Alexithymia and its relationship with cognition and psychological outcomes in patients with drug-resistant epilepsy

Drug-resistant epilepsy (DRE) is associated with substantial cognitive and psychosocial burden. Alexithymia has been proposed as a relevant emotional processing deficit in epilepsy, but data in DRE are limited. This study examines alexithymia and its associations with cognition and psychological outcomes in patients with DRE.

Seventy-five patients with DRE underwent cognitive and psychological assessment. Alexithymia was assessed using the TAS-20 and affective symptoms using the DASS-42. A comprehensive neuropsychological battery was administered and composite scores for attention/processing speed, verbal memory, and executive functions were derived from z-standardized test scores. Associations were examined using correlations and hierarchical multiple regression analyses.

Patients included 29 with frontal lobe epilepsy, 36 with mesial temporal lobe epilepsy, and 10 with genetic generalized epilepsy, with no significant group differences in demographic or most clinical variables. Alexithymia was present in 22.6% of patients and did not differ across epilepsy subgroups. Stress was independently associated with alexithymia, while externally oriented thinking (EOT) was associated with poorer verbal memory and executive functioning; no associations were found between alexithymia and attention/processing speed. Adjusted regression models accounted for 35-36% of the total variance in memory and executive performance, respectively, with EOT emerging as the only alexithymia dimension independently associated with poorer performance.

Alexithymia in drug-resistant epilepsy is primarily associated with stress and poorer cognitive performance, particularly verbal memory and executive functioning, underscoring the clinical importance of emotional dysregulation.