title: Decision making in patients with temporal lobe epilepsy.
abstract: The mesiotemporal lobe is involved in decision making processes because bilateral amygdala damage can cause impairments in decision making that is mainly based on the processing of emotional feedback. In addition to executive functions, previous studies have suggested the involvement of feedback processing in decision making under risk when explicit information about consequences and their probabilities is provided. In the current study, we investigated whether unilateral mesiotemporal damage, comprising of the hippocampus and/or the amygdala, results in alterations of both kinds of decision making. For this purpose, we preoperatively examined 20 patients with refractory unilateral mesiotemporal lobe epilepsy (TLE) and a comparison group (CG) of 20 healthy volunteers with the Iowa Gambling Task to assess decision making based on feedback processing, the Game of Dice Task to assess decision making under risk, and with a neuropsychological test battery. Results indicate that TLE patients performed normally in decision making under risk, but can exhibit disturbances in decision making on the Iowa Gambling Task. A subgroup analysis revealed that those patients with a preference for the disadvantageous alternatives performed worse on executive subcomponents and had seizure onset at an earlier age in comparison to the patient subgroup without disadvantageous decision making. Furthermore, disadvantageous decision making can emerge in patients with selective hippocampal sclerosis not extended to the amygdala. Thus, our results demonstrate for the first time that presurgical patients with TLE can have selective reductions in decision making and that these deficits can result from hippocampal lesions without structural amygdala abnormalities.
authors.affiliation: Department of Physiological Psychology, University of Bielefeld, P.O. Box 100131, 33501 Bielefeld, Germany. kirsten.labudda@uni-bielefeld.de
authors.forename: Kirsten
authors.initials: K
authors.lastname: Labudda
authors.forename: Kristina
authors.initials: K
authors.lastname: Frigge
authors.forename: Simone
authors.initials: S
authors.lastname: Horstmann
authors.forename: Joerg
authors.initials: J
authors.lastname: Aengenendt
authors.forename: Friedrich G
authors.initials: FG
authors.lastname: Woermann
authors.forename: Alois
authors.initials: A
authors.lastname: Ebner
authors.forename: Hans J
authors.initials: HJ
authors.lastname: Markowitsch
authors.forename: Matthias
authors.initials: M
authors.lastname: Brand
mesh_terms: D000293:Adolescent; D000328:Adult; D003657:Decision Making / Q000502:physiology*; D004833:Epilepsy, Temporal Lobe / Q000503:physiopathology*; D005260:Female; D005715:Gambling; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D013223:Statistics as Topic; D055815:Young Adult