Facial emotion recognition in temporal lobe epilepsy: Behavioral performance, reaction time and alexithymia

Facial emotion recognition (FER) deficits are well documented in temporal lobe epilepsy (TLE), but most studies have focused on recognition accuracy, with limited attention to reaction time (RT) and its relationship with alexithymia. This study aimed to compare FER accuracy, RT, and alexithymia levels between patients with TLE and healthy controls (HCs) and to examine associations between FER performance and alexithymia.

Twenty-two patients with unilateral TLE and 30 age-, sex-, and education-matched HCs were included. FER accuracy and RTs were assessed using a standardized facial emotion recognition task. Alexithymia was evaluated using the Toronto Alexithymia Scale (TAS-20). Group comparisons and correlation analyses were conducted, controlling for depression where appropriate.

Compared with HCs, patients with TLE showed significantly lower recognition accuracy for happiness, fear, disgust and neutral facial expressions, along with significantly prolonged RTs across all emotion categories. Across emotions, longer RTs were consistently associated with poorer recognition accuracy. TLE patients exhibited significantly higher alexithymia scores, even after controlling for depression. Higher difficulty describing feelings was associated with poorer recognition of fearful facial expressions.

Facial emotion processing deficits in TLE extend beyond reduced recognition accuracy and are characterized by a marked slowing of emotional information processing. The close relationship between RT, recognition accuracy, and alexithymia suggests that FER impairments in TLE reflect inefficiencies within broader emotional-cognitive networks rather than isolated hemispheric dysfunction. Assessing FER in terms of both accuracy and processing speed, alongside alexithymic features, may enhance the clinical evaluation of social cognition in TLE.