INTRODUCTION
Emotional
intelligence (EI) is a concept that may be defined in different ways by
psychological and medical disciplines that are concerned with its importance.
The four-branch model (perceiving emotions, facilitating thought, understanding
emotions, and managing emotions) of EI definition by Mayer and Salovey is a
concept that appears popular1. It is important for personal, social
and career success2. EI has
been studied in both healthy people and after brain illness. Beside cognitive impairment, temporal lobe epilepsy (TLE) is
associated with psychosocial difficulties including depression, anxiety,
personality changes and problems in social relationship3. The neuropathological link between these impairments have been studied
trying to reach a proper explanation and avoiding the easier route of
explanation related to the chronicity. This is called Social cognitive
neuroscience. Social cognitive abilities include skills involved in
recognizing, manipulating, and behaving in relation to socially relevant
information are hypothesized
to be mediated by a network
of interconnected brain regions including the amygdala, cingulated cortex,
orbitofrontal cortex, and right somatosensory cortex4. A recent study detected that patients with TLE showed both
impaired EI and impaired recognition of facial expressions. This study also
reported greater psychological distress, which correlated negatively with EI.
It is suggested that some of the psychosocial problems experienced by patients
with TLE can be conceptualized as the consequences of deficits in EI, possibly
resulting from epilepsy-related disruption to
medial temporal lobe
functioning5.
The aim of this study was to assess EI and other psychosocial
abilities in patients with TLE and compare them with patients with
extra-temporal lobe epilepsy. We aimed also to correlate EI with
electroencephalogram (EEG) and brain magnetic resonance imaging (MRI) in
patients with epilepsy.
PATIENTS AND METHODS
This
case-control study was conducted in Neurology and Psychiatry departments, Cairo University
hospital in the period between July 2010 and January 2011. Three groups
participated in this study: Group 1: Forty right-handed patients with temporal
lobe epilepsy (TLE) (18 males and 22 females), Group 2: Thirty patients with
extra temporal lobe epilepsy (14 males and 16 females), Group 3: Thirty healthy
control subjects who were age and sex matched with both patients groups.
Diagnosis of TLE was confirmed by recurrent unprovoked seizures of temporal
lobe origin based on clinical semiology, clinical history and interictal EEG,
according to the guidelines of the international League against Epilepsy in
1985. All the patients and control group have average IQ. Control group were
selected form general population without any history of neurological or
psychiatric diseases.
Exclusion criteria were: 1) History of epilepsy surgery, 2) History of head injury,
3) History of oxygen deprivation, 4) Substance abuse, psychotic
disorders, Personality disorder, autistic spectrum disorder, and 5) Other
neurological illness or drugs affecting cognition apart from antiepileptic
drugs.
Methodology
1.
Clinical evaluation: Detailed history of
epilepsy taking from the patient and eye-witness and clinical examination were
done for all patients. A specially designed semi structural interview
derived from the Kasr El-Aini psychiatric sheet was done for patients and
control subjects.
2.
Neuropsychological testing:
a. Progressive
matrices test to assess IQ6: Raven's "Progressive
Matrices" is a non-language test of intelligence that is suitable for use
with individuals above 6 years of age. The test consists of 60 "visual
pattern" type of items that increase progressively in difficulty.
b. General
Health Questionnaire (GHQ)7: Shorter versions of the GHQ
have been developed. The GHQ 28 item is one of them. It includes 4 factors
labeled scale “A” somatic symptoms, scale “B” anxiety and insomnia, scale “C”
social dysfunction and scale “D” severe depression. The total score of the GHQ
28 ranges from 0-28 with frequently used cut-off score 4/5 (a score within the
range of 0-4 representing absence of psychopathology). The version used in this
study was the Arabic version of the short 28-items scale7.
c.
Social Readjustment
Rating Scale (SRRS): Homlmes and colleagues8
have developed a 50 called schedule of recent experience questionnaire to
quantify the degree of adaptation
required by diverse life events .A gradually building up in life change
intensity has been observed to occur during the
course of several months prior to the onset of the illness.
d.
