Theory of mind in juvenile myoclonic epilepsy

Juvenile myoclonic epilepsy (JME) is a common idiopathic generalized epilepsy often accompanied by executive dysfunction, affective symptoms, unfavorable behavior, and social outcomes, yet its impact on theory of mind (ToM) remains underexplored. We conducted an unmatched case-control study assessing 34 JME patients and 48 healthy controls, adjusted for age, sex, education, intelligence quotient, anxiety, and depression. Participants completed a brief version of the Faux Pas Recognition Test (FPRT) and the Reading the Mind in the Eyes Test, alongside measures of executive function, prospective memory, and mood. In raw analyses, JME patients showed significantly lower FPRT total scores (mean ± SD = 22.9 ± 9 vs. 27.5 ± 7, p = .01) and FPRT Understanding (.80 ± .11 vs. .87 ± .14, p = .02). After adjusting for cognitive and affective covariates via propensity scoring, group differences in ToM performance were no longer significant (p > .20). These results suggest that ToM deficits in JME are mediated by broader cognitive and affective disturbances rather than reflecting a social cognitive impairment. Future longitudinal studies with larger samples and tighter pharmacological control are warranted.