Abstracts

Rationale: Genetic generalised epilepsy (GGE) is a common childhood-onset epilepsy, which is associated with widespread social difficulties. In clinical care, these social difficulties are often undetected and untreated, placing children at risk of ongoing social problems (isolation and stigma) as adults. Gaps in current clinical care are partly due to limited understanding of factors underpinning social difficulties in children with GGE.  Recent theoretical models purport that impairments in social cognition, especially Theory of Mind (ToM), which is the ability to understand the thoughts and emotions of others and oneself, might contribute to social difficulties in this group. Yet, research into ToM in this group is lacking. The aim of this study is to examine ToM and social competence in children with GGE, and explore how they relate to neurocognitive and epilepsy variables. Methods: Twenty-two children with GGE (8 to 16 years old) and 22 typically developing controls completed two behavioural ToM tasks (faux-pas, strange stories) and standardised neuropsychological tests assessing intellectual quotient (IQ) and executive functioning (EF). Parents completed questionnaires assessing ToM and social competence. Neurologists completed the Global Assessment Severity of Epilepsy (GASE) scale as a measure of epilepsy severity. Interviews with parents were used to obtain epilepsy-related information (i.e., age of seizure onset, duration of seizures, seizure frequency, period of untreated seizures and anti-epileptic drugs [AEDs]). Results: Compared to control children, children with GGE had significantly (i) lower IQ (pp=0.002) and inhibition (p=0.001), (ii) reduced social competence (p=0.007, d=1.55) and more peer problems (p=0.008, d=0.93), and (iii) decreased ToM, which was evident across ToM tasks and domains [cognitive ToM (pd=1.25) and affective ToM (pd=1.77)]. Impairments in ToM and social competence were evidence while controlling for IQ and EFs. In children with GGE, reduced social competence was associated with lower ToM (N=22, r=0.58, p=0.001). Clinical risk factors identified were: (i) higher daily dosage of valproate, which was associated with reduced affective ToM (N=13, r=–0.65, p=0.016), (ii) higher daily dosages of lamotrigine and ethosuximide, which were associated with reduced social competence (N=6, r=-0.98, p=0.005) and more peer problems (N=5, r=0.872, p=0.044), respectively, and (iii) greater epilepsy severity on the GASE, which was associated with reduced social competence (N=22, r=–0.840, p=0.001) and more peer problems (N=22, r=0.675 p=0.016). Conclusions: This study revealed several novel findings. First, ToM impairments in children with GGE are very large in magnitude, global, and associated with everyday social difficulties. Second, children with GGE on higher dosages of commonly prescribed AEDs and with greater epilepsy severity are at risk of ToM deficits and reduced social competence. These findings could assist in detection and development of screening procedures for social difficulties in children with GGE, which are currently lacking.  Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.