Neuropsychological profile and social cognition in children and adolescents with temporal lobe epilepsy

Objective: To characterize the neuropsychological profile and social cognition, particularly Theory of Mind (ToM), in 45 children and adolescents with temporal lobe epilepsy (TLE) compared with 56 age, gender, and schooling-matched healthy controls. Within the original sample, we also evaluated a subgroup of patients who underwent epilepsy surgery, compared with those who were not surgically treated. Methods: This is a prospective controlled study conducted between October 2020 and November 2022 at one center. We analyzed the study results for children (8-12 years old) and adolescents (13-18 years old) separately. We used univariate inferential statistical analyses (ANOVA or Kruskal-Wallis) and linear or logistic regression analyses. Results: We observed significant impairments in cognitive functions, social cognition, and ToM in children with TLE compared with controls, as confirmed also by logistic regression analyses. Conversely, we found lower scores in adolescents with TLE compared with controls only in the sub-components of the Verbal Fluency test and Recognition of behaviors in the social situations test. Regression analyses adjusted for epilepsy-related variables confirmed that children exhibit more severe neuropsychological and sociocognitive impairments than adolescents. ToM abilities were impaired in children who had been treated surgically compared with those who had not. This finding could be due to epilepsy-related factors, such as earlier onset and longer disease duration, ablation of anatomic structures involved in ToM, or both. Significance: A comprehensive neuropsychological and psychosocial assessment, including TOM, is recommended for children with TLE, especially if they are surgical candidates, to ensure timely psychoeducative and rehabilitative interventions. Plain language summary: Social cognition and ToM allow understanding of one's own and others' thoughts and feelings. These skills are often impaired in children and adolescents with temporal lobe epilepsy (TLE). We compared the neuropsychological and social profiles of young people with TLE to healthy peers and examined differences between those who underwent epilepsy surgery and those who did not. Children with TLE showed significant impairments in cognitive functions, social cognition, and ToM, with surgically treated children facing greater ToM challenges. Our findings highlight the need for comprehensive neuropsychological and psychosocial assessments to provide timely support for children with TLE.