تشخیص احساسات از حالات چهره در یک لوب تمپورال بیمار مبتلا به صرع با ترس
|کد مقاله||سال انتشار||مقاله انگلیسی||ترجمه فارسی||تعداد کلمات|
|37662||2005||8 صفحه PDF||سفارش دهید||5254 کلمه|
Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : Neuropsychologia, Volume 43, Issue 3, 2005, Pages 434–441
Abstract Ictal fear (IF) is an affective aura observed in patients with temporal lobe epilepsy. It has been suggested that the amygdala, a region implicated in emotion processing, is involved in generating IF. Several studies have reported that the patients with IF have disturbances in emotional experience, but there has been no testing of the emotional recognition in those patients. In this report, emotion recognition from facial expressions was investigated in a patient with IF. The patient suffered from IF due to temporal lobe epilepsy, and underwent hippocampectomy surgery which completely suppressed IF. We examined the patient before and after surgery. Before surgery, the patient tended to attach enhanced fear, sadness, and anger to various facial expressions. After surgery, such biases disappeared. As an underlying mechanism of the pre-surgical skewed perception of emotional stimuli, the abnormal epileptogenic circuits involving a hypersensitive amygdala possibly due to the kindling mechanism were suggested.
1. Introduction Ictal fear (IF) is a well-recognized affective aura in patients with temporal lobe epilepsy (TLE) (Cendes et al., 1994 and Gloor et al., 1982; Gupta, Jeavons, Hughes, & Covanis, 1983; Taylor & Lochery, 1987). Ictal fear is defined as “a sudden, often short, fearful affect at the beginning of, or during, an epileptic seizure, without context or any relation to a precedent causal perception or cognition (Feichtinger et al., 2001).” In most cases of TLE with IF, the epileptic discharges originated from the amygdala, the hippocampus, or its adjacent structures (Gloor, 1972; Palmini & Gloor, 1992). The involvement of the amygdala in generating IF is also supported by electrical stimulation studies (Gloor, 1972, Gloor, 1992, Gloor, 1997 and Gloor et al., 1982) and volumetric and quantitative analyses (Cendes et al., 1994 and Feichtinger et al., 2001; Van-Paesschen, King, Duncan, & Connelly, 2001). Recent neuropsychological and neuroimaging studies have demonstrated the crucial role of the amygdala in emotion recognition, particularly in the case of negative emotions, such as fear, sadness, and anger (Adolphs et al., 1994 and Adolphs et al., 1995; Adolphs et al., 1999; Anderson, Spencer, Fulbright, & Phelps, 2000; Blair, Morris, Frith, Perrett, & Dolan, 1999; Breiter et al., 1996, Broks et al., 1998 and Calder et al., 1996; Morris et al., 1996, Morris et al., 1998, Phillips et al., 1997, Sprengelmeyer et al., 1999, Thomas et al., 2001, Whalen et al., 1998 and Young et al., 1996). As indicated by patients with amygdala damage, failure to evaluate fear and danger would induce lowered sensitivity to situations that evoke fear in normal subjects, resulting in the reduced real-life experience of fear (Sprengelmeyer et al., 1999), in spite of a preserved ability to generate fearful expressions (Anderson & Phelps, 2000). For example, Sprengelmeyer et al. (1999) reported that a bilaterally amygdala-damaged patient showed an impaired recognition of others’ fearful facial expressions and reduced levels of fear experience in everyday situations. Previous clinical interviews reported that up to half of TLE patients have serious emotional experience disturbances (Blumer, Montouris, & Hermann, 1995), such as interictal experience of fear, anxiety, or depression (Adamec, 1990; Bear & Fedio, 1977; Dodrill & Batzel, 1986; Gloor, 1990; Hermann & Chhabria, 1980; Hermann, Dikman, Schwartz, & Karnes, 1982; Perini & Mendius, 1984; Schmitz, Robertson, & Trimble, 1999; Weil, 1956, Weil, 1959 and Williams, 1956). Using a self-report questionnaire, Bear and Fedio (1977) suggested that behavioral traits of TLE patients were the result of an attachment of enhanced affective tone to certain types of information. Some studies further suggested that these interictal emotional disturbances apply more to those with IF. Hermann and Chhabria (1980) reported increased interictal fear-related behavior in two TLE patients with IF. In addition, Hermann et al. (1982) compared TLE patients with and without IF, and revealed that those with IF had more deviation in Minnesota Multiphasic Personality Inventory profiles. From what has been reviewed above, we can make the following summary: (1) the amygdala is involved in IF; (2) the amygdala plays a crucial role in processing specific facial expressions, particularly negative ones; (3) epileptogenic abnormalities in medial temporal structures are associated with altered affective tone beyond the ictal event. Therefore, from points (1) and (2), one would hypothesize that patients with IF, who are suspected to possess epileptogenic abnormalities in the neural substrates that mediate emotion recognition (i.e., amygdala), may have certain types of bias in emotion recognition interictally. Moreover, the same hypothesis would also follow from point (3); one may speculate that biased emotion recognition would underlie the disturbed emotional experience in the subgroup of TLE patients including those with IF, though it might not be specific to patients with IF. As mentioned above, lesion studies provided evidence of impaired emotion recognition following bilateral amygdala damage. However, the selectivity of deficits remains unclear, such as whether the amygdala damage leads to a disproportionate impairment in recognizing fear (Adolphs et al., 1995 and Anderson and Phelps, 2000; Broks et al., 1998, Calder et al., 1996 and Sprengelmeyer et al., 1999), or a broader impairment in recognizing multiple negative emotions (Adolphs et al., 1999 and Schmolck and Squire, 2001). By studying patients with IF interictally and comparing their performance after surgery, we may further clarify the selectivity of deficits in which the amygdala is involved, and what the underlying mechanisms may be. In the present study, we examined an intractable TLE patient with IF before selective resection of the epileptic focus and after surgery, when seizures including IF, were suppressed. We adopted the method of facial expression intensity ratings developed by Adolphs et al. (1994). Our results revealed that the patient had skewed appraisal of facial expressions before surgery, and that this tendency disappeared after surgery when IF was completely suppressed.
