Theory of mind and alexithymia in patients with cryptogenic frontal lobe epilepsy

To investigate social cognitive functions, specifically theory of mind (ToM) and alexithymia, in patients with cryptogenic frontal lobe epilepsy (FLE) without detectable structural brain lesions, and examine their associations with clinical, and demographic characteristics.

A total of 14 patients with cryptogenic FLE, and 30 age-, sex-, and education-matched healthy controls (HCs) were included. The participants were aged 18 years or older. TheReading the Mind in the Eyes Test (RMET)was used to assess ToM, and theToronto Alexithymia Scale-20 (TAS-20)was used to evaluate alexithymia. Depression symptoms were controlled using the Beck Depression Inventory (BDI).

Patients with cryptogenic FLE showed significantly lower RMET scores, indicating poorer affective ToM, and higher TAS-20 total scores, indicating greater alexithymia, compared with the HCs. These differences remained significant after controlling for BDI. No significant associations were found between ToM or alexithymia scores, and clinical parameters such as age at onset, duration of epilepsy, or seizure frequency. Within the cryptogenic FLE group, male patients showed a trend toward poorer social cognitive performance compared with females, although this difference did not reach statistical significance.

Cryptogenic FLE is associated with impairments in ToM, and elevated alexithymia, independent of depressive symptoms and clinical epilepsy variables. These findings indicate that social cognitive dysfunctions may occur even in the absence of structural brain abnormalities and underscore the role of frontal networks in emotional awareness and affective mentalizing.