Emotional intelligence
scale9; a scale designed by Mayer
and Salovey1, it consisted of 62 statements. Then Schutte and
colleagues9 chose 33 statements included 13 statements for appraisal
and expression, 10 statements for regulation of emotion and the last 10
statements for utilization of emotion. Each statement followed by three
choices; disagree, cannot determine & agree given the degree of 1, 2, and
3. The smallest mark is 33 and the biggest one is 99.
e.
EEG: An awake interictal EEG under standard conditions was done
for all patients at the neurophysiology unit of Kasr El-Aini hospital, using
the Nikon Kohden 14 channel EEG machine where
electrodes were placed according to the 10-20 international system of
electrode placement using mono and bipolar montages. Hyperventilation for 3
minutes and photic stimulation were done for all patients to provoke any
existing abnormality. The EEG tracing were analyzed carefully as regards
frequency, amplitude and the background activity, as well as the presence of
any abnormalities. The abnormalities were described as focal, generalized or
focal with secondary generalization.
f.
Brain MRI: Non-enhanced MRI of the brain was performed for all
patients included in this study at the Department of Radiology, Cairo University
hospitals using a 1.5T Phillips Intera® scanner. Imaging protocol consisted of
: Sagittal 5 mm-thick T1-weighted images (TR470/TE12), Coronal 1.5 mm (no
intersection gap) 3D T1- weighted gradient echo images (TR1800/TE4.4, flip
angle 8º) through the entire brain, Coronal 2 mm-thick fluid attenuated
inversion recovery, (FLAIR) images (TR8600/TE108/TI2400), Coronal 3 mm-thick
T2-weighted images (TR6860/TE125) angled perpendicular to the long axis of the
hippocampi.
Data were statistically
described in terms of range, mean ± standard deviation (±SD),
median, frequencies (number of cases) and percentages when appropriate.
Comparison of numerical variables between the study groups was done using
Mann-Whitney U test for independent samples when comparing two groups
and Kruskal Wallis test with posthoc multiple 2-group comparisons when
comparing more than two groups. For comparing categorical data, Chi-square (c2)
test was performed. Exact test was used instead when the expected frequency is
less than 5. Correlation between various variables was done using Spearman rank
correlation equation for non-normal variables. P-value less than 0.05 was
considered statistically significant. All statistical calculations were done
using computer programs SPSS (Statistical Package for the Social Science; SPSS
Inc., Chicago, IL, USA) version 15 for Microsoft
Windows.
RESULTS
This study included three groups; Group 1: Patients with
TLE (n=40), Group 2: Patients with extra temporal lobe epilepsy (n=30), and
Group 3: Control healthy group (n=30). There were no statistically significant
differences between the three groups as regard age, sex, marital status,
occupation and educational level (p-value is 0.8, 0.8, 0.2, 0.08 & 0.07 consequently).
Comparative
data: As regards EI, we couldn’t find any statistically significant difference
between both epileptic groups (p=0.560) (Table 1). A highly statistically
significant difference was found when emotional intelligence was compared between
TLE patients and control (p=0.000) (Table 2) and between extra-temporal lobe
epilepsy patients and control group (p=0.000) (Table 3).
Neither
the General Health Questionnaire nor the mean of stressors in both epileptic
groups showed statistical significance (Table 4 and 5) with p-value 0.716 and
0.532 respectively.
Correlative
studies: There is significant negative correlation between EI and GHQ (r=-0.844
and p= 0.000) and significant negative correlation between EI and stressors (r=
-0.413 and p= 0.023) in extra temporal lobe epilepsy patients.
There is significant negative correlation between EI and
GHQ (r=-0.669 and p= 0.000) and significant negative correlation between EI and
stressors (r= -0.344 and p= 0.030) in temporal lobe epilepsy patients.
EEG Findings: As regards TLE group, patients were divided
according to EEG changes into right and left changes to study the relation of
laterality with psychological scales. There were 10 patients with left temporal
lobe changes while 3 patients with right temporal lobe changes and 27 patients
did not show EEG changes.
When comparing GHQ in right and left temporal lobe
epileptic subgroups, there was no statistically significant difference (p=
0.553) .When comparing EI in right and left temporal lobe epileptic subgroups,
there was a statistically significant difference (p=0.027) (Table 6).
