthy controls (HC) were examined using the Recognition of faux pas and the Reading the Mind in the Eyes (RME) tasks, to assess their ability of ToM. RESULTS The results of the study indicated that the TLCI group performed significantly worse compared with the HC group as revealed in the total faux pas-related score and in emotion recognition (Mind Reading). CONCLUSIONS Our results implied that patients with TLCI had difficulty in ToM. Our data provided new evidence that the temporal lobe may be involved in processing ToM inferences.
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Affiliation(s)
- Chunhua Xi
- Neuropsychology Laboratory, Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Jixi Road, Anhui Province, Hefei 230022, China
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Brand JG, Mindt MR, Schaffer SG, Alper KR, Devinsky O, Barr WB. Emotion processing bias and age of seizure onset among epilepsy patients with depressive symptoms. Epilepsy Behav 2012; 25:552-7. [PMID: 23153721 DOI: 10.1016/j.yebeh.2012.09.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Revised: 09/15/2012] [Accepted: 09/17/2012] [Indexed: 11/18/2022]
Abstract
The current study examined whether mood-congruent biases in emotion processing extend to epilepsy patients with depressive symptoms and the potentially moderating effects of age of seizure onset on these biases. In addition, we examined associations between depression (Beck Depression Inventory - 2nd Edition; BDI-II) and quality of life (Quality of Life in Epilepsy - 10-item questionnaire; QOLIE-10). Data from 101 epilepsy patients were analyzed, including 61 females and 40 males. Measures included the Comprehensive Affect Testing System - Abbreviated (CATS-A), from which indices of mood-congruent bias were derived. A significant interaction between BDI-II raw scores and age of seizure onset was found for mood-congruent bias scores in the facial affect modality (β=-0.24, p<.03). Beck Depression Inventory - 2nd Edition raw scores were significantly and positively correlated with quality of life (QOLIE-10; r=.69, p<.01). Results of the current study show that epilepsy patients with an early age of seizure onset may be most at risk for mood-congruent biases when experiencing depressive symptoms and that such symptoms have real-world implications for quality of life for persons living with epilepsy.
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Affiliation(s)
- Jesse G Brand
- University of Virginia Health System, Charlottesville, VA, USA.
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Dellacherie D, Bigand E, Molin P, Baulac M, Samson S. Multidimensional scaling of emotional responses to music in patients with temporal lobe resection. Cortex 2011; 47:1107-15. [DOI: 10.1016/j.cortex.2011.05.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Revised: 04/02/2010] [Accepted: 11/22/2010] [Indexed: 11/16/2022]
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Gosselin N, Peretz I, Hasboun D, Baulac M, Samson S. Impaired recognition of musical emotions and facial expressions following anteromedial temporal lobe excision. Cortex 2011; 47:1116-25. [DOI: 10.1016/j.cortex.2011.05.012] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Revised: 05/03/2010] [Accepted: 11/17/2010] [Indexed: 10/18/2022]
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Bonora A, Benuzzi F, Monti G, Mirandola L, Pugnaghi M, Nichelli P, Meletti S. Recognition of emotions from faces and voices in medial temporal lobe epilepsy. Epilepsy Behav 2011; 20:648-54. [PMID: 21459049 DOI: 10.1016/j.yebeh.2011.01.027] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Revised: 01/25/2011] [Accepted: 01/27/2011] [Indexed: 10/18/2022]
Abstract
Patients with chronic medial temporal lobe epilepsy (MTLE) can be impaired in different tasks that evaluate emotional or social abilities. In particular, the recognition of facial emotions can be affected (Meletti S, Benuzzi F, Rubboli G, et al. Neurology 2003;60:426-31. Meletti S, Benuzzi F, Cantalupo G, Rubboli G, Tassinari CA, Nichelli P. Epilepsia 2009;50:1547-59). To better understand the nature of emotion recognition deficits in MTLE we investigated the decoding of basic emotions in the visual (facial expression) and auditory (emotional prosody) domains in 41 patients. Results showed deficits in the recognition of both facial and vocal expression of emotions, with a strong correlation between performances across the two tasks. No correlation between emotion recognition and measures of IQ, quality of life (QOLIE-31), and depression (Beck Depression Inventory) was significant, except for a weak correlation between prosody recognition and IQ. These data suggest that emotion recognition impairment in MTLE is not dependent on the sensory channel through which the emotional stimulus is transmitted. Moreover, these findings support the notion that emotional processing is at least partly independent of measures of cognitive intelligence.
