Socio-Emotional Processing Deficits Following Insular Cortex Involvement in Temporal Lobe Epilepsy Surgery: Implications for Epilepsy Treatment
Abstract number :
1.502
Submission category :
11. Behavior/Neuropsychology/Language / 11A. Adult
Year :
2023
Submission ID :
1304
Source :
www.aesnet.org
Presentation date :
12/2/2023 12:00:00 AM
Published date :
Authors :
Presenting Author: Fareed Ahamad, Student – Emory University
Taylor Shade, BS – Emory University School of Medicine; Adam Dickey, MD – Emory University School of Medicine; Edward Valentin, Ph.D. – Emory University School of Medicine; Ammar Kheder, MD – Emory University School of Medicine; Nigel Pedersen, MD – UC Davis; Robert Gross, MD, Ph.D. – Emory University School of Medicine; Daniel Drane, Ph.D. – Emory University School of Medicine
Rationale: Epilepsy surgery is commonly performed to mitigate seizure activity, but concerns exist regarding cognitive surgical risks. While cognitive consequences of temporal lobe epilepsy surgeries have been extensively studied, there is a lack of attention to socioemotional deficits, especially with insular cortex ablation. As insular damage has been associated with socioemotional changes in patient populations (stroke), we hypothesized such changes may be prevalent in epilepsy surgeries involving this structure.
Methods: We explored behavioral change in a subset (n=5) of epilepsy patients whose surgeries involved the insular cortex on several relevant variables (e.g., loss of self-control, and alterations in emotion recognition). We reviewed their neuropsychological (NP) testing for changes in cognitive function and/or psychopathology. Patients underwent video-EEG monitoring, neuroimaging analysis, NP testing, and in some cases intracranial monitoring. Patients were assessed by an expert neuropsychologist (DLD) for behavioral change using a semi-structured interview format. NP scores were analyzed using reliable change scores or a standard deviation-based method for determining the change's significance.
Results: Behavioral changes were observed in all patients following surgeries involving the insula, specifically targeting the right cerebral hemisphere. The nature of these behavioral changes is detailed in the attached table, which includes alterations in emotional lability (60%), diminished emotion (60%), a lack of self-control (60%), and other relevant manifestations. We noted significant declines in memory functioning and other cognitive domains for most patients, and two of five had greater difficulty recognizing emotion in others. Patients 3 through 5 underwent laser ablation procedures involving the insula. Patients 1 and 2 first had right temporal lobectomy and later received insular ablations separately. The behavioral change was only noted after the addition of insular surgical lesions. Self-report of mood and anxiety were not significantly affected in most patients.
Conclusions:
We found a high rate of new-onset behavioral disturbance following epilepsy surgery, including the non-dominant insula. These results highlight the impact of neurosurgical insular damage on awareness/expression. They also demonstrate that the individual's self-perception of emotional well-being may be incongruent with their change in behavior. Our results emphasize a need for further study to determine the contribution of brain regions to socioemotional function. Identifying key regions/networks will enable the development of tasks to use with electrical stimulation mapping to spare such functions.
Funding: NIH/NINDS - R01 NS088748
Behavior