Decision-making in patient s with epilepsy: A systematic review and meta-analysis

Decision-making (DM) is an essential ability in everyday life. Some studies have reported DM deficits in patients with epilepsy. However, the reliability of the conclusions was limited by small sample sizes and inconsistent results. This review evaluated the current evidence concerning DM ability in epilepsy to provide a more detailed understanding and reliable conclusions.

Seven databases were searched to collect studies about DM ability in epilepsy. The weighted mean difference (WMD), standardised mean difference (SMD) and 95% confidence interval (CI) were used to compare continuous variables.

A total of 13 studies, including 395 patients with epilepsy, met our inclusion criteria. The overall size of DM deficits was moderate (SMD = -0.372, 95% CI = -0.529 - -0.215, p < 0.001). The performance of the Iowa Gambling Task were impaired (WMD = -11.961, 95% CI = -20.543 - -3.380, p = 0.006; SMD = -0.694, 95% CI = -0.856 - -0.532, <0.001). The performance of other DM tests was not significantly less in either WMD or SMD. Patients with right TLE and with left TLE had no statistically significant difference in DM ability. An amygdala or (and) hippocampus resection might be related to more severe DM deficits. Various cognitive domains were related to decision-making capacity, although these correlations were not consistent across studies.

Patients with epilepsy had poorer scores in avoid making risky decisions under ambiguity. Other types of DM ability might not be impaired; however, insufficient studies, with small samples, limited reliability of the results.