Abstracts

Rationale: In addition to seizures, medically intractable epilepsy often exerts widespread disruption of brain structure and function.  This can be particularly impactful in the pediatric population which is still undergoing neuronal maturation. Neuroimaging research has demonstrated a number of functional brain processes that continue to undergo maturational changes well into the second decade of life; social cognitive processes are among these late maturing functions. Neuroimaging studies in healthy populations have revealed that the temporal lobe plays an important role in a number of socio-cognitive properties – a region also frequently implicated in focal epilepsy. However, relatively little is known about functional or neural development of social cognition in children and adolescents with temporal lobe epilepsy (TLE). Methods: The current study examined neural activation while performing the basic social task of emotion recognition (ER) from facial and vocal displays.  The ER tasks were performed by 8- to 18-year-old typically-developing adolescents and youth with intractable temporal lobe epilepsy (TLE). Participants were asked to identify the expressed emotion (anger, fear, happiness, sadness, neutral) in photographs and audio recordings of standardized emotional content while undergoing functional magnetic resonance imaging. Multivariate analyses were conducted to examine the effect of epilepsy and age on neural activation while performing these relatively basic socio-emotional tasks. Results: Compared to controls, youth with focal epilepsy were less accurate in recognizing emotions in voices, but not faces. At a neural level, epilepsy patients showed widespread reductions in brain activation in areas typically involved in the perception of visual and auditory stimuli, such as the ventral occipito-temporal cortex, and superior temporal gyrus. Further, TLE youth showed aberrant patterns of activation in the right amygdala during both tasks. Both groups showed similar age-related changes in activation across the brain, though the TLE group’s growth was delayed compared to controls. Conclusions: These preliminary results suggest that emotional information contained in facial expressions and vocal prosody may be processed differently by typically-developing and TLE youth. Specifically, aberrant activation in the primary sensory areas and the amygdala may impair the recognition of emotional content in nonverbal cues. Contemporary models of brain organization across development have indicated that neural organization is guided by context-relevant neural activity. In patients with intractable epilepsy–particularly with involvement of the temporal lobe- such organization may be disrupted by persistent seizure activity.  The current findings suggest that normative development of social cognition may be impaired at both the behavioral and neural level in children with intractable TLE. These findings suggest that in addition to seizure control, the timing of medical interventions to reduce seizure activity may have implications for socio-emotional development in children and adolescents with epilepsy. Funding: Funded by internal funds from the Research Institute at Nationwide Children’s Hospital awarded to Eric Nelson.