In TLE
patient, only 4 patients showed signs of mesial temporal sclerosis. The rest of
the patients (36 patients) had normal brain MRI. In extra-temporal lobe
epilepsy patients, MRI brain did not show any abnormality. We did not include
MRI brain findings in our results due to paucity of positive data.
Table 1.
Comparison between EI in both epileptic groups.
|
Temporal
lobe epilepsy
|
Extra-temporal
lobe epilepsy
|
P
value
|
Mean
|
63.38
|
65.77
|
0.560
|
SD
|
16.387
|
19.031
|
Table 2.
Comparison between EI in TLE & control groups.
|
Temporal lobe epilepsy
|
Control
group
|
P-value
|
Mean
|
63.38
|
88.44
|
0.000*
|
SD
|
16.387
|
5.287
|
*Significant
at P<0.01
Table 3. Comparison
between EI in Extra- temporal lobe epilepsy & control groups.
|
Extra
temporal lobe epilepsy
|
Control
group
|
P-value
|
Mean
|
65.77
|
88.44
|
0.000*
|
SD
|
19.031
|
5.287
|
*Significant
at P<0.01
Table 4. General
Health Questionnaire in both epileptic groups.
|
Temporal lobe epilepsy group
|
Extra temporal lobe
epilepsy group
|
P-value
|
Healthy
count
(%
within group)
|
13
(32.5%)
|
11
(36.7%)
|
0.716
|
Non
healthy count
(% within group)
|
27
(67.5%)
|
19
(63.3%)
|
Table 5. Comparison
between mean of stressors in both epileptic groups.
|
Temporal lobe epilepsy group
|
Extra
temporal lobe epilepsy group
|
P-value
|
Mean
|
103.10
|
93.20
|
0.532
|
SD
|
68.167
|
68.911
|
Table 6. Emotional
intelligence in right and left temporal lobe epileptic subgroups.
|
RT temporal lobe epilepsy
|
Lt
Temporal lobe epilepsy
|
P-value
|
Mean
|
41.67
|
64.80
|
0.027*
|
SD
|
4.619
|
10.983
|
*Significant
at P<0.05
DISCUSSION
Bar-On has conceptualized the EI construct as comprising
the ability to (i) Understand emotions and express feelings, (ii) Understand
how others feel and relate with them (iii) Manage and control emotions, (iv)
Use emotions in adapting to one's environment and (v) Generate and use positive
affect to be self-motivated in coping with daily demands, challenges and
pressures 10.
The amygdala plays a crucial role in the elaboration and
expression of the appropriate autonomic and behavioral responses to emotional
relevant stimuli11. Functional
imaging studies demonstrated that the amygdala participates in facial
expression processing12. Accordingly, lesion studies showed
the importance of the amygdala and related structures of the anterior and
medial temporal lobes in the recognition of emotions from visual stimuli and in
emotional intelligence13.
Our study found emotional deficit in both patients groups
when compared with the control group. This goes in concordance with a study
assessed the prevalence of emotional dysfunction in epileptic patients and
found that, the prevalence of emotional disturbances is estimated at 5-50% in
population of patients with epilepsy14. Another study aimed
to establish whether TLE is also associated with deficits in EI. Sixteen
patients with TLE and 14 controls without epilepsy matched for age and current
intelligence quotient were compared on measures of EI. Results indicated that
patients with TLE showed impaired EI5.
Our study found no statistical significant differences
between group of patients with temporal lobe epilepsy and extra temporal lobe
epilepsy as regard GHQ, EI and stressors. This may lead us to the conclusion
that the two patients groups are exposed to the same CNS dysfunction and to the
same psychosocial stressors. This view can be supported by Mojs and colleagues14,
who suggested from their study that, there are two types of emotional
dysfunction in epileptic patients, primary and secondary emotional
dysfunctions. Primary emotional dysfunction might be caused by the same factor
that causes epilepsy, or develop due to the damage of the central nervous
system in the course of epilepsy or are related to the pharmacological
treatment. Secondary emotional deficits are connected with negative social
actions and negative social attitudes toward ill persons with epilepsy. It
concerns overprotective attitudes or social isolation.
