Higher levels of impulsivity and depression are present in patients with temporal and extra- temporal focal epilepsy

Higher levels of impulsivity and depression are present in patients with temporal and extra- temporal focal epilepsy | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Higher levels of impulsivity and depression are present in patients with temporal and extra- temporal focal epilepsy Ernesto Gonzalez Stivala, Camila Wolfzun, Mercedes Sarudiansky, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3822397/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose: To analyze patients with clearly and defined focal epilepsy from temporal (ELT) and extra-temporal lobe origin (ETE), and a control group, and to compare the prevalence of psychiatric comorbid disorders and the levels of impulsivity between them. Methods: Consecutive patients who met criteria of drug-resistant focal epilepsy of temporal and/or extra-temporal origin, clearly defined and confirmed by VEEG (Video-EEG), were included. Psychiatric assessment was conducted using the Structured Clinical Interview for Axis I and II diagnose of DSM-IV (SCID I-II), the Barrat-11 scale for measure impulsivity, and Beck inventory for depression. Results: 73 patients with drug-resistant temporal lobe epilepsy (TLE), 21 with extra-temporal focal epilepsy (ETE) and 58 healthy control subjects were included. A total of 45 patients (61.6%) in TLE group and 13 patients (61.9%) in ETE group met criteria for at least one present or past psychiatry disorder coded on Axis I of DSM-IV. Both ELT and ETE groups presented higher Barrat-11 scores compared to the control group (p<0.01). ETE showed a tendency to a higher impulsivity level, particularly in the motor factor compared to ELT (p=0.05). A left laterality of the epileptogenic zone, and the presence of psychiatric disorders (depression) were associated with higher impulsivity among patients with ELT (p<0.05). Conclusion: Impulsivity and psychiatric comorbidity are important issues to consider in clinical evaluation of patients with drug-resistant focal epilepsies. The evaluation by an adequately mental health team should be considered routine among these patients. focal epilepsy left laterality epileptogenic zone psychiatric disorders personality disorders Figures Figure 1 1. Introduction Psychiatric comorbid disorders such as depression, anxiety, psychosis are frequently reported among patients with epilepsy, particularly among those with focal resistant epilepsies, such as temporal lobe epilepsy (TLE) [ 1 – 4 ]. At the beginning of the last century epilepsy mental disorders were thought to be independent, however today in these days, resistant epilepsy has been considered a risk factor for developing comorbid psychiatric disorders [ 5 , 6 ]. Furthermore, psychiatric disorders have been associated with an increased risk of unprovoked epileptic seizures, and history of depression prior to seizure onset was higher in patients with epilepsy. As well the physiopathogenic mechanisms involved in this association are still unknown, stress mediators have been implicated to act synergistically with epileptic seizures on hippocampus function enhancing the vulnerability to depression [ 7 , 8 , 9 ]. Regarding impulsivity, it has been less study among epilepsy patients, but it was classically linked to a personality trait or as a behavioral symptom associated with epilepsy. Impulsivity has been considered a multidimensional construct defined by a pattern of behaviors that are deficiently conceived, prematurely executed, risky and inappropriate for the situation. There is a lack of proper planning and reflection, and it typically leads to undesirable consequences. It has been associated with lower a quality of life, a worst affective performance and poor social integration [ 10 ]. Impulsivity has been strongly associated with addictive and suicidal behavior and personality disorders [ 11 ]. All these factors highlight the importance of considering impulsivity not only in patients with mental health disorders but also in patients with epilepsy, who had also a high frequency of psychiatric comorbid disorders [ 5 , 6 ]. An association between impulsivity and juvenile myoclonic epilepsy (JME) (a common subtype of genetic generalized epilepsy (GGE) that arises in adolescence has been previously reported [ 3 , 12 ]. Regarding focal epilepsies, one study showed that comorbid depression was associated with impulsivity in patients with temporal lobe epilepsy, however very few researchers analyzed impulsivity as specific symptom among these patients [ 3 , 12 ]. In a previous study of our group, we explored the impulsivity levels after epilepsy surgery and we found that a bad epileptic seizure outcome (Engel III-IV), was associated with the presence of high levels of impulsivity [ 6 ]. In the present study, we aimed to analyze two groups of patients with clearly and defined drug-resistant focal epilepsy from temporal (ELT) and extratemporal lobe origin (ETE) and a control group, with the aim to compare the levels of impulsivity and the relationship with epilepsy (laterality) and psychiatric factors. 2. Methods 2.1 Selection of patients Patients who underwent VEGG at El Cruce Hospital, Buenos Aires Province, Argentina from January 2019 to July 2021 were consecutively evaluated and included according inclusion and exclusion criteria in the present study. All patients received AEDs according to international protocols. The public epilepsy program facilitates access to major AEDs that are freely available [ 13 , 14 ]. 2.1.1 Ethics committee and informed consent Approval was obtained from the Ethics Committees of El Cruce Hospital and Ramos Mejía Hospital to conduct the study in accordance with the ethical standards established in the 1964 Declaration of Helsinki of 1964, and all the subjects submitted informed consent to participate in the present study. 2.1.2 Inclusion criteria Patients between 18 and 65 years old who met criteria of drug-resistant focal epilepsy of temporal and/or extratemporal origin defined and confirmed by VEEG were included. Drug-resistant epilepsy (DRE) was defined as a failure to achieve sustained seizure control (no seizures for a period of 12 months or prolongation of three times the pre-intervention inter-seizure interval, whichever is longer), with at least two trials of well-tolerated, appropriately chosen, and adequately scheduled AEDs (irrespective of being administered as monotherapy or in combination) [ 15 ]. All patients underwent an exhaustive neurological evaluation to arrive to epilepsy diagnosis. At least two experienced neurologists analyzed complementary studies (VEEG, MRI) to define the epileptogenic zone and the laterality of the epileptic focus. Clinical data were obtained by anamnesis and clinical reports in all patients. Seizure frequency was calculated according to the last year, and separated in two groups: low seizure frequency ( 1 seizure by month). 