title: Theory of mind in frontal and temporal lobe epilepsy: cognitive and neural aspects.
abstract: OBJECTIVE
  Theory of mind (ToM) is an important prerequisite to social behavior. This study evaluated ToM in patients with temporal (TLE) or frontal lobe epilepsy (FLE) aiming to determine the cognitive aspects, severity, and pathophysiologic mechanisms of ToM impairment in focal epilepsy.
  
  
  METHODS
  One hundred thirty-eight patients with TLE (n = 109) or FLE (n = 29) and 69 healthy subjects underwent the Faux Pas task (FPT), which evaluates the recognition and comprehension of others' mental states, and neuropsychological tests for other cognitive functions.
  
  
  RESULTS
  Factor analysis of all test scores yielded two ToM factors (Recognizing faux pas, FP; Excluding nonexistent FP) distinct from the Control, Language, Matching, and Praxis factors. With respect to healthy subjects, both TLE and FLE patients showed correct exclusion of nonexistent FPs but significantly lower recognition and comprehension of real FPs. FLE patients were also impaired with respect to TLE patients. In the whole patient group, schooling and group membership predicted ToM impairment. In FLE patients, the comprehension of mental states was predicted by disease duration, whereas TLE patients' comprehension of affects and intentions was associated with early age of seizure onset and medial temporal lobe sclerosis (MTLS).
  
  
  CONCLUSIONS
  Focal epilepsy impairs advanced ToM abilities. FLE may affect online performances owing to long-lasting dysfunctions of the prefrontal areas. MTLS may provoke selective ToM deficits due to medial temporal damage, prefrontal dysfunctions, or early interference with cognitive development. Future studies are needed to determine the implications of ToM impairment on behavior and quality of life.
authors: Laboratory of Neuropsychology, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy. rgiovagnoli@istituto-besta.it
authors: Anna Rita
authors: AR
authors: Giovagnoli
authors: Silvana
authors: S
authors: Franceschetti
authors: Fabiola
authors: F
authors: Reati
authors: Annalisa
authors: A
authors: Parente
authors: Carmelo
authors: C
authors: Maccagnano
authors: Flavio
authors: F
authors: Villani
authors: Roberto
authors: R
authors: Spreafico
mesh_terms: D000328:Adult; D017668:Age of Onset; D016022:Case-Control Studies; D003071:Cognition / Q000502:physiology*; D003072:Cognition Disorders / Q000503:physiopathology / Q000523:psychology; D017034:Epilepsy, Frontal Lobe / Q000503:physiopathology / Q000523:psychology*; D004833:Epilepsy, Temporal Lobe / Q000503:physiopathology / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D056345:Theory of Mind / Q000502:physiology*