Social Cognition after epilepsy surgery: a long-term follow-up.

Abstract: Objectives: Previous studies have suggested that social cognition abilities do not change following surgical treatment for temporal lobe epilepsy (TLE). However, the follow-up period in these studies was no longer than 14 months. The present study investigated the long-term effects of epilepsy surgery on social cognition, extending the follow-up period to an average of 12 years (range 7- 15 years). Methods: Data from drug-resistant temporal lobe epilepsy 24 patients (age = 37 ± 11 years; 14 males) who had undergone temporal lobe resection were included. Emotion recognition test (ERT), an analog from Ekman and Friesen series, and a short version of the Faux-Pas est (FPT) adapted from Schacher et al. to measure Theory of Mind (ToM) were used in this study. To account for repeated measures, we employed linear mixed-effect models. Results: At the group level, ERT scores remained stable over time (estimate = 0.01, p = .405), while performance in FPT showed a gradual decline (estimate = -0.04, p = .009). Individuals with a later age of epilepsy onset had higher baseline FPT performance (estimate = 0.02, p = .036) but exhibited a steeper decline over the follow-up period (estimate = -0.01, p = .013). Epilepsy duration, side of epilepsy, IQ performance, sex and depressive symptoms did not affect the results. A review of individual trajectories revealed non-linear trends in both measures, with over half of the patients exhibiting either initial improvement, followed by subsequent decline, or vice versa. Significance: While emotion recognition appeared to remain stable over the extended time period, Theory of Mind (as measured by FPT) showed a gradual decline across the post-surgery follow-up. Later age at epilepsy onset was associated with steeper FPT deterioration. Our results challenge earlier conclusions from studies with shorter-term follow-ups regarding universal cognitive stability after epilepsy surgery.