2.1.3 Exclusion criteria Patients who did not complete all the diagnoses steps or when VEEG did not confirm the epileptogenic zone and patients with mental retardation (attending a special school and/or having an IQ < 70 according to the Wechsler Adult Intelligence Scale (WAIS-III) [ 16 ], were excluded. Patients with functional dissociative seizures instead epilepsy or concomitant to epilepsy, were excluded. 2.2 Complementary studies 2.2.1 Video EEG monitoring All patients underwent video-EEG (VEEG) monitoring to confirm and determine the epilepsy subtype and the epileptogenic zone. For VEEG monitoring, a Stellate-Bioscience EEG machine at a 200-Hz sample rate was used. All ictal recordings were obtained using the international ten-20 system, with the addition of temporal electrodes of the ten-20 system. Referential montages as well as longitudinal-bipolar and transverse bipolar montages were used for the analysis. The epileptogenic zone and the laterality (right/left) of the epileptogenic focus were defined according the VEEG findings, and diagnoses of TLE or ETE was confirmed by at least two different epileptologists [ 6 ]. 2.2.2 Magnetic resonance imaging All patients underwent a magnetic resonance imaging (MRI) with a temporal lobe epilepsy protocol. MRI acquisition was performed using a 3 T Philips Achieva system with body coil excitation and 8-channel receive phased array head coil at Hospital El Cruce. The sequences used were the following: Sagittal plane T1-weighted image for the purpose of detecting the hippocampus in the parasagittal slices; inversion-recovery (IR) pulse sequence, fluid- attenuated IR (FLAIR), and three-dimensional gradient echo sequence (volumetric), perpendicular to the long axis of the hippocampus, and T2-weighted axial sequence parallel to the long axis of the hippocampus [ 6 ]. 2.3 Psychiatric and Impulsivity assessment 2.3.1 Psychiatric diagnosis Psychiatric evaluation was performed by trained psychiatrists, during VEEG monitoring (which usually lasts five days), according to a standardized protocol [ 14 , 17 ]. The anamnesis was performed with patients and with the relatives. The examination was performed when patients were lucid, able to answer all the questions. If the patient had a seizure, the interview was interrupted until the postictal period ended. Psychiatric semiology was supplemented with structural interviews for the present and history of psychiatric disorders using a standardized psychiatric assessment, the Structured Clinical Interview for Axis I diagnose of DSM-IV (Structured Clinical Interview for DSM Disorders [SCID]-I and -II) [ 18 , 19 ]. 2.3.2 Global assessment of functionality Global assessment of functionality (GAF) was determined in all patients. The GAF is a numeric scale (0 through 100) comprised in Axis V of DSM-IV [ 20 ]. This scale rates the social, occupational, and psychological functioning of adults according to the psychiatrist's perspective. 2.3.3 Beck Depression Inventory The Beck Depression Inventory (BDI II) (Spanish version) [ 21 ] was administered to quantify the severity of depressive symptoms. The BDI-II is a widely used self-administered scale consisting of 21 items. The final score ranges from 0 and 63. A score of 10 points or over indicates presence of depressive symptoms in general population, and a score of 15 points is recommended to use as cut-off score in epileptic patients [ 22 ]. 2.3.4 Barratt Impulsiveness Scale 11 To determine impulsivity traits, we used the Barratt Impulsiveness Scale Spanish Version, also validated in Argentina with a Cronbach alpha of 0.84 [ 23 ]. The Barratt Impulsiveness Scale (BIS-11) [ 24 ] is a questionnaire designed to assess the personality/behavioral construct of impulsiveness, which is composed of 30 items describing common impulsive or non-impulsive behaviors and preferences. All items are answered on a 4-point scale (Rarely/Never, Occasionally, Often, Almost Always/Always). Items are scored 1,2,3,4; 4 indicates the most impulsive response. The higher the summed score for all items, the higher the level of impulsiveness. It is structured into 6 first-order factors (attention, cognitive instability, motor impulsiveness, perseverance, self-control, cognitive complexity) which are then regrouped into 3 second-order factors: Attentional Impulsiveness, Motor Impulsiveness, and Non-planning Impulsiveness. 2.4 Statistical analyses Descriptive measures of quantitative variables were analyzed. Statistical significance was considered at p < 0.05, and very significant at p < 0.001 (2-sided; β-1 power ≥ 0.80). Data were examined for normality using the Kolmogorov Smirnov test. Nonparametric tests (Kruskal Wallis and Mann-Whitney for post hoc), were used to compare the ER performance between groups of TLE and with the control group. Partial Epsilon squared was calculated to determine de effect size of comparisons. To compare qualitative variables a Chi square test was performed. Spearman’s ρ correlation coefficients were calculated considering very strong correlation, ρ = ≥ 0.8, strong correlation, ρ = ≥ 0.6 ≤ 0.79, moderate correlation ρ = ≥ 0.4 ≤ 0.59, weak correlation, ρ =≥ 0.39 ≤ 0.2. Secondly with the subpopulation of TLE patients (n = 73), a multiple regression linear analysis was performed when the model satisfied the assumptions of independence (Durbin Test), the homogeneity of the variance (Levene´s Test) and the normality of residuals distribution (Kolmogorov Smirnov test for one sample). 