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Affiliation(s)
- Annalisa Bonora
- Department of Neuroscience, Nuovo Ospedale Civile Sant'Agostino Estense, University of Modena e Reggio Emilia, Modena, Italy
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Dellacherie D, Hasboun D, Baulac M, Belin P, Samson S. Impaired recognition of fear in voices and reduced anxiety after unilateral temporal lobe resection. Neuropsychologia 2011; 49:618-29. [DOI: 10.1016/j.neuropsychologia.2010.11.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Revised: 11/02/2010] [Accepted: 11/09/2010] [Indexed: 11/29/2022]
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Giussani C, Pirillo D, Roux FE. Mirror of the soul: a cortical stimulation study on recognition of facial emotions. J Neurosurg 2010; 112:520-7. [DOI: 10.3171/2009.5.jns081522] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The capability of recognizing the expressions of facial emotions has been hypothesized to depend on a right hemispheric cortical-subcortical network. Its impairment deeply disturbs social relationships. To spare right hemispheric cortical areas involved in recognizing facial emotion, the authors used intraoperative cortical stimulation and the awake surgery technique in a consecutive series of patients. The feasibility and the interest to map them during brain mapping for neurosurgical procedures are discussed.
Methods
After a preoperative neuropsychological evaluation, 18 consecutive patients with right hemispheric lesions (5 metastases, 6 high-grade gliomas, 4 low-grade gliomas, 2 arteriovenous malformations, and 1 malignant meningioma) were tested by intraoperative cortical stimulation while performing a facial emotion recognition task along with sensorimotor and visuospatial tasks.
Results
Three hundred eighty-six cortical sites were studied. Five (1.30%) reproducible interference sites for facial emotion recognition were identified in 5 patients: 1 site in the medial segment of T1; 1 site in the posterior segment of T1; 1 site in the posterior segment of T2; and 2 sites in the supramarginal gyrus. No selective impairment was found regarding the emotion category. All facial emotion recognition sites were spared during surgery, and none of the patients experienced postoperative deficits in recognition of facial emotions.
Conclusions
The finding of interference sites in facial emotion recognition in the right posterior perisylvian area, independent to sensorimotor or visuospatial orientation processes, reinforces the theory about the role of anatomically and functionally segregated right hemisphere structures in this cognitive process. The authors advocate offering a brain mapping of facial emotion recognition to patients with right posterior perisylvian tumors.
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Affiliation(s)
- Carlo Giussani
- 1Institute National de la Santé et de la Recherche Médicale Unité 825 and L'Institut Fédératif de Recherche 96, Hôpital Purpan
- 2Pôle Neurosciences, Centre Hospitalier Universitaire, Hôpital Purpan; and
| | - David Pirillo
- 1Institute National de la Santé et de la Recherche Médicale Unité 825 and L'Institut Fédératif de Recherche 96, Hôpital Purpan
- 2Pôle Neurosciences, Centre Hospitalier Universitaire, Hôpital Purpan; and
| | - Franck-Emmanuel Roux
- 1Institute National de la Santé et de la Recherche Médicale Unité 825 and L'Institut Fédératif de Recherche 96, Hôpital Purpan
- 2Pôle Neurosciences, Centre Hospitalier Universitaire, Hôpital Purpan; and
- 3Université Paul-Sabatier, Toulouse, France
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Decision making under ambiguity and under risk in mesial temporal lobe epilepsy. Neuropsychologia 2010; 48:194-200. [DOI: 10.1016/j.neuropsychologia.2009.08.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Revised: 07/30/2009] [Accepted: 08/18/2009] [Indexed: 11/23/2022]
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Hermann BP, Lin JJ, Jones JE, Seidenberg M. The emerging architecture of neuropsychological impairment in epilepsy. Neurol Clin 2009; 27:881-907. [PMID: 19853214 PMCID: PMC2811050 DOI: 10.1016/j.ncl.2009.08.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
A new literature is now under way, one linking cognitive abnormalities directly to indices of structural, functional, metabolic, and other neurobiologic markers of cerebral integrity, independent of their association with clinical epilepsy characteristics. These trends are reviewed in this article. The focus is on temporal lobe epilepsy (TLE) as a model with which to address the core points because this form of localization-related epilepsy has been very carefully studied from both a cognitive and imaging standpoint. Some pertinent historical issues are touched on first, followed by more detailed reviews of the cognitive and neuroimaging abnormalities that have been found in TLE, followed by an overview of studies examining direct structure-function relationships in TLE and other epilepsies.
