Theory of Mind in Patients with Temporal Lobe Epilepsy

Abstract

Theory of mind (ToM) is a crucial aspect of social cognition and is mediated by a complex neural network. Studies on temporal lobe epilepsy (TLE) suggest that its neuropathological involvement includes several brain regions. Some regions seem to overlap the neural network responsible for ToM, and this overlap provides an opportunity to explore ToM in TLE patients. Another concern is psychosocial problems in TLE, and the study of ToM in TLE could serve as a basis for further understanding the nature of such psychosocial disturbances. Studies on whether TLE patients evidence ToM deficit, however, are scant and controversial. Consequently, we examine whether ToM deficit is evident in TLE. Thirty-one TLE patients and 24 matched controls were recruited and completed four tasks measuring different levels of ToM: false belief, faux pas recognition, processing of implied meanings, and cartoon ToM. The patients were impaired in both basic and advanced ToM. Right TLE had a more wide-ranging picture of deficit than left TLE. ToM appears to be vulnerable to TLE, especially on the right side. Since ToM might contribute to patients' psychosocial adjustment, we thus suggest that a ToM measure be included in regular neuropsychological assessments of such patients.

Relationship between social competence and neurocognitive performance in children with epilepsy

“…As generalized epilepsy involves epileptic activity in both brain hemispheres, it may cause a more severe impairment of cognitive and social skills than partial epilepsy, which usually involves one brain hemisphere. There are many studies that focus on cognitive abilities in partial epilepsy [17,18], but unfortunately, not enough attention to generalized epilepsy to date still. It is important to note that unfortunately, there were only 10 children with generalized epilepsy participating in our study; therefore, results regarding lower social and cognitive abilities in the group with generalized epilepsy need to be interpreted with caution.…”

“…The main brain regions associated with ToM are the medial prefrontal cortex, temporal lobes, temporoparietal junction, and superior temporal sulcus [15,16]. Adults with frontal lobe epilepsy have diminished ability to understand other's thoughts, humor, emotions, and eye gaze expressions [17]; adults with temporal lobe epilepsy also have diminished ability to understand other's thoughts and beliefs [18]. Children and adolescents with epilepsy are at risk of deficit in social cognition by having less ability to recognize facial expressions and to understand thoughts and motivations of others [19,20].…”

Social cognition and prefrontal cognitive function in patients with epilepsy treated with eslicarbazepine acetate

“…Since ToM develops during childhood and early adolescence [3], we believe that any ToM impairment in these patients would likely be caused by the etiology of epilepsy, the seizures that occur, or the AED treatment received. The incidence and type of drug-related adverse events recorded were in line with previous clinical reports, and no relevant drug-related psychiatric events were reported during the study [12].…”

“…Epilepsy is a chronic disorder characterized by an enduring predisposition to experience recurrent seizures, which are often associated with neurobehavioral comorbidities, including cognitive impairment, psychiatric disorders, and social problems that may have an impact on the patient's quality of life [1][2][3][4].…”

“…ToM, which is essential for social interaction, develops mainly during childhood and adolescence [3] and includes cognitive perspective-taking (cognitive ToM) and emotional understanding (affective ToM).…”