This is
different from results of Walpole
and colleagues5 study who stated that the psychosocial problems in
TLE associated with low EI may be a consequence of epilepsy-related disruption
to the functions of the medial temporal lobe. This could be explained by the
paucity of mesial temporal lobe sclerosis in our patients with TLE when
compared with Walpole
and colleagues.5
In our study, we found that 63.3% of extra temporal
epileptic patients and 67.5% of temporal epileptic patients have higher scores
in GHQ which indicate presence of psychopathology. This in concordance with the
findings of a controlled study done in Egyptian epileptic male patients and
found that patients with generalized or focal epilepsy had higher scores than
healthy controls on all tests of behavior and depression and on the tests for
neurosis15. In our study we found significant negative correlation
between EI and GHQ in both patients groups. This can be explained by the brain
pathology that causes psychiatric disorders or due to maladjustment to the
illness.
Within
the TLE group analyses confirmed a statistically significant difference in EI
between patients with left versus right seizure with p=0.026. This does not go
in concordance with a previous study found no statistical significant
difference 5
In our study, we could not find brain MRI lesions except in
4 patients. It was found that roughly 30% of patients with electrographic
evidence of temporal lobe epilepsy have normal MRI scans. The location of the
seizure focus is unclear in this patient population. Possibilities include (a)
a subtle form of MTS that is not apparent on MRI; (b) other pathology of the
medial temporal lobe not visible on MRI, such as microdysgenesis or alterations
in synaptic or receptor physiology; or (c) temporal neocortical pathology not
detected by MRI, such as certain forms of cortical dysplasia).16
Limitations of our Study
1. We used
progressive matrices test to assess IQ in patients and controls, this test
assess performance IQ and give an idea about global IQ, this test can be
affected by aging but most of our sample were young and it takes less time to
be applied
2. Most of our patients have normal MRI, so
we cannot make an association between mesial temporal lobe sclerosis and EI.
[Disclosure: Authors report no
conflict of interest]
REFERENCES
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intelligence: Educational implications. New
York: Basic Books; 1997. pp. 3-31.
2. Wolff SB, Druskat VU,
Koman ES, Messer TE. The link between group emotional competence and group
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PM, Baker G . The neuropsychological and emotional consequences of living with
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in people with and without temporal lobe epilepsy. Epilepsia. 2008; 49(8): 1470-4.
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Antonio, TX: Harcourt
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JS, Friston KJ, Büchel C, Frith CD, Young AW, Calder AJ, et al. A
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الملخص العربى
دراسة مقارنة
الذكاء الوجدانى فى مرضى صرع الفص الصدغى ومقارنته
بمرضى الصرع
الفص غير الصدغى : دراسة اكلينكية وإشعاعية
يعتبر الذكاء الوجدانى من أكثر المفاهيم التى
حظيت باهتمام وقد أجريت هذه الدراسة لتحديد مستوى
الذكاء الوجدانى فى مرضى صرع الفص
الصدغى ومقارنته بمرضى الصرع الفص غير الصدغى والعينة الضابطة وعلاقة الذكاء
الوجدانى بالضغوط النفسية والاجتماعية
والديناميكية النفسية وقد أجريت الدراسة على 40 من مرضى صرع الفص الصدغى ومقارنتهم
بـ 30 من مرضى الصرع غير الفص الصدغى و30 من العينة الضابطة.
وقد وجد انه لا توجد فروق ايجابية بين مستوى الذكاء الوجدانى فى مرضى صرع الفص الصدغى ومرضى الصرع غير الفص
الصدغى ولكن توجد فروق ايجابية بين مستوى الذكاء الوجدانى فى كلا من مرضى صرع الفص
الصدغى ومرض غير الفص الصدغى والعينة الضابطة كما توجد علاقة عكسية بين مستوى
الضغوط الاجتماعية والنفسية والذكاء
الوجدانى فى كل من مرضى صرع الفص الصدغى ومرض غير الفص الصدغى ولا توجد فروق
ايجابية من حيث الضغوط بين مرضى الصرع من النوعين