نتیجه گیری انگلیسی
. Results 4.1. Facial recognition task All the comparison participants showed normal ability to process facial stimuli on BFRT (mean = 49 ± 1.8). The patient also had no difficulties in processing these stimuli before and after surgery, scoring 49 and 50 respectively. 4.2. Intensity ratings of faces matching the rating category Regarding the mean intensity ratings of faces matching the rating category, i.e. mean ratings of, for instance, happiness intensity over six different happy faces, the patient's ratings were not different from comparison means before surgery (Table 2). After surgery, no impairments were found except for disgust, which yielded a mean rating of 1.5 out of 5 (z = −2.39, P < 0.01). Specifically, her ratings of fear, sadness, and anger were not different from comparisons before or after surgery. Table 2. The patient's and comparisons’ mean ratings of the degree to which facial expressions of each emotion type looked like its corresponding emotion term on a scale of 0 (not at all) to 5 (very much) Pre-operation Post-operation Comparisons (mean ± S.D.) Score z Score z Happiness 4.50 −1.01 5.00 0.34 4.88 ± 0.37 Sadness 4.33 −0.07 4.67 0.33 4.39 ± 0.85 Fear 3.83 −0.51 3.33 −0.98 4.38 ± 1.07 Anger 4.17 −0.14 4.00 −0.29 4.32 ± 1.1 Surprise 4.17 −0.33 4.17 −0.33 4.49 ± 0.98 Disgust 2.67 −1.37 1.50* −2.39 4.24 ± 1.14 The patient is largely able to judge emotional meaning from faces with the exception of the expression of disgust after surgery. * P < 0.01. Table options 4.3. Intensity ratings of faces not matching the rating category Compared with the emotion intensity ratings before and after surgery for the patient, significant interactions between operation conditions (pre or post) and the emotional categories of facial stimuli were obtained only for sadness intensity ratings [F(5, 25) = 7.38; P = 0.000], fear intensity ratings [F(5, 25) = 7.84; P = 0.000], and anger intensity ratings [F(5, 25) = 3.81; P = 0.009]. Simple effect analyses showed significant differences between before and after the operation as follows. For sadness intensity ratings ( Fig. 3a), the patient perceived significantly higher sadness intensities in facial expressions of fear [F(1, 5) = 7.50; P < 0.05], anger [F(1, 5) = 49.00; P < 0.001], surprise [F(1, 5) = 62.50; P < 0.001], and disgust [F(1, 5) = 8.45; P < 0.05] before surgery (mean: 3.00, 2.50, 1.67, 2.17, respectively) than after surgery (mean: 1.00, 1.67, 0.00, 1.00). For fear intensity ratings ( Fig. 3b), the patient perceived significantly higher fear intensities toward sad [F(1, 5) = 22.50; P < 0.01], angry [F(1, 5) = 121.00; P < 0.001], surprised [F(1, 5) = 49.00; P < 0.001], and disgusted [F(1, 5) = 7.50; P < 0.05] expressions before surgery (mean 3.67, 2.00, 1.33, 1.50) than after surgery (mean 0.67, 0.17, 0.00, 0.50). For anger intensity ratings ( Fig. 3c), the patient perceived higher anger intensities toward fearful [F(1, 5) = 7.50; P < 0.05], surprised [F(1, 5) = 49.00; P < 0.001], and disgusted [F(1, 5) = 7.50; P < 0.05] expressions before surgery (mean: 1.17, 1.17, 3.33) than after surgery (mean: 0.17, 0.00, 2.33). Ratings of (a) sadness intensity, (b) fear intensity, and (c) anger intensity ... Fig. 3. Ratings of (a) sadness intensity, (b) fear intensity, and (c) anger intensity across all facial expressions. Data for comparisons are represented by open squares (□) with S.D. The patient's ratings are represented by filled squares (■; pre-operation) and filled triangles (▴; post-operation). Figure options Moreover, by comparing the patient's pre- and post-operative intensity ratings with comparison group means, it is revealed that the observed shift of intensity ratings after surgery was attributable not to her abnormally low post-surgical ratings but to abnormally high pre-surgical ratings. The following pre-operative ratings were significantly higher than that of the comparison group: sadness intensity ratings for angry (z = 1.82, P < 0.05), surprised (z = 3.50, P < 0.001), disgusted (z = 1.78, P < 0.05) expressions; fear intensity ratings for sad (z = 3.14, P < 0.001), angry (z = 1.92, P < 0.05), disgusted (z = 2.13, P < 0.05) expressions; anger ratings for surprised expression (z = 3.90, P < 0.001). None of post-operative ratings were significantly different from comparisons. In sum, significant pre-surgical deviations were observed in sadness, fear, and to a lesser extent, anger ratings of various facial expressions except for happiness.