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Affiliation(s)
- Bruce P Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, 600 North Highland Avenue, Madison, WI 53792, USA.
| | - Jack J Lin
- Department of Neurology, University of California-Irvine, Irvine, CA 92697, USA
| | - Jana E Jones
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, 600 North Highland Avenue, Madison, WI 53792, USA
| | - Michael Seidenberg
- Department of Psychology, Rosalind Franklin School of Medicine and Science, 3333 N. Green Bay Road, North Chicago, IL 60064, USA
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Cristinzio C, N'Diaye K, Seeck M, Vuilleumier P, Sander D. Integration of gaze direction and facial expression in patients with unilateral amygdala damage. Brain 2009; 133:248-61. [PMID: 19828596 DOI: 10.1093/brain/awp255] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Affective and social processes play a major role in everyday life, but appropriate methods to assess disturbances in these processes after brain lesions are still lacking. Past studies have shown that amygdala damage can impair recognition of facial expressions, particularly fear, as well as processing of gaze direction; but the mechanisms responsible for these deficits remain debated. Recent accounts of human amygdala function suggest that it is a critical structure involved in self-relevance appraisal. According to such accounts, responses to a given facial expression may vary depending on concomitant gaze direction and perceived social meaning. Here we investigated facial emotion recognition and its interaction with gaze in patients with unilateral amygdala damage (n = 19), compared to healthy controls (n = 10), using computer-generated dynamic face stimuli expressing variable intensities of fear, anger or joy, with different gaze directions (direct versus averted). If emotion perception is influenced by the self-relevance of expression based on gaze direction, a fearful face with averted gaze should be more relevant than the same expression with direct gaze because it signals danger near the observer; whereas anger with direct gaze should be more relevant than with averted gaze because it directly threatens the observer. Our results confirm a critical role for the amygdala in self-relevance appraisal, showing an interaction between gaze and emotion in healthy controls, a trend for such interaction in left-damaged patients but not in right-damaged patients. Impaired expression recognition was generally more severe for fear, but with a greater deficit for right versus left damage. These findings do not only provide new insights on human amygdala function, but may also help design novel neuropsychological tests sensitive to amygdala dysfunction in various patient populations.
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Affiliation(s)
- Chiara Cristinzio
- Hôpitaux Universitaires de Genève, 24, rue Micheli-du-Crest, 1211 Geneva 14, Switzerland.
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Meletti S, Benuzzi F, Cantalupo G, Rubboli G, Tassinari CA, Nichelli P. Facial emotion recognition impairment in chronic temporal lobe epilepsy. Epilepsia 2009; 50:1547-59. [PMID: 19175397 DOI: 10.1111/j.1528-1167.2008.01978.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate facial emotion recognition (FER) in a cohort of 176 patients with chronic temporal lobe epilepsy (TLE). METHODS FER was tested by matching facial expressions with the verbal labels for the following basic emotions: happiness, sadness, fear, disgust, and anger. Emotion recognition performances were analyzed in medial (n = 140) and lateral (n = 36) TLE groups. Fifty healthy subjects served as controls. The clinical and neuroradiologic variables potentially affecting the ability to recognize facial expressions were taken into account. RESULTS The medial TLE (MTLE) group showed impaired FER (86% correct recognition) compared to both the lateral TLE patients (FER = 93.5%) and the controls (FER = 96.4%), with 42% of MTLE patients recording rates of FER that were lower [by at least 2 standard deviations (SDs)] than the control mean. The MTLE group was impaired compared to the healthy controls in the recognition of all basic facial expressions except happiness. The patients with bilateral MTLE were the most severely impaired, followed by the right and then the left MTLE patients. FER was not affected by type of lesion, number of antiepileptic drugs (AEDs), aura semiology, or gender. Conversely, the early onset of seizures/epilepsy was related to FER deficits. These deficits were already established in young adulthood, with no evidence of progression in older MTLE patients. CONCLUSION These results on a large cohort of TLE patients demonstrate that emotion recognition deficits are common in MTLE patients and widespread across negative emotions. We confirm that early onset seizures with right or bilateral medial temporal dysfunction lead to severe deficits in recognizing facial expressions of emotions.
