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Epileptic Disorders - Editor's Choice

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March, 2015

Visual and auditory socio-cognitive perception in unilateral temporal lobe epilepsy in children and adolescents: a prospective study

Epileptic Disorders December 2014

Epileptic Disorders 2014; 16(4): 456-70.

Commentary by Michael Duchowny, MD, Associate Editor.
Miami Children's Hospital, Miami, Florida, USA

Chronic childhood-onset temporal lobe epilepsy is no longer viewed as either a localized or static disorder. A wealth of experimental and clinical data attests to significant disturbances of neurocognitive function affecting multiple domains in a high proportion of patients. Declines in language competence, memory skills (verbal and non-verbal) executive functions are particularly well-documented but compromised social recognition of emotions is also known to occur. Younger patients and individuals with dominant temporal lobe involvement may be especially vulnerable. Neuroimaging studies provide correlative evidence of reduced cortical volume and white matter loss.

The study by Laurent et al (2014) adds a plethora of new and somewhat disconcerting findings to the growing list of functional disturbance in this disorder. Comparing 39 children with chronic temporal lobe epilepsy with 72 controls, the authors prospectively identified social deficits in the recognition of facial identity and emotional facial expression and direction of eye gaze. These findings were independent of seizure history, hemisphere of primary involvement and presence of memory deficit. While the social deficits correlated with lower intelligence, they were not uniform in all children with intellectual disability and could be observed in some children with normal intelligence.

While the loss of social perceptual competence may at first appear less problematic than for example verbal memory deficit, it is worth pointing out (as noted by the authors) that social deficiency is a cardinal clinical manifestation of childhood autism. The socio-emotional dysfunction in children with temporal lobe epilepsy may therefore place them at even greater developmental risk than previously appreciated. However, the variability in the expression of the social deficits and lack of a positive association with seizure variables remain unexplained and raise important questions regarding the source of the deficits and their ultimate expression. While socio-emotional neural circuit disruption very likely occurs in those affected individuals, further exploration of these important new findings is a critical step in our ability to prevent deterioration and provide optimal care.

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