title: Decision-making in patients with temporal lobe epilepsy: Delay gratification ability is not impaired in patients with hippocampal sclerosis.
abstract: Decision-making abilities have rarely been examined in patients with temporal lobe epilepsy related to hippocampal sclerosis (TLE-HS). We aimed to investigate the ability to delay gratification, a decision-making subdomain, in patients with intractable TLE-HS and to verify the association of delay gratification performance and cool executive function tests.
  
  
  
  We evaluated 27 patients with TLE-HS (mean age: 35.46 [±13.31] years; 7 males) and their cognitive performance was compared with that of 27 age- and gender-matched healthy controls (mean age: 35.33 [±12.05] years; 7 males), without epilepsy and psychiatric disorders. Patients were assessed using the delay discounting task (DDT) and tests of attention, shifting, inhibitory control, and concept formation. Results were correlated with clinical epilepsy variables such as age of onset, epilepsy duration, AED use, history of status epilepticus, febrile seizures, and the presence of generalized seizures. Statistical analysis was performed using one-way ANCOVA with years of education as a confounding factor.
  
  
  
  Patients and controls demonstrated similar performance on DDT, showing similar discount rate (p=0.935) and probability rate (p=0.585). Delay gratification was not related to cool executive function tests (Digit Span, Stroop Color Test, Trail Making Test, Wisconsin Card Sorting Test, and Connors' CPT). History of status epilepticus, presence of generalized seizures and higher seizure frequency, age at onset, and epilepsy duration had a significant impact on DDT.
  
  
  
  Patients with intractable TLE-HS showed unimpaired delay gratification abilities, being able to accept a higher delay and a lower amount of chance for receiving a higher reward in the future. Clinical variables related to the epilepsy severity impacted the performance on delay gratification. Impairment on cool aspects of executive function was unrelated to this decision-making domain.
authors.affiliation: Laboratory of Neuroimaging in Psychiatry (LIM 21),University of São Paulo (USP) School of Medicine,São Paulo, SP, Brazil; Group for the Study of Cognitive and Psychiatric Disorders in Epilepsy - Clinics Hospital,University of Sao Paulo (USP),Brazil; Center for Interdisciplinary Research on Applied Neurosciences (NAPNA),University of Sao Paulo (USP),Brazil. Electronic address: patriciarzezak@gmail.com.
authors.forename: Patricia
authors.initials: P
authors.lastname: Rzezak
authors.affiliation: Group for the Study of Cognitive and Psychiatric Disorders in Epilepsy - Clinics Hospital,University of Sao Paulo (USP),Brazil.
authors.forename: Ellen Marise
authors.initials: EM
authors.lastname: Lima
authors.affiliation: Laboratory of Neuroimaging in Psychiatry (LIM 21),University of São Paulo (USP) School of Medicine,São Paulo, SP, Brazil.
authors.forename: Fabricio
authors.initials: F
authors.lastname: Pereira
authors.affiliation: Ribeirao Preto School of Medicine,Department of Neurosciences and Behavior,University of Sao Paulo (USP),Brazil.
authors.forename: Ana Carolina
authors.initials: AC
authors.lastname: Gargaro
authors.affiliation: Ribeirao Preto School of Medicine,Department of Neurosciences and Behavior,University of Sao Paulo (USP),Brazil.
authors.forename: Erica
authors.initials: E
authors.lastname: Coimbra
authors.affiliation: Laboratory of Clinical Neurophysiology,Psychiatry Department,University of São Paulo (USP) School of Medicine,São Paulo, SP, Brazil; Laboratory of Neuroimaging in Psychiatry (LIM 21),University of São Paulo (USP) School of Medicine,São Paulo, SP, Brazil; Group for the Study of Cognitive and Psychiatric Disorders in Epilepsy - Clinics Hospital,University of Sao Paulo (USP),Brazil; Center for Interdisciplinary Research on Applied Neurosciences (NAPNA),University of Sao Paulo (USP),Brazil.
authors.forename: Silvia
authors.initials: S
authors.lastname: de Vincentiis
authors.affiliation: Ribeirao Preto School of Medicine,Department of Neurosciences and Behavior,University of Sao Paulo (USP),Brazil.
authors.forename: Tonicarlo Rodrigues
authors.initials: TR
authors.lastname: Velasco
authors.affiliation: Ribeirao Preto School of Medicine,Department of Neurosciences and Behavior,University of Sao Paulo (USP),Brazil.
authors.forename: João Pereira
authors.initials: JP
authors.lastname: Leite
authors.affiliation: Laboratory of Neuroimaging in Psychiatry (LIM 21),University of São Paulo (USP) School of Medicine,São Paulo, SP, Brazil; Group for the Study of Cognitive and Psychiatric Disorders in Epilepsy - Clinics Hospital,University of Sao Paulo (USP),Brazil.
authors.forename: Geraldo F
authors.initials: GF
authors.lastname: Busatto
authors.affiliation: Laboratory of Clinical Neurophysiology,Psychiatry Department,University of São Paulo (USP) School of Medicine,São Paulo, SP, Brazil; Laboratory of Neuroimaging in Psychiatry (LIM 21),University of São Paulo (USP) School of Medicine,São Paulo, SP, Brazil; Group for the Study of Cognitive and Psychiatric Disorders in Epilepsy - Clinics Hospital,University of Sao Paulo (USP),Brazil; Center for Interdisciplinary Research on Applied Neurosciences (NAPNA),University of Sao Paulo (USP),Brazil.
authors.forename: Kette D
authors.initials: KD
authors.lastname: Valente
mesh_terms: D000293:Adolescent; D000328:Adult; D003657:Decision Making; D065786:Delay Discounting; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis* / Q000523:psychology*; D056344:Executive Function; D005260:Female; D006624:Hippocampus / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D012598:Sclerosis / Q000473:pathology; D055815:Young Adult
keywords: Decision-making; Delay discounting; Epilepsy; Executive functions; Hippocampal sclerosis; Temporal lobe