3. Results During January 2019 to July 2021, 147 patients were consecutively admitted to the VEEG unit of El Cruce Hospital. Of these, 37 patients were excluded from this analysis because functional dissociative seizures and/or intellectual disability and 16 patients were excluded because the inconclusive results of the VEEG, to determine the epileptogenic zone. Ninety-four patients were included, 73 (66.4%) had temporal lobe epilepsy (TLE) and 21 (19.1%) had extratemporal focal epilepsy (ETE) (16 were frontal, 4 were parietal, and 1 insular). In addition, 58 healthy control subjects, without psychiatric neither neurological comorbidity, with similar sociodemographic characteristics, matched for age (p > 0.05) and sex (p > 0.05) were included. In a first analysis, the clinical variables of epilepsy and the frequency of psychiatric disorders were compared between both groups of patients with ELT and ETE (Table 1 ). Patients with ETE showed a higher seizure frequency compared to ELT (p < 0.05, Chi Square test). In relation to the psychiatric evaluation, a total of 45 patients (61.6%) in TLE group and 13 patients (61.9%) in the ETE group met criteria for at least one present or past psychiatry disorder coded on Axis I of DSM-IV. The most frequent disorder was depression in both groups of patients, and no significant differences were found between them. Twelve patients (12.8%) met criteria for more than one diagnosis. Regarding the evaluation of personality disorders (Axis II of DSM-IV), 30 (41%) in TLE group and 8 (38%) in ETE group met criteria for at least one personality disorder subtype. Regarding impulsivity (BIS II score), the ETE group presented higher total scale scores compared to the TLE group (p < 0.05). Table 1 Epileptic and psychiatric variables in patients with Temporal (TLE) and Extratemporal (ETE) lobe epilepsy TLE Temporal (n= 73) ETE Extratemporal (n= 21) p Neurological variables Epilepsy duration(years) [X (SD)] 19.2 (±12) 18 (±14) 0.589 Seizures onset (years) [X (SD)] 15.4 (±10) 14.3 (±9) 0.692 Lateralization of epileptic zone Left 38 (52%) 12 (57.1%) 0.812 Right 34 (46.6%) 9 (42.9%) Seizure frequency Low 45 (61.6%) 5 (23.8%) 0.002** High 28 (38.4%) 16 (76.2%) Neurologic History Febrile seizures 10 (13.7%) 1 (4.8%) 0.615 Traumatic injury 3 (4.1%) 1 (4.8%) Status epilepticus 1 (1.4%) 0 Meningitis 4 (5.5%) 0 Psychiatric Variables Axis I 45 (61.6%) 13 (61.9%) 0.983 Depression 29 (39.7%) 12 (57.1%) 0.156 Anxiety 8 (11%) 1 (4.8%) 0.172 Psychosis 5 (6.8%) 2 (9.6%) 0.681 Other 13 (17.8%) 3 (14.3%) 0.705 Axis II 30 (41%) 8 (38%) 0.805 GAF [X (SD)] 61.2 (± 10) 60.7 (± 12) 0.861 BDI-II [X (SD)] 14.7 (± 12) 15.3 (± 8) 0.361 BIS II total [X (SD)] 68,41(± 12) 74,76 (± 11) 0.030* * p < 0.05, ** p < 0.01 (Chi square for qualitative variables, Mann-Whitney for quantitative variables). [X (SD)]: Mean and Standard deviation. Low seizure frequency ( 1 seizure by month). In a second analysis impulsivity scores were compared between the groups of patients (TLE and ETE) and with a healthy control group. The second-order factors of impulsivity considered were: Attention (Attention + Cognitive instability), Motor (Motor + Perseverance), Non-planning (Self-control + Cognitive complexity). The TLE group presented higher score of impulsivity in Attention, in Non-planning, and in the Total Score compared to the group control (p < 0.01) (Kruskal Wallis). The ETE group presented higher scores in Attention, in Motor, in Non-planning and in the total score (p < 0.01), compared to the control group. ELT and ETE showed no differences in impulsivity factors except for a tendency to a higher level in the motor factor in the ETE group compared to ELT (p = 0.05) (Table 2 and Graphic 1). Table 2 Impulsivity levels (BIS-11 score) in patients with Temporal (TLE), Extratemporal (ETE) lobe epilepsy and healthy controls BIS − 11 Temporal [X (SD)](n= 73) Extratemporal [X (SD)] (n= 21) Control [X (SD)] (n= 58) H P Ɛ 2 Total Score 68.41 (±12) 74.76 (±12) 60,90 ±12 21.15 0,0001** 0.37 Attention 18.75 (±4) 19.19 (±4) 16.17 (±4) 11.95 0.003** 0.28 Motor 22.75 (±5) 25.76 (±4) 21.34 (±5) 13.37 0.004 ** 0.29 Non-planning 26.9 (±6) 29.81 (±6) 23.38 (±6) 20.02 0.0001 ** 0.36 [X (SD)]: Mean and Standard deviation. H: Kruskal Wallis, ** p < 0.01, Ɛ 2 : partial Epsilon Squared (Effect size). Graphic 1. Box Plot graphic showing the scores of impulsivity levels (BIS-11 second order factors) in patients with Temporal (TLE), Extratemporal (ETE) and controls Finally, in TLE group (n = 73) we explored the influence of psychiatric and epileptic variables on impulsivity levels in a multiple regression linear model. We explored the variables of interest according to the statistical assumptions mentioned in methods section and to the significance in the univariate analysis. We included as independent variables; the laterality of the epileptic foci, the presence of Axis I and II disorder, the presence of depression, the Beck Depression Inventory, and the GAF score. Main results are resumed in Table 3. We found that the presence of an Axis I disorder, depression comorbidity and a lower GAF were significantly associated with higher impulsivity in the total score (R2 = 0,29, F (6,64) = 4.1, p = 0.002) and in the Non-planning factor (R2 = 0,21, F (6,64) = 2.64, p = 0.025). Regarding epileptic variables, a left laterality of the epileptogenic zone was associated with higher impulsivity in the motor factor (R2 = 0,24, F (6,64) = 3.2, p = 0.009). No significant differences were found in the ETE group however the sample was very small (n = 21). Table 3. Lineal regression analysis of psychiatric and epileptic variables in relation to impulsivity in patients with ELT epilepsy Dependent Variable Impulsivity Total BIS II Score Attention Motor Non-planning Independent Variable Standardized Beta coefficient p Confidence interval 95% Standardized Beta coefficient p Confidence interval 95% Beta coefficient P Confidence interval 95% Standardized Beta coefficient p Confidence interval 95% Axis I Disorders - 0.35 0.021* -16.64 /- 1.38 - 0.23 0.15 - 4.9 / 0.78 - 0.22 0.16 -5.42 / 0.96 - 0.37 0.021* - 8.70 / - 0.72 Depression 0.38 0.011* 2.29 / 17.34 0.22 0.17 - 0.87 / 4.74 0.22 0.14 -0.81/5.48 0.43 0.007** 1.60 / 9.48 BECK 0.010 0.94 - 0.28 / 0.30 0.081 0.59 - 0.08 / 0.14 0.11 0.44 -0.076/ 0.17 -0.12 0.39 -0.22/0.088 GAF - 0,32 0.020* - 0.73 / - 0.06 - 0.19 0.18 - 0.20 /- 0.04 - 0.21 0.12 -0.24 / - 0.032 -0.34 0.020* -0.38 /-0.035 Personality Disorder (Axis II) 0.10 0.46 - 4.71 / 10.16 0.055 0.73 -3.19/4.59 0.15 0.32 -1.57/4.65 0.056 0.72 -3.19/4.59 Laterality Epileptogenic zone (right/left) - 0.21 0.063 - 10.84 / 0.29 - 0.23 0.060 -1.92/ 0.060 - 0.24 0.039* -4.78 / - 0.12 -0.06 0.57 -3.74 / 2.08 A left laterality of the epileptic zone in patients with TLE was associated with higher impulsivity in the motor factor (*p<0.05, **p<0.01). 