Emotional Profile of Pharmaco-resistant Temporal Epilepsy Patients: BOLD-functional Magnetic Resonance Imaging Study

A BSTRACT Objective: To investigate the effects of neural reorganization on emotional functioning in patients with drug-resistant mesial temporal lobe epilepsy (MTLE) by comparing blood oxygen level dependent (BOLD) functional magnetic resonance imaging (fMRI) findings and clinical evaluations between preoperative patients and healthy controls. Materials and Methods: The study included 19 patients (age range: 22–52, median 36) scheduled for unilateral temporal lobectomy. The research methodology integrated clinical and neuropsychological assessments with MRI-based analyses, including BOLD fMRI, to evaluate emotion processing. The influence of cultural context on emotional stimulus perception was also considered. Results: Primary clinical assessments revealed more pronounced deficits in the processing of positive emotions, while the recognition of negative emotions was relatively preserved. fMRI analysis identified significant differences in brain activation patterns between patients and controls across three emotion types. These differential activations were primarily localized in the brainstem, parietal cortex, and temporal cortex. The observed emotional processing discrepancies are hypothesized to stem from the engagement of an extensive neural network, particularly involving the prefrontal cortex, insula, and temporal cortex. Conclusions: By integrating multimodal data, this study provides new insights into the distinct emotional profiles of patients with MTLE, highlighting a specific vulnerability in positive emotion processing. The findings underscore the role of a widespread neural network beyond the temporal lobe in emotion-processing deficits associated with temporal lobe epilepsy.