Co-operative Behavior and Decision-making in Frontal Lobe Epilepsy

Civil Hospices of Lyon

Status

Completed

Conditions

Frontal Lobe Epilepsies

Treatments

Radiation: functional magnetic resonance imaging exam

Study type

Interventional

Funder types

Other

Identifiers

NCT02441478

69HCL14-0269

Details and patient eligibility

About

Epilepsy is a frequent neurological disorder with about a third of patients having seizures despite treatment. At least some of these seizures can be linked to a low compliance and therapy adherence of patients. Compliance is defined as "the extent to which a person's behavior (in terms of taking medication, following diets, or executing life style changes) coincides with medical or health advice". Therapy adherence of patients suffering from epilepsy is low with reported rates between 30 and 50%, although adherence to anticonvulsive drug therapy is critical for effective disease management and low therapy adherence is associated to higher mortality in epilepsy. The reasons for low therapy adherence are still a matter of research. Some known factors influencing compliance in epilepsy are related to its chronic nature, but others seem to lie in a complex interaction between psychiatric comorbidity and an impairment of neural systems underlying behavior. Furthermore, therapy adherence rests a variable difficult to measure, especially in epileptic patients where classical tools such as questionnaires and electronic monitoring devices have been shown to be imprecise. It has been argued that the term 'compliance' should be replaced by 'co-operative behavior' and non-compliance can therefore be interpreted as troubled co-operative behavior. This behavioral approach offers the potential of using tools and methods of the latest developments in behavioral neuroscience. Neuroeconomics, a scientific field on the border of psychology, economics and neuroscience, has used economic game paradigms in order to operationalize cooperative behavior and to identify several brain areas by functional brain imaging that have been linked to social co-operative behavior. The majority of these brain areas are located in the frontal cortex [ventromedial frontal/orbitofrontal cortex, and rostral anterior cingulate cortex. Epilepsies originating in the frontal lobe are subsumed under the term "frontal lobe epilepsy" (FLE) and represent 20-30% of all partial seizures and 25% of all refractory focal epilepsies referred to epilepsy surgery.

The investigator's project plans to study compliance and cooperative behavior of patients suffering from frontal lobe epilepsies through a neuroeconomic approach by (1) comparing the behavior of these patients in the prisoners' dilemma game to the behavior of age-, gender-, and education-matched healthy controls, (2) correlation of game behavior to brain activation measured by functional magnetic resonance imaging in both patients and healthy controls and (3) studying the link between cooperative behavior to compliance captured by pill counts and questionnaires.

Enrollment

30 patients

Sex

All

Ages

18 to 50 years old

Volunteers

Accepts Healthy Volunteers

Inclusion and exclusion criteria

Inclusion Criteria (Patients):

Age between 18 and 50
Diagnosis of frontal lobe epilepsy
Written consent to participate
Right-handed
Hospital Anxiety and Depression Scale Score under 10
Obsessive Compulsive Inventory Score under 40
Sufficient language skills
Social insurance

Inclusion criteria (controls):

Age between 18 and 50
Written consent to participate
Right-handed
Hospital Anxiety and Depression Scale Score under 10
Obsessive Compulsive Inventory Score under 40
Sufficient language skills
Social insurance

Exclusion Criteria (Patients):

Seizures types other than epileptic (psychogenic etc.)
Mental retardation
Epilepsies other than FLE
Other known neurological diseases
Hospital Anxiety and Depression Scale Score over 10
Obsessive Compulsive Inventory Score over 40
Pregnancy
non-MRI suitable transplants (cardiac pacemaker etc.), claustrophobia, orthopedic diseases that prevent lying in the scanner
During exclusion period of other studies
No social insurance

Exclusion criteria (controls)

History of neurological or psychiatric diseases
Hospital Anxiety and Depression Scale Score over 10
Obsessive Compulsive Inventory Score over 40
Medication other than contraceptives
Pregnancy
non-MRI suitable transplants (cardiac pacemaker etc.), claustrophobia, orthopedic diseases that prevent lying in the scanner
Major perceptive impairments
During exclusion period of other studies
No social insurance