Some of the psychological problems associated with epilepsy have their origins in the ability of people with epilepsy (PWE) to engage in meaningful and appropriate social interactions. PWE often report difficulties in social settings, yet there is a paucity of research investigating the socio-cognitive skills of this group. This thesis aimed to investigate these skills and relate them to the patient's perceived impact of epilepsy on their social competence. An additional objective was to see whether studying social cognition in focal epilepsy might provide some insight into the organic basis of social cognitive abilities in the normal population. The thesis consists of four separate studies which aimed to investigate social cognition and social functioning in patients with focal epilepsy. With this in mind, a test battery assessing a range of skills linked to social cognition was administered to a cross section of experimental groups (N=95). These included patients with seizure foci in the right frontal lobe (RF), left frontal lobe (LF), right temporal lobe (RT), left temporal lobe (LT) and a group with idiopathic generalised epilepsy (IGE). A normal control group (NC) and a frontal head injured (FHI) group with no epilepsy were also recruited for the study. In Studies 1 and 2 theory of mind (ToM) deficits were apparent in people with RF and LT epilepsy. These groups demonstrated impairment in the appreciation of false belief and deception at first and second order levels of intentionality. They also exhibited deficits in the appreciation of pragmatic language when attempting to infer the meaning underlying hints given by story characters. These impairments were in part attributable to deficits in narrative memory in the LT group. In Study 3 embedding problems within a social context significantly facilitated conditional reasoning in the NC, LT and RF groups but not in the other experimental groups. This finding was unexpected and suggests a double dissociation between ToM and social conditional reasoning. Study 4 investigated the extent to which socio-cognitive impairment was associated with the perceived impact of epilepsy on everyday social functioning. No statistically significant relationship between these variables was found, although a significant negative correlation between education level and impact of epilepsy was observed. Taken together the findings suggest that impairment in ToM may be a particular feature of right frontal lobe pathology and that social conditional reasoning and ToM may be functionally dissociated. PWE do not appear to have insight into their social functioning difficulties, which may well reflect underlying pathology. In light of this, future research should obtain objective measures of social competence from `significant others'. This is the only series of studies to date to assess social cognition in people with frontal lobe epilepsy (FLE) and temporal lobe epilepsy (TLE) within the same design. It is also the first time that social conditional reasoning in epilepsy has been systematically assessed and represents one of the largest lesion studies within the field of social cognition. It is hoped that some of the test material used in the thesis, may prove to be a useful and inexpensive clinical resource to help identify PWE who are at risk of reduced social competence, and in localising the site of seizure foci in patients during clinical audit, particularly where anterior foci are suspected.
BF Psychology, HM Sociology, RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry
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