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Affiliation(s)
- Stefano Meletti
- Department of Neurosciences, Nuovo Ospedale Civile S Agostino-Estense, University of Modena and Reggio Emilia, Modena, Italy.
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Labudda K, Frigge K, Horstmann S, Aengenendt J, Woermann FG, Ebner A, Markowitsch HJ, Brand M. Decision making in patients with temporal lobe epilepsy. Neuropsychologia 2009; 47:50-8. [DOI: 10.1016/j.neuropsychologia.2008.08.014] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2008] [Revised: 07/08/2008] [Accepted: 08/17/2008] [Indexed: 11/30/2022]
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Shamim S, Hasler G, Liew C, Sato S, Theodore WH. Temporal lobe epilepsy, depression, and hippocampal volume. Epilepsia 2008; 50:1067-71. [PMID: 19054394 DOI: 10.1111/j.1528-1167.2008.01883.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the relationship between hippocampal volume loss, depression, and epilepsy. BACKGROUND There is a significantly increased incidence of depression and suicide in patients with epilepsy. Both epilepsy and depression are associated with reduced hippocampal volumes, but it is uncertain whether patients with both conditions have greater atrophy than those with epilepsy alone. Previous studies used depression measures strongly weighted to current state, and did not necessarily assess the influence of chronic major depressive disorder ("trait"), which could have a greater impact on hippocampal volume. METHODS Fifty-five epilepsy patients with complex partial seizures (CPS) confirmed by electroencephalography (EEG) had three-dimensional (3D)-spoiled gradient recall (SPGR) acquisition magnetic resonance imaging (MRI) scans for hippocampal volumetric analysis. Depression screening was performed with the Beck Depression Inventory (BDI, 51 patients) and with the structured clinical inventory for DSM-IV (SCID, 34 patients). For the BDI, a score above 10 was considered mild to moderate, above 20 moderate to severe, and above 30 severe depression. MRI and clinical analysis were performed blinded to other data. Statistical analysis was performed with Systat using Student's t test and analysis of variance (ANOVA). RESULTS There was a significant interaction between depression detected on SCID, side of focus, and left hippocampal volume. Patients with a diagnosis of depression and a right temporal seizure focus had significantly lower left hippocampal volume. A similar trend for an effect of depression on right hippocampal volume in patients with a right temporal focus did not reach statistical significance. CONCLUSIONS Our results suggest that patients with right temporal lobe epilepsy and depression have hippocampal atrophy that cannot be explained by epilepsy alone.
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Affiliation(s)
- Sadat Shamim
- EEG Section, NINDS, NIH, Bethesda, Maryland, USA
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Hlobil U, Rathore C, Alexander A, Sarma S, Radhakrishnan K. Impaired facial emotion recognition in patients with mesial temporal lobe epilepsy associated with hippocampal sclerosis (MTLE-HS): Side and age at onset matters. Epilepsy Res 2008; 80:150-7. [PMID: 18468867 DOI: 10.1016/j.eplepsyres.2008.03.018] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2007] [Revised: 03/13/2008] [Accepted: 03/23/2008] [Indexed: 11/30/2022]
Abstract
To define the determinants of impaired facial emotion recognition (FER) in patients with mesial temporal lobe epilepsy associated with hippocampal sclerosis (MTLE-HS), we examined 76 patients with unilateral MTLE-HS, 36 prior to antero-mesial temporal lobectomy (AMTL) and 40 after AMTL, and 28 healthy control subjects with a FER test consisting of 60 items (20 each for anger, fear, and happiness). Mean percentages of the accurate responses were calculated for different subgroups: right vs. left MTLE-HS, early (age at onset <6 years) vs. late-onset, and before vs. after AMTL. After controlling for years of education, duration of epilepsy and number of antiepileptic drugs (AEDs) taken, on multivariate analysis, fear recognition was profoundly impaired in early-onset right MTLE-HS patients compared to other MTLE patients and control subjects. Happiness recognition was significantly better in post-AMTL MTLE-HS patients compared to pre-AMTL patients while anger and fear recognition did not differ. We conclude that patients with right MTLE-HS with age at seizure onset <6 years are maximally predisposed to impaired fear recognition. In them, right AMTL does not further worsen FER abilities. Longitudinal studies comparing FER in the same patients before and after AMTL will be required to refine and confirm our cross-sectional observations.
