Comorbid psychosis in temporal lobe epilepsy is associated with auditory emotion recognition impairments

LIMA, MÓNICA FERNÁNDEZ; SARUDIANSKY, MERCEDES; ODDO, SILVIA; GIAGANTE, BRENDA; KOCHEN, SILVIA; D'ALESSIO, LUCIANA

SCHIZOPHRENIA RESEARCH

ELSEVIER SCIENCE BV

Año: 2023 vol. 254 p. 8 - 10

0920-9964

Letter to the Editor Comorbid psychosis in temporal lobe epilepsy is associated with auditory emotion recognition impairments Temporal lobe epilepsy (TLE), characterized by recurrent unprovoked seizures originating from the temporal lobe, is the most common form of focal epilepsy and is frequently associated with brain lesions (i.e. hippocampal sclerosis) involving the medial temporal lobe region (Monti and Meletti, 2015). Psychiatric comorbid disorders are very frequent among patients with drug-resistant TLE; psychosis affects about 8–13 % and depression approximately 30–50 % of patients (Nadkarni et al., 2007; D´Alessio et al., 2020). The pathogenesis of this association is still unknown, but it has been proposed that recurrent epileptic discharges acting on medial temporal lobe structures (hippocampusamygdala) may induce neurotransmitters changes, neurogenesis alterations and inflammation, increasing the vulnerability to stressors (Sachdev, 2007; D´Alessio et al., 2020). These brain areas play a central role in emotion recognition (ER), the brain function by which the emotions expressed by others are recognized (Yovel and Belin, 2013). Many reports demonstrated a lower performance of visual and auditory ER among patients with TLE, but only a few studies analyzed anxiety and depression symptoms with no reference to psychosis (Fowler et al., 2006; Brand et al., 2009; Monti and Meletti, 2015). Epileptic psychosis has been classified by temporal ictal relationship in postictal, interictal and alternating psychosis, nonetheless it has been considered a unified pathogenic process related to epilepsy (Sachdev, 2007; D´Alessio et al., 2020; Kanemoto et al., 2012). However, since other schizophrenia-spectrum disorders showed ER deficits (Ruocco et al., 2014), comorbid psychosis in patients with TLE may affect ER performance. The aim of the present study was to explore the ER in a cohort of patients with drug-resistant TLE diagnosed by VideoElectroencephalography (VEEG), using visual (faces) and auditory (prosody) stimuli, focusing on the main comorbid psychiatric disorders (depression and psychosis). Patients with defined right or left drug-resistant temporal lobe epilepsy (TLE) confirmed by VEEG according to the ILAE criteria (Kwan et al., 2010), consecutively admitted from October 2014 until December 2017 to the VEEG unit of El Cruce Hospital of Buenos Aires, were included. Exclusion criteria are resumed in Table 1, Supplementary materials. All patients underwent a standardized protocol with neurological, neuropsychological, neuroimaging (MRI) and psychiatric assessment (SCID I-II of DSM-IV and ictal classification of psychosis) to differentiate psychosis from ictal symptoms (D´Alessio et al., 2009; D´Alessio et al., 2020). Healthy subjects without neurological disorders, who did not attend to special school neither had a psychiatric disorder according to SCID I of DSM-IV, matched by age, sex and level of education (p > 0.05), were included as controls. For ER exploration two tasks were carried out for the emotions happiness, sadness, fear, disgust, anger, surprise and neutral using an Inspiron DELL PC, Psychootolbox, a toolkit for Matlab®, and a gamepad joystick with USB (Havit®). Pictures of facial affect (POFA) were used for visual ER assessment (Eckman and Friesen, 1976). The Montreal Affective Voices, nonverbal affect bursts of vocalizations without semantic content, were used for auditory ER assessment (Belin et al., 2008). The study was approved by the Ethics Committee of El Cruce Hospital and written informed consents were obtained. The assessments were performed during seizure free period within the VEEG monitoring unit. For data analysis, a p-value