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In temporal lobe epilepsy and lobectomy, deficits in emotion identification have been found consistently, but there is limited evidence for complex social inference skills such as theory of mind. Furthermore, risk factors and the specific neural underpinnings of these deficits in this population are unclear. We investigated these issues using a comprehensive range of social inference tasks (emotion identification and comprehension of sincere, deceitful and sarcastic social exchanges) in individuals with temporal lobe epilepsy or lobectomy (n = 87). We observed deficits across patient groups which were partly related to the presence of mesial temporal lobe sclerosis, early age of seizure onset and left lobectomy. A voxel-based morphometry analysis conducted in the pre-operative group confirmed the importance of the temporal lobe by showing a relationship between left hippocampal atrophy and overall social inference abilities, and between left anterior neocortex atrophy and sarcasm comprehension. These findings are in keeping with theoretical proposals that the hippocampus is critical for binding diverse elements in cognitive domains beyond canonical episodic memory operations, and that the anterior temporal cortex is a convergence zone of higher-order perceptual and emotional processes, and of stored representations. As impairments were frequent, we require further investigation of this behavioural domain and its impact on the lives of people with epilepsy.

Social inference deficits in temporal lobe epilepsy and lobectomy: risk factors and neural substrates