The affective value of faces in patients achieving long-term seizure freedom after temporal lobectomy

Dynamic facial emotion recognition and affective prosody recognition are associated in patients with temporal lobe epilepsy

Deficits in facial emotion recognition have frequently been established in temporal lobe epilepsy (TLE). However, static, rather than dynamic emotion recognition paradigms have been applied. Affective prosody has been insufficiently studied in TLE, and there is a lack of studies investigating associations between auditory and visual emotion recognition. We wished to investigate potential deficits in a dynamic morph task of facial emotion recognition and in an affective prosody recognition task, as well as associations between both tasks. 25 patients with TLE and 24 healthy controls (CG) performed a morph task with faces continuously changing in their emotional intensity. They had to press a button, as soon as they were able to recognize the emotion expressed, and label it accordingly. In the auditory task, subjects listened to neutral sentences spoken in varying emotional tones, and labeled the emotions. Correlation analyses were conducted across both tasks. TLE patients showed significantly reduced prosody recognition compared to CG, and in the morph task, there was a statistical trend towards significantly reduced performance for TLE. Recognition rates in both tasks were significantly associated. TLE patients show deficits in affective prosody recognition, and they may also be impaired in a morph task with dynamically changing facial expressions. Impairments in basic social-cognitive tasks in TLE seem to be modality-independent.

Revisiting emotion recognition in different types of temporal lobe epilepsy: The influence of facial expression intensity

Temporal lobe epilepsy (TLE) can induce various difficulties in recognizing emotional facial expressions (EFE), particularly for negative valence emotions. However, these difficulties have not been systematically examined according to the localization of the epileptic focus. For this purpose, we used a forced-choice recognition task in which faces expressing fear, sadness, anger, disgust, surprise, or happiness were presented in different intensity levels from moderate to high intensity. The first objective of our study was to evaluate the impact of emotional intensity on the recognition of different categories of EFE in TLE patients compared to control participants. The second objective was to assess the effect of localizationof epileptic focus on the recognition of EFE in patients with medial temporal lobe epilepsy (MTLE) associated or not with hippocampal sclerosis (HS), or lateral temporal lobe epilepsy (LTLE). The results showed that the 272 TLE patients and the 68 control participants were not differently affected by the intensity of EFE. However, we obtained group differences within the clinical population when we took into account the localization of the temporal lobe epileptic focus. As predicted, TLE patients were impaired in recognizing fear and disgust relative to controls. Moreover, the scores of these patients varied according to the localization of the epileptic focus, but not according to the cerebral lateralization of TLE. The facial expression of fear was less well recognized by MTLE patients, with or without HS, and the expression of disgust was less well recognized by LTLE as well as MTLE without HS patients. Moreover, emotional intensity modulated differently the recognition of disgust and surprise of the three patient groups underlying the relevance of using moderate emotional intensity to distinguish the effect of epileptic focus localization. These findings should be taken into account for interpreting the emotional behaviors and deserve to befurther investigated before considering TLE surgical treatment or social cognition interventions in TLE patients.

Toward social neuropsychology of epilepsy: a meta-analysis on social cognition in epilepsy phenotypes and a critical narrative review on assessment methods

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.

Theory of mind and facial emotion recognition in adults with temporal lobe epilepsy: A meta-analysis

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.

Emotion recognition and theory of mind after temporal lobe epilepsy surgery: A systematic review

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.

Emotional reactivity in mesial temporal lobe epilepsy: A pilot study

PURPOSE

Emotional reactivity (ER) is the early rapidly evoked response to a salient emotional stimulus which influences an individual's coping mechanisms, eliciting adaptive responses. We investigated ER in patients with mesial temporal lobe epilepsy (MTLE) in order to obtain an emotion-processing measure that can be related to behavioral regulation.

METHODS

We measured ER in twelve patients with (MTLE) using the International Affective Picture System (IAPS), the most widely employed instrument to measure ER, and compared their results with those of a matched sample of healthy subjects. Ninety color pictures depicting events with different kinds of affective valence (pleasant, unpleasant, and neutral) were shown to the patients. Unpleasant and pleasant pictures were also distinguished depending on whether or not they involved social human conditions. The ER was rated on the basis of valence and arousal.

RESULTS

Patients with MTLE showed higher mean arousal and valence ratings than controls for neutral and socially pleasant pictures. A higher valence for unpleasant pictures and a trend toward significantly higher arousal and valence for pleasant pictures were also recorded.

CONCLUSIONS

Patients with MTLE seem to feel the environment in a more sensitive and positive way compared with controls, likely in relationship with social functioning alterations.

Facial emotion perception in patients with epilepsy: A systematic review with meta-analysis

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.

Social cognition in temporal lobe epilepsy: A systematic review and meta-analysis

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.

Third International Congress on Epilepsy, Brain and Mind: Part 1

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.

Arousal in response to neutral pictures is modified in temporal lobe epilepsy

The objectives of the present study were to (i) better characterize visual emotional experience in patients with temporal lobe epilepsy (TLE), (ii) identify clinical risk factors that might be predictive of a change in emotional experience, and (iii) study the relationships between emotional experience and psychobehavioral/quality-of-life factors. Fifty patients with TLE and fifty matched controls evaluated the emotional content of unpleasant, pleasant, and neutral pictures with respect to their valence (unpleasant-to-pleasant) and arousal (low-to-high) levels. Demographic, cognitive, and psychobehavioral data were recorded for all participants, and clinical data and factors related to quality of life were also collected for patients with TLE. There were no significant differences between the group with TLE and the control group in terms of valence evaluations. However, arousal scores for neutral pictures were significantly higher in patients with TLE than in controls. There was also a nonsignificant trend towards lower arousal scores for pleasant pictures in patients with TLE than in controls. Although none of the recorded clinical factors were found to be related to emotional experience, the level of apathy was predictive of greater arousal experience for neutral pictures in patients with TLE. In conclusion, emotional experience appears to be modified in TLE and might be related to apathy. Changes in emotional experience should be taken into account in studies in which neutral stimuli are used to establish a baseline level when assessing emotional and cognitive processing.