Abstracts

While memory, language, and executive functions have been extensively studied in patients with mesial temporal lobe epilepsy (MTLE), investigations into advanced social cognitive abilities have been neglected despite knowledge that temporo-limbic structures are important in emotional processing and social cognition. This paucity of research could be due to the lack of readily apparent social deficits in patients with MTLE. Nevertheless, comprehensive clinical studies have revealed that psychosocial maladjustment is a serious problem in many patients with chronic epilepsies. Whether these maladjustments are due to dysfunctional social cognition remains an open question. However, the fact that psychosocial maladjustment and psychiatric comorbidity are more frequent in MTLE compared to other epilepsy syndromes may reflect a specific pathologic association.
In the present study we investigated the ability to detect social faux pas and studied possible mediating clinical and demographical variables in adult patients with MTLE compared to patients with an epilepsy not originating within the MTLE and healthy controls., 27 MTLE patients (16 were investigated pre- and 11 postoperatively), 27 patients with an extra-mesio-temporal epilepsy (except frontal lobe epilepsy) and 12 healthy controls performed a shortened version of the faux-pas test. The participant read the faux pas story silently and, to reduce memory demands, the story remained in front of the subject while questions were being asked. After each story the subject was asked four questions, three of them regarding interpersonal relations and emotional states and one control question. Correct answers required that the subject could (1) understand the faux pas correctly, that he (2) could impute the mental state of another and that he (3) could attribute emotions to another. A fourth question was asked to control for text comprehension. Additionally, we used standardized tests to measure intelligence. Only patients with intact reading comprehension abilities were included in the study., MTLE patients, both pre and postoperative, performed the faux pas test significantly worse than patients with extra-mesio-temporal lobe epilepsy and healthy controls (p [lt].0001, power = 1). The latter two groups showed comparable performance. No statistical association was found between the MTLE patients[apos] deficit in recognizing a faux pas and the variables IQ, age, age at seizure onset, and duration of epilepsy., We report for the first time that patients with MTLE are specifically impaired in recognising faux pas, suggesting that MTLE as such is a specific etiology of deficits in higher-order social cognition. Correlative behavioral and psychiatric studies are necessary to show whether faux pas deficits are related to impaired social interactions in family, educational, and vocational contexts., (Supported by Swiss Epilepsy Foundation, Novartis Switzerland AG.)