Abstracts

Rationale: Recent neuroimaging studies have reported structural and functional brain abnormalities in patients with JME, which may also involve cortical brain areas and subcortical networks that are important for decision making1;2. It may be therefore expected that patients with JME have difficulties in making advantageous decisions. This study examined for the first time decision making in patients with JME and healthy controls.Methods: Twenty-two patients with JME (13 female; median age 26.0 years, range 18-50; median education 11.0 years, range 8-17) and 33 healthy controls (23 female; median age 26.0 years, range 18-57; median education 12.0 years, range 10-16) completed the Iowa Gambling Task (IGT), a widely used standard task of decision making3. In this task, contingencies are not explained and processing of feedback on previous decisions has to be used in order to learn to choose the advantageous alternatives. Participants also performed routine neuropsychological tests of attention and executive functions. For the JME group, median age at seizure onset was 14.0 years (range 1-20); median epilepsy duration was 11.5 years (range 3-45). Eleven patients (50%) had pharmacoresistant seizures.Results: Compared to healthy controls, patients with JME showed difficulty in learning to choose advantageously across time. The median differences between advantageous and disadvantageous selections were -4.0 in block1 and 8.0 in block5 for the healthy control group, 0.0 in block1 and 2.0 in block5 for the JME group. Performance of patients with JME was comparable to that of patients with MTLE, previously described by our working group4. Difficulties in the IGT were enhanced for the patients with JME and pharmacoresistant seizures (block1 = -2.0, block5 = 2.0) relative to the patients with seizure control (block1 = 0.0, block5 = 6.0). A correlation analysis revealed an influence of attention and executive functions on decision-making abilities of patients with JME.Conclusions: Results of this study indicate that patients with JME have difficulties in making advantageous decisions and that these difficulties are related to executive dysfunction. Also, persistence of seizures proves to be a critical factor for cognitive functioning. Patients with JME do not differ from patients with MTLE in decision-making and executive-function tests. Findings of this study add a new aspect to the neuropsychological profile of JME. Reference List: 1. de Araujo Filho GM, Jackowski AP, Lin K et al. Personality traits related to juvenile myoclonic epilepsy: MRI reveals prefrontal abnormalities through a voxel-based morphometry study. Epilepsy Behav 2009;15:202-7. 2. Ciumas C, Wahlin TB, Jucaite A, Lindstrom P, Halldin C, Savic I. Reduced dopamine transporter binding in patients with juvenile myoclonic epilepsy. Neurology 2008;71:788-94. 3. Bechara A, Damasio H, Damasio AR. Emotion, decision making and the orbitofrontal cortex. Cereb Cortex 2000;10:295-307. 4. Delazer M, Zamarian L, Bonatti E et al. Decision making under ambiguity and under risk in mesial temporal lobe epilepsy. Neuropsychologia 2010;48:194-200.