4. Discussion In the present study we performed a complete neurological and psychiatric evaluation of a cohort of patients with epilepsy who were admitted to the VEEG monitoring unit and compared the psychiatric profile and the impulsivity levels in two sub groups of patients with clearly defined temporal lobe (ELT) and extratemporal lobe (ETE) resistant epilepsy. Both groups of patients with TLE and ETE group presented significantly higher impulsivity values compared to the control group. As well higher values of impulsivity were found in ETE group when were compared with TLE group, no significant differences were found when the control group was incorporated to the analysis. However, patients with ETE presented a tendency but not significant to have a higher impulsivity in the motor factor (p = 0.05) compared to TLE. In this study we used the most cited instrument to measure impulsivity, which has been developed by Ernest S. Barratt (1925–2005). Barratt have been worked on this scale during more than 40 and defined impulsivity as the predisposition to rapid and unexpected reactions to internal or external stimuli without regard to the negative consequences of these reactions [ 25 ]. Similar to our results, other authors [ 26 ] studied temporal lobe epilepsy (TLE) and frontal lobe epilepsy (FLE) patients, using Iowa Gamble Game test, and found that both patients with ELT and FLE were more impulsive than controls, with no significant differences between them [ 26 ]. Other studies were reported among patients with juvenile myoclonic epilepsy [ 12 , 27 , 28 ]. These studies showed that these patients have higher impulsivity scores [ 12 , 27 , 28 ]. Indeed, an overlap in prefrontal, striatal, and limbic networks involved in both JME and impulse control has been proposed to explain these findings [ 27 ]. Recently, other study showed higher impulsivity levels among patients with generalized epilepsy and in patients with frontal lobe epilepsy, similar to our results. However, they found the contrary among TLE patients[ 29 ]. Nevertheless, in our study we included patients with drug-resistant epilepsy, who are specially associated with comorbid psychiatric disorders and impulsivity. Our results also coincide with previous researchers that reported an exacerbation of impulsivity in patients who suffered traumatic brain lesions [ 30 – 33 ]. Frontal lobe regions compromise, particularly orbital and left ventrolateral lesions have been classically related to higher impulsivity and engaging in risk-taking behaviors [ 31 ]. Such risk behaviors have also been described in patients with frontal lobe epilepsies, and could be due to the alteration in the normal functioning of frontal structures due to the epileptogenic network [ 34 ]. It has been postulated that prefrontal cortex areas can act as a brake on impulsive tendencies, exerting inhibitory control over subcortical structures and favoring optimal decision-making, while striatal structures without such adequate braking would stimulate the occurrence of impulsive behaviors [ 35 ]. This hypothesis is known as the "brake-and-throttle", consider also the temporal function and suggest that the frontal lobe could be regulated in turn by temporal structures, which would add a hierarchically superior instance in the control of impulsive behavior [ 36 ]. Indeed, it can explain why we also found higher impulsivity in both groups of patients with temporal and extratemporal epilepsy (most of them were frontal lobe epilepsies). In both frontal and temporal lobe epilepsies, the frontal-hippocampal networks are involved in the epileptogenic zone and/or in the propagation zone of the epileptic discharges [ 37 ]. It has been postulated that temporal structures could exert a regulatory function on frontal structures and in turn on subcortical structures to control impulsive behavior. These structures (frontal lobe and temporal lobe) are highly connected through the uncinate fasciculus, which unites the orbitofrontal lobe with the anterior temporal lobe [ 38 , 39 ]. As expected, we found that the most frequent psychiatric comorbidity was depression in both groups of patients. It was followed by anxiety disorders and psychosis. This is in line with the international literature [ 17 , 40 , 41 ]. Similarly, to our findings other researchers endorsed significantly more depressive symptoms in both ELT and ELF groups, than in the control group without epilepsy [ 42 ]. The high prevalence of depression in both TLE and ETE has been related to the high epileptic activity in the temporal lobe, which may have distal effects on the frontal lobe and vice versa [ 43 ]. Regarding TLE group analysis, we observed that greater impulsivity was associated with psychiatric disorders and with comorbid depression. The importance of depression in TLE patients has emerged in the last years and the ILAE (International League Against Epilepsy) recognize depression as a main comorbid disorder in patients with epilepsy [ 44 ]. A bidirectional relationship between depression and TLE has been postulated [ 8 ], mainly based on epidemiological [ 7 ] experimental studies [ 8 ] and histopathological studies [ 9 ]. It is estimated that 30–50% of epilepsy patients suffer from comorbid depression at some point during life. It has been described that epilepsy may favor the development of depression by activating pathophysiological mechanisms associated with stress [ 45 , 46 ], but depression can also may favor the development of epilepsy (a positive history of depression was associated with an increased risk of developing epilepsy)[ 7 ]. Particularly in TLE, hippocampal involvement has been linked to an increased risk of depression [ 8 ]. Epilepsy would act synergistically increasing the susceptibility of the hippocampus to stressors that favor a state of increased vulnerability and risk of depression [ 47 ]. It has been postulated that epileptic discharges could affect neurobiological pathogenic mechanisms of depressive disorders, and in turn depressive disorders, which have been associated with lower GABAergic activity and higher glutamatergic activity in the brain, could potentiate cortical hyperexcitability and/or facilitate the development of treatment-resistant epilepsy [ 48 ]. In 2012, Butler et al. [ 49 ] described different neuroanatomical substrates for depression with and without temporal lobe epilepsy and suggested an important role for the orbitofrontal cortex (OFC) (a limbic region that exerts a fundamental role in emotional processing and is strongly interconnected with medial temporal structures). In the group of patients without TLE, higher levels of depressive symptoms were associated with thinning of the left lateral orbito frontal cortex, somewhat opposite to what was found in patients with TLE [ 49 ]. Limbic areas usually affected in TLE such as the amygdala, and the hippocampus, are involved in social behaviors, including impulse control, anxiety, and emotional memory [ 3 ]. In addition, the temporal pole (TP) which has been considered a paralimbic region may be affected in TLE. Furthermore, the association between depression and impulsivity has been previously described by several