Abstracts

Rationale: Decision making (DM) is a complex process that includes weighing short and long-term costs and gains of different options. DM is a dynamic interaction between an impulsive system, which responds to immediate outcomes, and a reflective system, which controls long-term outcomes, with a profitable choice strategy. Implicit DM is determined by implicit outcomes and probabilities with effective information by means of processing feedback of previous choices. In contrast, some decision contains explicit information about the potential consequences of the choices and their probabilities are provided. This type of DM is termed DM under risk, usually measured by the Game of Dice Task (GDT). There is evidence that implicit DM is impaired in patients with JME (Wandschneider et al., 2013; Zamarian et al., 2013), however to date there is no evaluation of explicit DM in this group of patients. Therefore, we aimed to evaluate explicit DM in JME and its correlation with epilepsy-related factors. Methods: We evaluated 25 patients with JME (mean age 29.04 [SD 9.05]; 17 females [68%]; mean IQ of 99.9 [SD 13.8]) and 25 matched controls (mean age 31.12 years; 14 [56%] female; mean IQ of 102.7 [SD 13.7]) using computerized GDT. The GDT has explicit rules for gains, losses and probabilities are available from the beginning of the task. In the GDT, subjects are required to choose among four different options to maximize fictitious starting money, and the different options are explicitly related to a specific amount of gain/loss. Some options, which are related with high potential gains/losses but low winning probabilities are risky; and other options, which are related with lower potential gains/losses but higher winning probabilities are non-risky. Thus, subjects can estimate the risk related with each option and may apply strategies to maximize profit. The association with epilepsy-related factors (i.e. age of onset, duration of epilepsy, seizure control for GTC, seizure control for myoclonic seizures, seizure control for absence seizures, refractoriness, AEDs ?" mono versus polytherapy). Group differences were analyzed with statistical tests for nonparametric data. Data were analyzed using SPSS Statistics Version 17.0 (SPSS Inc., Chicago, IL, U.S.A.). Chi-square tests were applied to categorical data. Results: The study showed higher scores in the JME group in number of risky decisions (p 0.016), lower scores on secure decision (p 0.034) and lower scores on net-scores (p 0.023). Epilepsy-related factors were not associated with GDT scores. Conclusions: Patients with JME showed impairment on decision making process even when receiving explicit information about the potential consequences of their choices, regardless intelligence and seizure control. This finding adds a new piece of evidence on the understanding of the risk taking behavior presented by these patients. Funding: None