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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