Abstracts

Rationale: Temporal lobe epilepsy (TLE) is a chronic condition classically characterized by recurrent unprovoked episodes of involuntary violent motion and/or behavior whose degree and nature often overshadows subtle inter-ictal neuropsychiatric symptoms that impact the quality of life. A primary feature of this neuropsychiatric constellation is impairment of social cognition traditionally measures in terms of Theory of Mind and emotional facial recognition. A new testing paradigm inspired by the interactive brain hypothesis suggests that social contingency, measured by dyadic interaction in the ‘perceptual crossing’ model, constitutes a metric of social cognition. The purpose of the proposed research is to investigate whether social interaction/contingency is impaired in subjects with a history of drug-resistant TLE. Methods: Using a modified model previously validated by Froese in 2014, we recorded the dynamics of real-time sensorimotor interaction of 10 participants with a history of drug-resistant temporal lobe epilepsy (TLE) taking at least two AED and 10 control subjects. The subjects were paired with a remote examiner. We used a minimalistic human-computer interface paradigm known as Perceptual Crossing. We recorded measures of social contingency such as clicking accuracy, turn-taking, movement synchrony, and the ability of players to accurately discriminate other players from conflicting stimuli. Subjects with a history of drug-resistant TLE were selected from the University of South Alabama Epilepsy Clinic, as they appear for their follow up visit and were age-gender matched with controls without a history of epilepsy. (See Table 1) Results: Our analysis reveals that using a simplified, computer-mediated, embodied form of social interaction; people with TLE demonstrated a statistically significant decrease in identification accuracy ratio (p-value is 0.00084 p < .05), a decrease in turn-taking (p-value is 0.03216 p < .05), decrease in player-object discrimination specificity (p-value is 0.0116 p < 0.05), and a decrease time spend in contact (p-value is 0.01578, p<0.05) when compared to age-gender matched controls. (See Chart 1) Conclusions: We found that co-regulated interactions differed significantly between patients with a history of drug-resistant TLE and normal controls consistent with prior meta-analysis observations regarding social cognition impairment in TLE. This is the first study to demonstrate social contingency impairment through dyadic interaction in the TLE population. The pathophysiology of this impairment may be related to both long-term and short-term consequences of TLE such as interictal/postictal temporolimbic network dysfunction and/or side effects of anti-epileptic medications. Further refinement of this testing methodology and a larger subject population is necessary for further characterization of this deficit. This finding supports the increasing role of virtual reality interfaces in research that could eventually be the basis for the development of bio-behavioral markers and therapeutic interventions to improve quality of life. Funding: No funding