authors, who have established a direct relationship between both manifestations in patients with psychiatric disorders [ 3 , 50 – 53 ]. This relationship could help to interpret the existing link between temporal lobe, depression, and impulsivity [ 4 ]. In relation to EZ laterality, in this study a left laterality of the epileptogenic zone in the ELT group, was associated with higher impulsivity scores on the motor factor. These results contrast with one of the few studies about impulsivity and epilepsy and laterality, the study of McIntyre et al. in 1973 [ 54 ], in which it was found that adult patients with right-sided lesions were more impulsive. Although, these authors measured impulsivity with a different instrument (the familiar figure test). On the contrary, other previous studies using VBM in psychiatric patients with impulsivity found that a lower left lateral orbito frontal cortex volume was associated with greater attention impulsivity. Also, a lower volume in the left superior temporal gyrus was associated with greater impulsivity [ 55 ]. Also in this line, orbital and left ventrolateral lesions have been associated with increased risk behaviors in the general population and in patients with psychiatric disorders [ 31 , 56 – 62 ]. However, there is only very few information in the literature about epilepsy clinical variables and impulsivity. 5. Conclusions Our results have allowed us to conclude that impulsivity is an important issue to consider in clinical evaluation of patients with focal epilepsies. High levels of impulsivity interfere with different aspects of daily life that hinder the subject's social integration and integrity, such as correct planning of activities, efficient management of resources, control of emotional responses in different situations, substance use and self-injury, and suicide attempts. 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Psychological Assessment Gill SJ, Lukmanji S, Fiest KM, Patten SB, Wiebe S, Jetté N (2017) Depression screening tools in persons with epilepsy: A systematic review of validated tools. Epilepsia 58:695–705. https://doi.org/10.1111/epi.13651 Pablo LLópez, Cetkovich-Bakmas M, Lischinsky A, Prado DA, Fernando Torrente. Psychometric properties of the Barratt Impulsiveness Scale in a sample of the city of Buenos Aires. Vertex n d ;23:85–91 Patton JH, Stanford MS, Barratt ES (1995) Factor structure of the barratt impulsiveness scale. J Clin Psychol 51:768–774. https://doi.org/10.1002/1097-4679(199511)51:63.0.CO;2-1 Groman SM (2020) The Neurobiology of Impulsive Decision-Making and Reinforcement Learning in Nonhuman Animals. In: de Wit H, Jentsch JD (eds) Recent Advances in Research on Impulsivity and Impulsive Behaviors. Springer International Publishing, Cham, pp 23–52. https://doi.org/10.1007/7854_2020_127 . Simsekoglu R, Tombul T, Demirci H, Özdemir M, Ankaralı H (2022) Comparison of decision-making under ambiguity in patients with temporal lobe and frontal lobe epilepsy. Epilepsy Behav 129:108636. https://doi.org/10.1016/j.yebeh.2022.108636 Shakeshaft A, Panjwani N, McDowall R, Crudgington H, Ceballos JP, Andrade DM et al (2021) Trait impulsivity in Juvenile Myoclonic Epilepsy. Ann Clin Transl Neurol 8:138–152. https://doi.org/10.1002/acn3.51255 Moschetta S, Valente KD (2013) Impulsivity and seizure frequency, but not cognitive deficits, impact social adjustment in patients with juvenile myoclonic epilepsy. Epilepsia 54:866–870. https://doi.org/10.1111/epi.12116 Lee S-A, Yang H, Im K, Choi EJ, Jeon J-Y, Han S-H et al (2022) Comparisons of impulsivity among patients with different subtypes of epilepsy. Epilepsy Res 186:106997. https://doi.org/10.1016/j.eplepsyres.2022.106997 Borod JC (2000) The Neuropsychology of Emotion. Oxford University Press Floden D, Alexander MP, Kubu CS, Katz D, Stuss DT (2008) Impulsivity and risk-taking behavior in focal frontal lobe lesions. Neuropsychologia 46:213–223. https://doi.org/10.1016/j.neuropsychologia.2007.07.020 Coccaro EF, Sripada CS, Yanowitch RN, Phan KL (2011) Corticolimbic Function in Impulsive Aggressive Behavior. Biol Psychiatry 69:1153–1159. https://doi.org/10.1016/j.biopsych.2011.02.032 Bechara A, Damasio H, Damasio AR, Emotion (2000) Decision Making and the Orbitofrontal Cortex. Cereb Cortex 10:295–307. https://doi.org/10.1093/cercor/10.3.295 Moeller FG, Barratt ES, Dougherty DM, Schmitz JM, Swann AC (2001) Psychiatric Aspects of Impulsivity. AJP 158:1783–1793. https://doi.org/10.1176/appi.ajp.158.11.1783 Fineberg NA, Chamberlain SR, Goudriaan AE, Stein DJ, Vanderschuren LJMJ, Gillan CM et al (2014) New developments in human neurocognition: clinical, genetic, and brain imaging correlates of impulsivity and compulsivity. CNS Spectr 19:69–89. https://doi.org/10.1017/S1092852913000801 Buckholtz JW, Meyer-Lindenberg A (2012) Psychopathology and the Human Connectome: Toward a Transdiagnostic Model of Risk For Mental Illness. Neuron 74:990–1004. https://doi.org/10.1016/j.neuron.2012.06.002 Findikli E, Izci F, Camkurt M, Tuncel D, Sahin M, Kuran M et al (2016) Eysenck personality characteristics of epilepsy patients and its effect on quality of life. JMOOD 6:124. https://doi.org/10.5455/jmood.20160425114144 Olson IR, Heide RJVD, Alm KH, Vyas G (2015) Development of the uncinate fasciculus: Implications for theory and developmental disorders. Dev Cogn Neurosci 14:50–61. https://doi.org/10.1016/j.dcn.2015.06.003 Gilchrist C, Thompson DK (2021) Chapter 29 - Features of white matter development in very preterm children from infancy to late childhood. In: Martin CR, Preedy VR, Rajendram R (eds) Factors Affecting Neurodevelopment. Academic Press, pp 335–345. https://doi.org/10.1016/B978-0-12-817986-4.00029-8 . Brandt C, Mula M (2016) Anxiety disorders in people with epilepsy. Epilepsy Behav 59:87–91. https://doi.org/10.1016/j.yebeh.2016.03.020 Shinagawa S, Naasan G, Karydas AM, Coppola G, Pribadi M, Seeley WW et al (2015) Clinicopathological Study of Patients With C9ORF72-Associated Frontotemporal Dementia Presenting With Delusions. J Geriatr Psychiatry Neurol 28:99–107. https://doi.org/10.1177/0891988714554710 Pizzi AM, Chapin JS, Tesar GE, Busch RM (2009) Comparison of personality traits in patients with frontal and temporal lobe epilepsies. Epilepsy Behav 15:225–229. https://doi.org/10.1016/j.yebeh.2009.03.028 Salzberg M, Taher T, Davie M, Carne R, Hicks RJ, Cook M et al (2006) Depression in Temporal Lobe Epilepsy Surgery Patients: An FDG-PET Study. Epilepsia 47:2125–2130. https://doi.org/10.1111/j.1528-1167.2006.00860.x Scheffer IE, Berkovic S, Capovilla G, Connolly MB, French J, Guilhoto L et al (2017) ILAE classification of