title: A functional magnetic resonance imaging investigation of theory of mind impairments in patients with temporal lobe epilepsy.
abstract: Although patients with mesial temporal lobe epilepsy (mTLE) are known to have theory of mind (ToM) impairments, the latter's neural functional bases have yet to be explored. We used functional magnetic resonance imaging (fMRI) to gain insights into the neural dysfunction associated with ToM impairments in patients with mTLE. Twenty-five patients (12 and 13 with right and left mTLE, respectively) and 25 healthy controls performed the "animated shapes" task during fMRI. This complex ToM task requires both explicit reasoning about mental states and implicit processing of information on biological motion and action. The animated shapes evoke both ToM and non-ToM interaction perception, and the corresponding neural activation patterns were compared. Behavioral performance (i.e. categorization of the interactions) was also recorded. Relative to healthy controls, both patients with right and left mTLE were impaired in categorizing ToM interactions. The fMRI results showed that both patients with right and left mTLE had less intense neural activation (relative to controls) in regions involved in the implicit component of ToM processes (i.e. the fusiform gyrus in patients with right mTLE and the supplementary motor area in patients with left mTLE). In patients with right mTLE, we also observed more intense activation (relative to controls) in regions involved in the explicit component of ToM processes (i.e. the dorsal medial prefrontal cortex); age at onset of epilepsy also mediated activation in regions involved in the explicit component (i.e. the ventral medial prefrontal cortex and the temporoparietal junction). Patients with left mTLE displayed greater activation of the contralateral mesial regions (relative to controls); we speculate that this may correspond to the deployment of a compensatory mechanism. This study provides insights into the disturbances of the implicit/explicit ToM neural network in patients with mTLE. These impairments in the ToM neural network depend on clinical characteristics, such as the laterality (right or left mTLE) and the age at onset of epilepsy.
authors.affiliation: Epilepsy Unit, Department of Clinical Neurophysiology, Lille University Medical Center, Lille, France; Vascular and Degenerative Cognitive Disorders Research Unit (INSERM U-1171), University of Lille 2, Lille, France. Electronic address: hennion.sophie@gmail.com.
authors.forename: Sophie
authors.initials: S
authors.lastname: Hennion
authors.affiliation: Vascular and Degenerative Cognitive Disorders Research Unit (INSERM U-1171), University of Lille 2, Lille, France; Memory Resource and Research Center, Lille University Medical Center, Lille, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Delbeuck
authors.affiliation: Department of Psychiatry and Psychotherapy, School of Medicine, University of Muenster, Muenster, Germany.
authors.forename: Katja
authors.initials: K
authors.lastname: Koelkebeck
authors.affiliation: Neurology and Movement Disorders Unit, Lille University Medical Center, Lille, France.
authors.forename: Marine
authors.initials: M
authors.lastname: Brion
authors.affiliation: Department of Neurology, Nancy University Medical Center, University of Lorraine, Nancy, France.
authors.forename: Louise
authors.initials: L
authors.lastname: Tyvaert
authors.affiliation: Epilepsy Unit, Department of Clinical Neurophysiology, Lille University Medical Center, Lille, France; Vascular and Degenerative Cognitive Disorders Research Unit (INSERM U-1171), University of Lille 2, Lille, France.
authors.forename: Lucie
authors.initials: L
authors.lastname: Plomhause
authors.affiliation: Epilepsy Unit, Department of Clinical Neurophysiology, Lille University Medical Center, Lille, France; Vascular and Degenerative Cognitive Disorders Research Unit (INSERM U-1171), University of Lille 2, Lille, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Derambure
authors.affiliation: Vascular and Degenerative Cognitive Disorders Research Unit (INSERM U-1171), University of Lille 2, Lille, France; Department of Neuroradiology, Institute of Predictive Medicine and Therapeutic Research, Lille University Medical Center, Lille, France.
authors.forename: Renaud
authors.initials: R
authors.lastname: Lopes
authors.affiliation: Epilepsy Unit, Department of Clinical Neurophysiology, Lille University Medical Center, Lille, France; Vascular and Degenerative Cognitive Disorders Research Unit (INSERM U-1171), University of Lille 2, Lille, France.
authors.forename: William
authors.initials: W
authors.lastname: Szurhaj
mesh_terms: D000328:Adult; D017668:Age of Onset; D001921:Brain / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001931:Brain Mapping; D060825:Cognitive Dysfunction / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D004833:Epilepsy, Temporal Lobe / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000523:psychology*; D005260:Female; D007839:Functional Laterality; D006801:Humans; D007600:Judgment / Q000502:physiology; D008279:Magnetic Resonance Imaging; D008297:Male; D009039:Motion Perception / Q000502:physiology*; D009483:Neuropsychological Tests; D010364:Pattern Recognition, Visual / Q000502:physiology; D012044:Regression Analysis; D056345:Theory of Mind / Q000502:physiology*; D013997:Time Factors
keywords: Animated shapes; Functional imaging; Mesial temporal epilepsy; Theory of mind