School of Psychology, University of Sydney, Camperdown, NSW 2007, Australia.
Department of Psychology, University of Toronto Mississauga, Mississauga, ON L5L 1C6, Canada; Neurosciences and Mental Health Program, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada.
Epilepsy Behav. 2019 Nov;100(Pt B):106146. doi: 10.1016/j.yebeh.2019.01.031. Epub 2019 Mar 18.
Over the past decade, a growing number of studies have shown that children and adolescents with focal and generalized epilepsies have marked impairments in social cognition, including deficits in facial emotion perception (FEP) and Theory of Mind (ToM). At present, it remains unclear whether FEP and ToM impairments are comparable in children with focal and generalized epilepsies or whether distinct syndrome-specific deficits have emerged. This question of whether unique or overlapping social cognitive profiles exist in epilepsy is of interest, given that the revised International League Against Epilepsy (ILAE) classification guidelines propose that seizures arise from a diseased network (i.e., network account), rather than being confined to discrete regions near the site of seizure foci (i.e., localization account). The purpose of this review was as follows: (1) to summarize studies examining FEP and ToM in pediatric patients with epilepsy, (2) to examine epilepsy and psychosocial correlates of these difficulties, and (3) to determine whether patterns of sociocognitive impairment better support a localization or neural network account of epilepsy. Twelve studies were reviewed examining FEP (N = 5) and/or ToM (N = 8). Findings revealed significant FEP and ToM impairments across the studied subgroups with epilepsy, which did not differ between children with generalized and focal (localization-related) epilepsies nor among children with different subtypes of localization-related epilepsy. Similarly, other epilepsy variables (i.e., seizure frequency, side of seizure focus, number of antiepileptic drugs (AEDs) or surgical status) were not related to FEP or ToM, with the exception of younger age at seizure onset and longer duration of epilepsy. Several studies documented a significant relationship between impaired ToM and reduced social competence in pediatric patients with epilepsy, whereas evidence for a relationship between FEP and psychosocial functioning is currently weak. In conclusion, findings suggest that social cognitive impairments represent a shared feature of epilepsy in childhood. The results support a neural network account of epilepsy, in which a shared neural network of dysfunction may be underlying social cognitive deficits in this group. Further research is needed to examine the functional correlates of social cognitive impairments, as well as to evaluate screening tools and treatment methods to identify and address significant social and emotional difficulties in this patient group. This article is part of the Special Issue "Epilepsy and social cognition across the lifespan".
在过去的十年中，越来越多的研究表明，患有局灶性和全面性癫痫的儿童和青少年在社会认知方面存在明显障碍，包括面部情绪感知（FEP）和心理理论（ToM）缺陷。目前，尚不清楚局灶性和全面性癫痫患儿的 FEP 和 ToM 损伤是否具有可比性，或者是否出现了不同的综合征特异性缺陷。鉴于修订后的国际抗癫痫联盟（ILAE）分类指南提出癫痫发作源于病变网络（即网络学说），而不仅仅局限于发作灶附近的离散区域（即定位学说），因此，探讨癫痫患者是否存在独特或重叠的社会认知特征是很有意义的。本综述的目的如下：（1）总结研究儿科癫痫患者 FEP 和 ToM 的研究；（2）检查这些困难与癫痫和心理社会的相关性；（3）确定社会认知障碍的模式是否更支持癫痫的定位或神经网络学说。共回顾了 12 项研究，涉及 FEP（N=5）和/或 ToM（N=8）。研究结果表明，在研究的癫痫亚组中存在显著的 FEP 和 ToM 损伤，且在全面性和局灶性（与定位相关）癫痫患儿之间、不同定位相关癫痫亚组患儿之间均无差异。同样，其他癫痫变量（即发作频率、发作灶侧、抗癫痫药物（AED）数量或手术状况）与 FEP 或 ToM 无关，除了发作起始年龄较小和癫痫持续时间较长。几项研究记录了在患有癫痫的儿科患者中，受损的 ToM 与社交能力降低之间存在显著的相关性，而 FEP 与心理社会功能之间的关系目前证据较弱。总之，研究结果表明，社会认知障碍是儿童癫痫的共同特征。这些结果支持癫痫的神经网络学说，即功能障碍的共享神经网络可能是该组社会认知缺陷的基础。需要进一步研究来检查社会认知障碍的功能相关性，以及评估筛查工具和治疗方法，以确定和解决该患者群体的重大社会和情感困难。本文是特刊“癫痫与全生命周期的社会认知”的一部分。