the epilepsies: Position paper of the ILAE Commission for Classification and Terminology. Epilepsia 58:512–521. https://doi.org/10.1111/epi.13709 Błaszczyk B, Czuczwar SJ (2016) Epilepsy coexisting with depression. Pharmacol Rep 68:1084–1092 Wulsin AC, Solomon MB, Privitera MD, Danzer SC, Herman JP (2016) Hypothalamic-pituitary-adrenocortical axis dysfunction in epilepsy. Physiol Behav 166:22–31. https://doi.org/10.1016/j.physbeh.2016.05.015 D’Alessio L, Korman GP, Sarudiansky M, Guelman LR, Scévola L, Pastore A et al (2020) Reducing Allostatic Load in Depression and Anxiety Disorders: Physical Activity and Yoga Practice as Add-On Therapies. Front Psychiatry 0. https://doi.org/10.3389/fpsyt.2020.00501 Kanner AM (2014) Is depression associated with an increased risk of treatment-resistant epilepsy? Research strategies to investigate this question. Epilepsy Behav 38:3–7. https://doi.org/10.1016/j.yebeh.2014.06.027 Butler T, Blackmon K, McDonald CR, Carlson C, Barr WB, Devinsky O et al (2012) Cortical thickness abnormalities associated with depressive symptoms in temporal lobe epilepsy. Epilepsy Behav 23:64–67. https://doi.org/10.1016/j.yebeh.2011.10.001 Lejoyeux M, Arbaretaz M, McLOUGHLIN M, Adès J (2002) Impulse control disorders and depression. J Nerv Ment Dis 190:310–314 McGirr A, Turecki G (2007) The relationship of impulsive aggressiveness to suicidality and other depression-linked behaviors. Curr Psychiatry Rep 9:460–466 Carver CS, Johnson SL, Joormann J (2008) Serotonergic function, two-mode models of self-regulation, and vulnerability to depression: what depression has in common with impulsive aggression. Psychol Bull 134:912 Johnson SL, Porter PA, Modavi K, Dev AS, Pearlstein JG, Timpano KR (2022) Emotion-related impulsivity predicts increased anxiety and depression during the COVID-19 pandemic. J Affect Disord 301:289–299 McIntyre M, Pritchard PB III, Lombroso CT (1976) Left and Right Temporal Lobe Epileptics: A Controlled Investigation of Some Psychological Differences. Epilepsia 17:377–386. https://doi.org/10.1111/j.1528-1157.1976.tb04449.x Lee AKW, Jerram M, Fulwiler C, Gansler DA (2011) Neural correlates of impulsivity factors in psychiatric patients and healthy volunteers: a voxel-based morphometry study. Brain Imaging and Behavior 5:52–64. https://doi.org/10.1007/s11682-010-9112-1 Korponay C, Koenigs M (2021) Gray matter correlates of impulsivity in psychopathy and in the general population differ by kind, not by degree: a comparison of systematic reviews. Soc Cognit Affect Neurosci 16:683–695. https://doi.org/10.1093/scan/nsab045 Wolf RC, Thomann PA, Sambataro F, Vasic N, Schmid M, Wolf ND (2012) Orbitofrontal cortex and impulsivity in borderline personality disorder: an MRI study of baseline brain perfusion. Eur Arch Psychiatry Clin Neurosci 262:677–685. https://doi.org/10.1007/s00406-012-0303-1 Boes AD, Bechara A, Tranel D, Anderson SW, Richman L, Nopoulos P (2009) Right ventromedial prefrontal cortex: a neuroanatomical correlate of impulse control in boys. Soc Cognit Affect Neurosci 4:1–9. https://doi.org/10.1093/scan/nsn035 Yokoyama R, Nozawa T, Takeuchi H, Taki Y, Sekiguchi A, Nouchi R et al (2015) Regional Gray Matter Density Associated with Cognitive Reflectivity–Impulsivity: Evidence from Voxel-Based Morphometry. PLoS ONE 10:e0122666. https://doi.org/10.1371/journal.pone.0122666 Charpentier J, Dzemidzic M, West J, Oberlin BG, Eiler WJA, Saykin AJ et al (2016) Externalizing personality traits, empathy, and gray matter volume in healthy young drinkers. Psychiatry Research: Neuroimaging 248:64–72. https://doi.org/10.1016/j.pscychresns.2016.01.006 Besteher B, Gaser C, Nenadic I, Nenadic I (2019) Brain structure and trait impulsivity: A comparative VBM study contrasting neural correlates of traditional and alternative concepts in healthy subjects. Neuropsychologia. https://doi.org/10.1016/j.neuropsychologia.2019.04.021 Wolfs EML, Klaus J, Schutter DJLG (2022) Cerebellar Grey Matter Volumes in Reactive Aggression and Impulsivity in Healthy Volunteers. Cerebellum. https://doi.org/10.1007/s12311-021-01337-5 N.d. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3822397","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":264663329,"identity":"812b3e92-3a8b-4007-a7c6-a7f9ce95d58b","order_by":0,"name":"Ernesto Gonzalez Stivala","email":"","orcid":"","institution":"Universidad de Buenos Aires (UBA), Centro de Epilepsia del Hospital Ramos Mejía","correspondingAuthor":false,"prefix":"","firstName":"Ernesto","middleName":"Gonzalez","lastName":"Stivala","suffix":""},{"id":264663330,"identity":"2bc4f7e9-31fd-42c9-94c3-2cd19a2a63ed","order_by":1,"name":"Camila Wolfzun","email":"","orcid":"","institution":"National Scientific and Technical Research Council","correspondingAuthor":false,"prefix":"","firstName":"Camila","middleName":"","lastName":"Wolfzun","suffix":""},{"id":264663331,"identity":"b42abad0-ca65-461d-92b8-be10e8ccb1a3","order_by":2,"name":"Mercedes Sarudiansky","email":"","orcid":"","institution":"National Scientific and Technical Research Council","correspondingAuthor":false,"prefix":"","firstName":"Mercedes","middleName":"","lastName":"Sarudiansky","suffix":""},{"id":264663332,"identity":"e08a974e-6665-427b-a6dc-11990ff745ff","order_by":3,"name":"Silvia Kochen","email":"","orcid":"","institution":"National Scientific and Technical Research Council","correspondingAuthor":false,"prefix":"","firstName":"Silvia","middleName":"","lastName":"Kochen","suffix":""},{"id":264663333,"identity":"448a9764-5ace-499f-87ce-0df10476bd8f","order_by":4,"name":"Brenda Giagante","email":"","orcid":"","institution":"Hospital El Cruce","correspondingAuthor":false,"prefix":"","firstName":"Brenda","middleName":"","lastName":"Giagante","suffix":""},{"id":264663334,"identity":"36ce2ba6-0499-4204-b232-540c496777b5","order_by":5,"name":"Silvia Oddo","email":"","orcid":"","institution":"Hospital El Cruce","correspondingAuthor":false,"prefix":"","firstName":"Silvia","middleName":"","lastName":"Oddo","suffix":""},{"id":264663335,"identity":"728c6e42-d372-40da-83c5-ded899bebb1f","order_by":6,"name":"Guido Korman","email":"","orcid":"","institution":"National Scientific and Technical Research Council","correspondingAuthor":false,"prefix":"","firstName":"Guido","middleName":"","lastName":"Korman","suffix":""},{"id":264663336,"identity":"69e02f6d-19c5-43f7-a359-d89cde1c31e1","order_by":7,"name":"Luciana D´Alessio","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8UlEQVRIiWNgGAWjYBACPiA+AMSM/SBeAjFa2GBaZjZAtEgQpQUEGDccgDCI0CKR/PDAzx12spuPHz724EGNTR0D/+JjEgw19/BoSTM42Hsm2XjbmbR0g4RjaRIMEs+AxLFiPFpyGA7wtjEnbrvBYyaR2HAYqOWMsQEDWwJeLQf/ttUnbp4B1vIfquUffi2HedsOJ26QAGs5IMHA32P4gLENjxaeZwaHZduOG884k5YmkXAsWbJNgi3xQWIfbi387MmPP75tq5btbz98TPJHjR0/P//hAwc+fMOtBZtTE4hMBkgWHyBN/SgYBaNgFAx7AAB+1VCyOfd7YQAAAABJRU5ErkJggg==","orcid":"","institution":"National