Functional MRI of facial emotion processing in left temporal lobe epilepsy

• Temporal lobe epilepsy (TLE) may negatively affect the ability to recognize emotions.
• We compared facial emotion recognition in patients with LTLE with matched healthy participants.
• LTLE has a minor effect on emotion processing as examined with fMRI.
• There is a significant relationship between seizure control and emotion processing.

Temporal lobe epilepsy (TLE) may negatively affect the ability to recognize emotions. This study aimed to determine the cortical correlates of facial emotion processing (happy, sad, fearful, and neutral) in patients with well-characterized left TLE (LTLE) and to examine the effect of seizure control on emotion processing. We enrolled 34 consecutive patients with LTLE and 30 matched healthy control (HC) subjects. Participants underwent functional MRI (fMRI) with an event-related facial emotion recognition task. The seizures of seventeen patients were controlled (no seizure in at least 3 months; LTLE−sz), and 17 continued to experience frequent seizures (LTLE+sz). Mood was assessed with the Beck Depression Inventory (BDI) and the Profile of Mood States (POMS). There were no differences in demographic characteristics and measures of mood between HC subjects and patients with LTLE. In patients with LTLE, fMRI showed decreased blood oxygenation level dependent (BOLD) signal in the hippocampus/parahippocampus and cerebellum in processing of happy faces and increased BOLD signal in occipital regions in response to fearful faces. Comparison of groups with LTLE+sz and LTLE−sz showed worse BDI and POMS scores in LTLE+sz (all p < 0.05) except for POMS tension/anxiety (p = 0.067). Functional MRI revealed increased BOLD signal in patients with LTLE+sz in the left precuneus and left parahippocampus for “fearful” faces and in the left periarcheocortex for “neutral” faces. There was a correlation between the fMRI and Total Mood Disturbance in the left precuneus in LTLE−sz (p = 0.019) and in LTLE+sz (p = 0.018). Overall, LTLE appears to have a relatively minor effect on the cortical underpinnings of facial emotion processing, while the effect of seizure state (controlled vs. not controlled) is more pronounced, indicating a significant relationship between seizure control and emotion processing.