Social Cognition in Temporal and Frontal Lobe Epilepsy: Systematic review, Meta-analysis, and Clinical Recommendations

Abstract

Despite the importance of social cognitive functions to mental health and social adjustment, assessment of these functions is absent in routine epilepsy patients' examinations. Hence, there is a clear need for developing a clinical and practical assessment which is a critical step towards designing new interventions. To do so, we first need to gain a nuanced understanding of the difficulties patients face in different domains of social cognition, including emotion recognition, empathy, the theory of mind, and social adjustment. The aim of this paper is, thus, to provide a comprehensive overview of the existing literature on social cognitive functions and changes among epileptic patients: frontal and temporal lobe epilepsy. Papers from 1990-2021 were reviewed and examined for inclusion in this study and after the deduplication process, 44 papers (out of 6181 numbers that were first identified) were included in the systematic review and 40 papers in the meta-analysis. Our results indicated that first, all patients, both frontal and temporal lobe epilepsy, have difficulties in all aspects of social cognition relative to non-clinical controls. However, the effect sizes were larger for theory of mind (TOM) relative to emotion domain, suggesting sensitivity of the TOM for assessing social cognitive functions among this population. Additionally, right temporal lobe epilepsy patients performed more poorly than non-clinical control relative to left side seizure focus patients, specifically in the TOM domain. Results from the empathy and social behavior domains need to be considered cautiously as these two domains are the least studied and more research is warranted in these domains of social cognition. Finally, we suggest a step-by-step pipeline for the assessment of impairments in social cognition that can be integrated into standard clinical practices for epilepsy treatment.

Cortico-limbic disruption, material-specificity, and deficits in cognitive-affective theory of mind

“…Compared to metaphors, irony processing (especially sarcastic irony used in the present study) relies predominantly on the left-lateralized semantic network. 32 When mentalizing about others in semantic terms, the right temporal lobe’s ToM deficit 33 reflects spared/intact verbal processing compared to the deteriorated non-verbal component of figurative metaphor processing. The summary of component-wise analyses indicates non-verbal deficit (first & second-order belief), specifically in second-order belief ToM for right-side seizures.…”

“…Right-side epilepsy shows material-specific deficit 34 and right-side TLE shows ToM deficits, 33 material-specific ToM deficit for right TLE are unclear, 35 and social deficits in right AH are poorly understood. 36 Subcortical alteration of right AH is a diagnostic challenge in epilepsy.…”