Scientific and Technical Research Council","correspondingAuthor":true,"prefix":"","firstName":"Luciana","middleName":"","lastName":"D´Alessio","suffix":""}],"badges":[],"createdAt":"2023-12-29 21:14:06","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3822397/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3822397/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":49140643,"identity":"442c1314-3915-4e85-a885-a1a5efacd092","added_by":"auto","created_at":"2024-01-03 18:22:13","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":162341,"visible":true,"origin":"","legend":"\u003cp\u003eGraphic 1. Box Plot graphic showing the scores of impulsivity levels (BIS-11 second order factors) in patients with Temporal (TLE), Extratemporal (ETE) and controls\u003c/p\u003e\n\u003cp\u003eGraphic 1. The TLE group presented higher scores in Attention (p=0.003), in Motor (p=0.001), in Non-planning (p=0.0001) and in the total score (p\u0026lt;0.0001), compared to the control group (Kruskal Wallis-post hoc). The ETE group presented higher scores in Attention (p=0.003), in Motor factor (p=0.001), in Non-planning factor (p=0.0001) and in the total score (p=0.0001), compared to the control group (Kruskal Wallis-post hoc). A tendency but not significant difference was observed in the motor factor between temporal and extratemporal epilepsy group, with higher levels in the ETE group (p=0.055).\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-3822397/v1/600616cf5d2c681152017a85.jpeg"},{"id":49682530,"identity":"2917daf8-662b-4979-989d-f6889d622fe1","added_by":"auto","created_at":"2024-01-16 11:52:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":414137,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3822397/v1/0d618f2c-9be4-4476-b208-e1420e73277d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Higher levels of impulsivity and depression are present in patients with temporal and extra- temporal focal epilepsy","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003ePsychiatric comorbid disorders such as depression, anxiety, psychosis are frequently reported among patients with epilepsy, particularly among those with focal resistant epilepsies, such as temporal lobe epilepsy (TLE) [\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. At the beginning of the last century epilepsy mental disorders were thought to be independent, however today in these days, resistant epilepsy has been considered a risk factor for developing comorbid psychiatric disorders [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Furthermore, psychiatric disorders have been associated with an increased risk of unprovoked epileptic seizures, and history of depression prior to seizure onset was higher in patients with epilepsy. As well the physiopathogenic mechanisms involved in this association are still unknown, stress mediators have been implicated to act synergistically with epileptic seizures on hippocampus function enhancing the vulnerability to depression [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRegarding impulsivity, it has been less study among epilepsy patients, but it was classically linked to a personality trait or as a behavioral symptom associated with epilepsy. Impulsivity has been considered a multidimensional construct defined by a pattern of behaviors that are deficiently conceived, prematurely executed, risky and inappropriate for the situation. There is a lack of proper planning and reflection, and it typically leads to undesirable consequences. It has been associated with lower a quality of life, a worst affective performance and poor social integration [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Impulsivity has been strongly associated with addictive and suicidal behavior and personality disorders [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. All these factors highlight the importance of considering impulsivity not only in patients with mental health disorders but also in patients with epilepsy, who had also a high frequency of psychiatric comorbid disorders [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAn association between impulsivity and juvenile myoclonic epilepsy (JME) (a common subtype of genetic generalized epilepsy (GGE) that arises in adolescence has been previously reported [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Regarding focal epilepsies, one study showed that comorbid depression was associated with impulsivity in patients with temporal lobe epilepsy, however very few researchers analyzed impulsivity as specific symptom among these patients [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In a previous study of our group, we explored the impulsivity levels after epilepsy surgery and we found that a bad epileptic seizure outcome (Engel III-IV), was associated with the presence of high levels of impulsivity [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In the present study, we aimed to analyze two groups of patients with clearly and defined drug-resistant focal epilepsy from temporal (ELT) and extratemporal lobe origin (ETE) and a control group, with the aim to compare the levels of impulsivity and the relationship with epilepsy (laterality) and psychiatric factors.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Selection of patients\u003c/h2\u003e \u003cp\u003ePatients who underwent VEGG at El Cruce Hospital, Buenos Aires Province, Argentina from January 2019 to July 2021 were consecutively evaluated and included according inclusion and exclusion criteria in the present study. All patients received AEDs according to international protocols. The public epilepsy program facilitates access to major AEDs that are freely available [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e \u003ch2\u003e2.1.1 Ethics committee and informed consent\u003c/h2\u003e \u003cp\u003e Approval was obtained from the Ethics Committees of El Cruce Hospital and Ramos Mej\u0026iacute;a Hospital to conduct the study in accordance with the ethical standards established in the 1964 Declaration of Helsinki of 1964, and all the subjects submitted informed consent to participate in the present study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003e2.1.2 Inclusion criteria\u003c/h2\u003e \u003cp\u003ePatients between 18 and 65 years old who met criteria of drug-resistant focal epilepsy of temporal and/or extratemporal origin defined and confirmed by VEEG were