Brief CommunicationArousal in response to neutral pictures is modified in temporal lobe epilepsy
Introduction
A growing number of studies have highlighted emotional processing disorders in patients with temporal lobe epilepsy (TLE), with a current focus on the patients' ability to recognize emotional stimuli (such as emotional faces and prosodic sentences) [1], [2]. However, the emotional experience of patients with TLE has been investigated much less extensively [3], [4]. Nevertheless, it is important to consider this aspect because it is likely to be related to the psychological well-being and quality of life of patients with TLE. In fact, patients with TLE frequently exhibit social and psychobehavioral difficulties (such as depression often with concomitant anxiety) and poor quality of life [5], [6], [7], [8]. Several researchers have hypothesized that social cognition disorders in patients with TLE (emotional processing and the attribution of mental states, i.e., theory of mind) are related to psychological well-being and quality of life [1], [9], [10]. However, social and psychobehavioral disturbances in epilepsy are often atypical and, thus, difficult to assess with conventional nosological tools [11]. This might explain the failure of two recent, large studies to find associations between self-reported depression and quality of life on the one hand, and performances in emotion recognition tasks on the other [1], [9]. We have suggested that a more specific, comprehensive assessment of psychobehavioral disturbances and quality of life might be able to detect this type of association [12].
One of the most widely used methods for assessing emotional experience in healthy controls and patients with neuropsychiatric disorders involves the evaluation of emotional content (notably emotional pictures taken from the International Affective Picture System (IAPS)) [13]. Indeed, many neurophysiological and neuroimaging studies have shown that exposure to IAPS pictures induces emotions. The IAPS is based on a model in which emotions are defined according to two main dimensions: (i) valence, which is the level of pleasantness associated with an emotional experience (ranging from unpleasant to pleasant) and (ii) arousal, which indexes the intensity of an emotional experience (ranging from low to high). To the best of our knowledge, only one study (Batut et al. [3]) has investigated emotional experience in a sample of patients with mesial TLE using the IAPS. The results did not support a change in emotional experience in patients with mesial TLE (relative to controls). However, Batut et al. only evaluated picture valence. Furthermore, the pictures' arousal levels were not controlled for in the experiment and were not evaluated by the participants. In a task requiring evaluation of fearful faces only, Labudda et al. [4] did not find any change in arousal experience in patients with mesial TLE.
The primary objective of the present study was to better characterize emotional experience in patients with TLE (compared with controls), as judged by the valence and arousal in response to pictures from the IAPS. The study also investigated clinical risk factors capable of modifying emotional experience and assessed the relationships between emotional experience and psychobehavioral/quality-of-life factors.
Section snippets
Participants
The data presented here were collected as part of a larger study of social cognition disorders in patients with TLE [12]. The study protocol had been approved by the local investigational review board (CPP Nord Ouest IV, Lille, France; reference: 2012-A00339-34).
Fifty patients with TLE seen in consultation at Lille University Medical Center's Epilepsy Unit (Lille, France) were consecutively recruited on the basis of clinical evaluation, electroencephalographic monitoring (an interictal EEG
Characteristics of the patients with TLE
The mean MoCA score in the patient group was lower than that in the control group (Table 1). There was a group effect of laterality and the presence of HS on educational level, the MoCA score, the presence of febrile seizures, the age at the first seizure, and the duration of epilepsy (Supplementary data—Table 3). The laterality and the type of epilepsy (considered independently or in combination) did not have a group effect on demographic, cognitive, or clinical parameters.
Emotional experience and clinical correlates in patients with TLE (Fig. 1)
For valence scores,
Discussion
The objectives of the present study were to (i) better characterize visual emotional experience in patients with TLE (with respect to valence and arousal levels), (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.
We found that controls and patients with TLE did not differ significantly in terms of the valence of emotional experience. Batut
Conclusions
The emotional experience of arousal by neutral pictures appears to be modified in patients with TLE and might be associated with apathy. In future research on emotional and cognitive processing, this change in arousal experience should be taken into account when neutral stimuli are used to establish a baseline level.
Acknowledgments
This work was funded by the Nord-Pas de Calais Regional Council and the Lille University Medical Center. The authors thank the study's patients and controls for their participation, M. Brion for her help with neuropsychological assessments, and the other members of the medical staff at Lille University Medical Center for their help with patient inclusion.
Disclosure of conflicts of interest
None.
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2019, Epilepsy and BehaviorCitation Excerpt :A growing number of studies of patients with temporal lobe epilepsy (TLE) have highlighted emotional processing disorders, with a current focus on the ability to recognize basic emotional stimuli on the basis of facial and vocal emotional expressions [18,19]. However, some aspects of emotional processing have not been extensively explored in patients with TLE; one such aspect is emotional experience [20–22]. In previous work, we found that experiencing the emotional valence of pictures (ranging from very unpleasant to very pleasant) might be – in contrast to the arousal experience – unaffected in patients with TLE [22].
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