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Affiliation(s)
- Ulf Hlobil
- R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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Impaired social cognition 30 years after hemispherectomy for intractable epilepsy: the importance of the right hemisphere in complex social functioning. Epilepsy Behav 2008; 12:460-71. [PMID: 18222112 DOI: 10.1016/j.yebeh.2007.12.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2007] [Revised: 12/08/2007] [Accepted: 12/10/2007] [Indexed: 10/22/2022]
Abstract
Clinical research with individuals following hemispherectomy typically quantifies the success of surgical outcomes by focusing primarily on the achievement of seizure control and the preservation of general brain functions, such as movement, sensation, language, and memory. In addition to these outcomes, careful study of individuals following hemispherectomy also has the potential to contribute to our understanding of functional brain asymmetries involving other complex cognitive behaviors. In this study, we report preliminary evidence for the lateralization of social perception. We administered a series of neuropsychological tests that were developed to assess emotional recognition and the formation of social inferences and advanced social cognitive judgments, as they occur in everyday situations, to two adult participants who underwent complete anatomic left- or right-sided hemispherectomy. Our results show that despite a 30-year postsurgical period of recovery and consistent and high levels of family support and social engagement, distinct cognitive profiles are still evident between our right- and left-sided participants. In particular, participant S.M., who underwent an anatomic right hemispherectomy, showed the most severe impairments in identifying negative emotional expressions and conversational exchanges involving lies and sarcasm and in "mentalizing" the intent of others. In contrast, participant J.H., who underwent an anatomic left hemispherectomy was highly skilled interpersonally, despite evident language-related limitations, and showed only mild difficulties when asked to identify emotional expressions involving disgust and anger. These results suggest that the right hemisphere plays a particularly important role in social cognitive functioning and reasoning. Further examination of the extent of social perceptual difficulties prior to and following surgical intervention for epilepsy may guide the development of effective social skills training programs that can improve quality of life beyond seizure control.
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Golouboff N, Fiori N, Delalande O, Fohlen M, Dellatolas G, Jambaqué I. Impaired facial expression recognition in children with temporal lobe epilepsy: Impact of early seizure onset on fear recognition. Neuropsychologia 2008; 46:1415-28. [DOI: 10.1016/j.neuropsychologia.2007.12.019] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2007] [Revised: 12/17/2007] [Accepted: 12/19/2007] [Indexed: 11/25/2022]
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Abstract
The field of epilepsy has contributed significantly to localization of neurologic function, particularly in the neocortex. Methodologies such as cortical stimulation, positron emission tomography, functional MRI, trans-cranial magnetic stimulation, surgical resection, and magnetoencephalography have been used successfully in patients with epilepsy to locate specific functions, primarily for the purpose of defining eloquent cortex before surgical resections. The left hemisphere serves language-related functions and verbal memory in most people, whereas the right hemisphere serves some language function in addition to perceiving most components of music and other forms of nonverbal material. Both hemispheres cooperate in understanding spatial relationships. Studies in patients with developmental abnormalities have enriched our understanding of localization of function within the cortex. Future studies may help us understand the sequence in which specific regions are activated during specific tasks and determine which regions are necessary for tasks and which are supplementary. The ability to predict preoperatively the effect of removal of specific tissues would benefit surgical planning for all patients who undergo cortical resections, including those with epilepsy.
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Millichap JG. Recognition of Facial Expressions in ADHD. Pediatr Neurol Briefs 2006. [DOI: 10.15844/pedneurbriefs-20-9-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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