Digital communication and social cognition in adults with frontal lobe epilepsy: A scoping review

Patients with Frontal Lobe Epilepsy (FLE) face problems with social cognition (SC) since their difficulties in humor appreciation, facial and eye gaze emotional recognition. The effects of frontal (and temporal) seizures on SC may be understood in terms of emotion recognition (ER), Theory of Mind (ΤοΜ), empathy, and social behavior deficits in relation to their relevant pathophysiology. The impact of FLE on SC as expressed in digital environments still represents a terra incognita, as well as the objective of this exploratory work.

We aimed at exploring, elaborate and critically examine a) the ways deficits in SC impact digital communication (DC) in FLE; b) the way specific neuropsychological abnormalities that may disrupt DC in FLE; c) how to integrate neuropsychological assessment and rehabilitation to provide FLE patients strategies and enhance social outcomes in DC. We anticipate that a) since FLE as other types of frontal syndromes present with deficits in SC, frontal seizures will adversely affect DC; b) executive dysfunction, besides deficits in working memory (WM) and ToM, vigilance and attention, memory and thought in FLE may interfere with SC during online interactions; c) considering FLE's neurobehavioral and emotional breakdowns in DC, compensatory neurorehabilitation approaches along with psychological and stigma-related ones may be planned, respectively.

A scoping review approach was opted as the most appropriate one due to the exploratory nature of our research questions, which aim to map the existing literature, identify gaps, and understand the breadth of evidence available on this topic.

The effects of FLE (and TLE) on SC may be translated into deficits of ER, ToM, empathy, and social behavior in either physical or DC environments. Particularly in FLE, response maintenance/inhibition deficits link to aberrant emotional control and impulsivity, while during on-line interactions inferential reasoning may be secondarily affected. Executive dysfunction in FLE may impair encoding and retrieval, plus the ability to coherently organize thinking and clearly communicate on social media. Deficits in WM systems may further disrupt DC in FLE, since the prefrontal involvement in the temporal organization of conscious behavior. Such neurocognitive abnormalities can help to understand problems in interpreting emotional behavior and exerting emotional control, making social judgments and appropriate decisions in digital environments encountered in FLE. Excessive use of digital devices seems to impact both brain anatomy and physiology with cognitive impairments resembling dementia. Neurobehavioral abnormalities linked to the use of digital tools in psychiatric patients should be given careful consideration, since their cognitive deficits parallel those of FLE and may likewise interact and exacerbate psychopathology.

Understanding impaired SC in the light of the above neurobehavioral breakdowns and their role in digital environments is essential for tailoring DC strategies that address FLE's unique needs.