Abstract
Recent neuroimaging studies have reported structural and functional brain abnormalities in patients with juvenile myoclonic epilepsy (JME), which may also involve cortical and subcortical networks that are important for decision making. This study is the first attempt to examine decision making in JME. Twenty-two patients with JME (median age 26.00, range 18–50) and 33 healthy controls (median age 26.00, range 18–57) participated in the study. For the JME group, the median age at seizure onset was 14.00 years (range 1–20); the median epilepsy duration was 11.50 years (range 3–45). Eleven patients (50 %) had pharmacoresistant seizures. All participants completed the Iowa Gambling Task (IGT), a widely used standard task of decision making. In this task, contingencies are not explained and feedback on previous decisions has to be used in order to learn to choose the advantageous alternatives. In the IGT, patients with JME showed difficulty in learning to choose advantageously compared to healthy controls. Difficulty was enhanced for the patients with pharmacoresistant seizures. A correlation analysis revealed an association between decision-making performance of patients with JME and executive functions. Results indicate that patients with JME have difficulty in making advantageous decisions and that persistence of seizures might be a critical factor for cognitive functioning. Findings of this study add a new aspect to the neuropsychological profile of JME. Difficulty in decision making may impair functioning of patients with JME in everyday life and affect their adherence to treatment plans.
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Notes
As indicated by Student’s t-tests and χ2 test, these healthy and patient subgroups did not differ from each other in terms of age, education, and gender distribution (all p > 0.1).
A separate MANOVA with gender as between subject factor indicated no significant differences between males and females in the decision-making task.
There are contrasting results in the literature regarding the potential effect of aging on decision making under ambiguity as measured by the IGT [28, 29]. In this study, the age range of the tested sample was very broad. However, we did not find a significant correlation between the net score in block 5 and age either for the patient group or for the control group. Results were also not significant, when the correlation analysis was carried out on the whole sample (all p > 0.1).
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Conflicts of interest
L Zamarian has held the following grants: MFI-2007-419, TWF-2010-1-993. L. Zamarian has received research support from FWF P21636-B18. J. Höfler has received speaker honoraria from UCB and travel grants from UCB, Eisai, and Gerot. G. Kuchukhidze has received research support from FWF P21636-B18. M. Delazer has held the following grant TWF-2008-1-594. E. Bonatti reports no disclosures. G. Kemmler reports no disclosures. E. Trinka has acted as a paid consultant to Eisai, Biogen Idec, Medtronics, Bial, and UCB. He has received research funding from UCB, Biogen-Idec, Sanofi-Aventis, and speakers’ honoraria from Bial, Cyberonics, Desitin Pharma, Eisai, Gerot, Böhringer, Sanofi, Medis, and UCB.
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All human studies must state that they have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki.
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L. Zamarian and J. Höfler contributed equally to the manuscript.
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Zamarian, L., Höfler, J., Kuchukhidze, G. et al. Decision making in juvenile myoclonic epilepsy. J Neurol 260, 839–846 (2013). https://doi.org/10.1007/s00415-012-6715-z
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DOI: https://doi.org/10.1007/s00415-012-6715-z