Emotional processing in epilepsy: Investigating alexithymia and its associated factors

Alexithymia refers to the difficulty in identifying and expressing emotions. Although it is frequently observed in patients with epilepsy (PWE), its relationship with the neurological condition remains poorly understood. This review aims to synthesize existing findings on the relationship between alexithymia and sociodemographic, psychological, and epilepsy-related factors in PWE, offering a comprehensive analysis of how these variables interact to influence alexithymia levels within this population.

The PRISMA guidelines were followed, and a comprehensive search of electronic databases (PubMed, Science Direct) was conducted to identify original research articles published till the end of January 2025 in English. Two reviewers conducted the screening independently. Study quality was evaluated using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Analytical Cross-Sectional Studies.

Six studies were included in the review involving 832 PWE. The average TAS-20 score across studies indicates moderate levels of alexithymia across studied populations. Psychological factors such as depression, anxiety, emotional dysregulation, stigma, and suicidal ideation are closely related to alexithymia, while the link between alexithymia, sociodemographic, and epilepsy-related characteristics remains less clear.

Alexithymia is prevalent in PWE, highlighting emotional processing difficulties as a critical yet often overlooked aspect of the condition. The relationship between alexithymia and various sociodemographic, psychological, and epilepsy-related factors is complex and multifaceted. Future research is essential to understand these associations better and to develop targeted interventions that address the emotional and psychological needs of PWE.