Behavioral flexibility impairment with negative feedback in refractory temporal lobe epileptic patients with unilateral amygdala and hippocampal resection.

INTRODUCTION: Patients with amygdala dysfunction generally have behavioral impairment. Temporal lobe surgery might be a model of study of unilateral amygdala resection. The objective of this study was to evaluate behavioral flexibility in epileptic patients who undergo amygdala resection for epilepsy surgery and evaluate its relationship with their neuropsychiatric symptoms. MATERIAL AND METHODS: Ten epileptic patients who underwent amygdala and hippocampal resection (6 left and 4 right) matched by age and educational level with 10 healthy controls were tested with an extensive neuropsychological and neuropsychiatric battery. Psychiatric symptomatology was measured with the positive and negative syndrome scale (PANSS) and the Beck depression inventory. To assess behavioral flexibility the emotion-related visual reversal-learning task (O'Doherty et al., 2001) and the gambling task (Bechara et al., 1994) were used. RESULTS: Patient's mean scores were: Beck: 8 +/- 1.5; PANSS positive: 10 +/- 1.3, and negative: 14.4 +/- 2.2; intellectual quotient (IQ): 101.4 +/- 6.3; category number in Wisconsin card sorting test: 4.6 +/- 2.4. The emotion-related visual reversal-learning task showed significance differences in the number of reversion: healthy controls: 9.3; epileptic patients: 4.23 (p < 0.001); in the number of trials to the first reversion: healthy controls: 5; epileptic patients: 23.42 (p < 0.05). There was no correlation between reversion and depression, PANSS and IQ. CONCLUSIONS: Patients with epilepsy who undergo unilateral hippocampal and amygdala resection appear to have alterations in the reversion capacity with an emotional component that would explain the lack of behavior flexibility that they sometimes have and that are not related with either the isolated presence of executive alterations or low intellectual quotient.

Flexibilidad conductual ante un feedback negativo en pacientes epilépticos temporales refractarios con resección amigdalohipocámpica unilateral / Behavioral flexibility impairment with negative feedback in refractory temporal lobe epileptic patients with unilateral amygdala and hippocampal resection

Introducción. Los pacientes con disfunciones amigdalinas suelen presentar alteraciones en su conducta. La cirugía de epilepsia temporal proporciona un modelo de estudio de la resección amigdalina unilateral. El objetivo de este trabajo fue estudiar la flexibilidad conductual ante un feedback afectivo negativo en pacientes con resección de amígdala por cirugía de epilepsia y evaluar su relación con los síntomas neuropsiquiátricos. Material y métodos. Diez pacientes con epilepsia del lóbulo temporal (ELT) con resección de amígdala e hipocampo, 6 derechas y 4 izquierdas, apareados por edad y nivel de educación con 10 sujetos controles normales, fueron evaluados con una extensa batería neuropsicológica y neuropsiquiátrica que incluyó la Escala de síndromes positivos y negativos (PANSS) y la Escala de depresión de Beck. Para estudiar la adaptabilidad conductual se utilizaron el Test de Aprendizaje y reversión afectiva (O'Doherty et al., 2001) y el Test del Casino (Bechara et al., 1994). Resultados. Los pacientes tenían los siguientes puntajes (en media ± DE): escala de Beck de 8 ± 1,5, PANSS positiva de 10 ± 1,3 y negativa de 14,4 ± 2,2, un cociente intelectual (CI) de 101,4 ± 6,3, las categorías completadas en el Test de las cartas de Wisconsin fueron de 4,6 ± 2,4. En el test de aprendizaje y reversión afectiva mostraron diferencias significativas en el número de reversiones: controles, 9,3; ELT, 4,23 (p < 0,001), y en los ensayos para lograr la primera reversión: controles, 5; ELT, 23,42 (p < 0,05). No hubo correlación significativa entre las variables de reversión, depresión, la puntuación de la PANSS o el CI. Conclusiones. Los pacientes epilépticos con resección amigdalohipocámpica unilateral tendrían alteraciones en la capacidad de reversión con componente afectivo que explicarían la falta de flexibilidad conductual que a veces presentan los mismos y que no se relacionan ni con la presencia aislada de alteraciones ejecutivas ni con un bajo cociente intelectual

Introduction. Patients with amygdala dysfunction generally have behavioral impairment. Temporal lobe surgery might be a model of study of unilateral amygdala resection. The objective of this study was to evaluate behavioral flexibility in epileptic patients who undergo amygdala resection for epilepsy surgery and evaluate its relationship with their neuropsychiatric symptoms. Material and methods. Ten epileptic patients who underwent amygdala and hippocampal resection (6 left and 4 right) matched by age and educational level with 10 healthy controls were tested with an extensive neuropsychological and neuropsychiatric battery. Psychiatric symptomatology was measured with the positive and negative syndrome scale (PANSS) and the Beck depression inventory. To assess behavioral flexibility the emotion-related visual reversal-learning task (O'Doherty et al., 2001) and the gambling task (Bechara et al., 1994) were used. Results. Patient's mean scores were: Beck: 8 ± 1.5; PANSS positive: 10 ± 1.3, and negative: 14.4 ± 2.2; intellectual quotient (IQ): 101.4 ± 6.3; category number in Wisconsin card sorting test: 4.6 ± 2.4. The emotion-related visual reversal-learning task showed significance differences in the number of reversion: healthy controls: 9.3; epileptic patients: 4.23 (p < 0.001); in the number of trials to the first reversion: healthy controls: 5; epileptic patients: 23.42 (p < 0.05). There was no correlation between reversion and depression, PANSS and IQ. Conclusions. Patients with epilepsy who undergo unilateral hippocampal and amygdala resection appear to have alterations in the reversion capacity with an emotional component that would explain the lack of behavior flexibility that they sometimes have and that are not related with either the isolated presence of executive alterations or low intellectual quotient