included. Drug-resistant epilepsy (DRE) was defined as a failure to achieve sustained seizure control (no seizures for a period of 12 months or prolongation of three times the pre-intervention inter-seizure interval, whichever is longer), with at least two trials of well-tolerated, appropriately chosen, and adequately scheduled AEDs (irrespective of being administered as monotherapy or in combination) [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. All patients underwent an exhaustive neurological evaluation to arrive to epilepsy diagnosis. At least two experienced neurologists analyzed complementary studies (VEEG, MRI) to define the epileptogenic zone and the laterality of the epileptic focus. Clinical data were obtained by anamnesis and clinical reports in all patients. Seizure frequency was calculated according to the last year, and separated in two groups: low seizure frequency (\u0026thinsp;\u0026lt;\u0026thinsp;=\u0026thinsp;1 seizure by month), high seizure frequency (\u0026gt;\u0026thinsp;1 seizure by month).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003e2.1.3 Exclusion criteria\u003c/h2\u003e \u003cp\u003ePatients who did not complete all the diagnoses steps or when VEEG did not confirm the epileptogenic zone and patients with mental retardation (attending a special school and/or having an IQ\u0026thinsp;\u0026lt;\u0026thinsp;70 according to the Wechsler Adult Intelligence Scale (WAIS-III) [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], were excluded. Patients with functional dissociative seizures instead epilepsy or concomitant to epilepsy, were excluded.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Complementary studies\u003c/h2\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003e2.2.1 Video EEG monitoring\u003c/h2\u003e \u003cp\u003eAll patients underwent video-EEG (VEEG) monitoring to confirm and determine the epilepsy subtype and the epileptogenic zone. For VEEG monitoring, a Stellate-Bioscience EEG machine at a 200-Hz sample rate was used. All ictal recordings were obtained using the international ten-20 system, with the addition of temporal electrodes of the ten-20 system. Referential montages as well as longitudinal-bipolar and transverse bipolar montages were used for the analysis. The epileptogenic zone and the laterality (right/left) of the epileptogenic focus were defined according the VEEG findings, and diagnoses of TLE or ETE was confirmed by at least two different epileptologists [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003e2.2.2 Magnetic resonance imaging\u003c/h2\u003e \u003cp\u003eAll patients underwent a magnetic resonance imaging (MRI) with a temporal lobe epilepsy protocol. MRI acquisition was performed using a 3 T Philips Achieva system with body coil excitation and 8-channel receive phased array head coil at Hospital El Cruce. The sequences used were the following: Sagittal plane T1-weighted image for the purpose of detecting the hippocampus in the parasagittal slices; inversion-recovery (IR) pulse sequence, fluid- attenuated IR (FLAIR), and three-dimensional gradient echo sequence (volumetric), perpendicular to the long axis of the hippocampus, and T2-weighted axial sequence parallel to the long axis of the hippocampus [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Psychiatric and Impulsivity assessment\u003c/h2\u003e \u003cdiv id=\"Sec11\" class=\"Section3\"\u003e \u003ch2\u003e2.3.1 Psychiatric diagnosis\u003c/h2\u003e \u003cp\u003ePsychiatric evaluation was performed by trained psychiatrists, during VEEG monitoring (which usually lasts five days), according to a standardized protocol [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The anamnesis was performed with patients and with the relatives. The examination was performed when patients were lucid, able to answer all the questions. If the patient had a seizure, the interview was interrupted until the postictal period ended. Psychiatric semiology was supplemented with structural interviews for the present and history of psychiatric disorders using a standardized psychiatric assessment, the Structured Clinical Interview for Axis I diagnose of DSM-IV (Structured Clinical Interview for DSM Disorders [SCID]-I and -II) [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e \u003ch2\u003e2.3.2 Global assessment of functionality\u003c/h2\u003e \u003cp\u003eGlobal assessment of functionality (GAF) was determined in all patients. The GAF is a numeric scale (0 through 100) comprised in Axis V of DSM-IV [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. This scale rates the social, occupational, and psychological functioning of adults according to the psychiatrist's perspective.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section3\"\u003e \u003ch2\u003e2.3.3 Beck Depression Inventory\u003c/h2\u003e \u003cp\u003eThe Beck Depression Inventory (BDI II) (Spanish version) [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] was administered to quantify the severity of depressive symptoms. The BDI-II is a widely used self-administered scale consisting of 21 items. The final score ranges from 0 and 63. A score of 10 points or over indicates presence of depressive symptoms in general population, and a score of 15 points is recommended to use as cut-off score in epileptic patients [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section3\"\u003e \u003ch2\u003e2.3.4 Barratt Impulsiveness Scale 11\u003c/h2\u003e \u003cp\u003eTo determine impulsivity traits, we used the Barratt Impulsiveness Scale Spanish Version, also validated in Argentina with a Cronbach alpha of 0.84 [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The Barratt Impulsiveness Scale (BIS-11) [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] is a questionnaire designed to assess the personality/behavioral construct of impulsiveness, which is composed of 30 items describing common impulsive or non-impulsive behaviors and preferences. All items are answered on a 4-point scale (Rarely/Never, Occasionally, Often, Almost Always/Always). Items are scored 1,2,3,4; 4 indicates the most impulsive response. The higher the summed score for all items, the higher the level of impulsiveness. It is structured into 6 first-order factors (attention, cognitive instability, motor impulsiveness, perseverance, self-control, cognitive complexity) which are then regrouped into 3 second-order factors: Attentional Impulsiveness, Motor Impulsiveness, and Non-planning Impulsiveness.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Statistical analyses\u003c/h2\u003e \u003cp\u003eDescriptive measures of quantitative variables were analyzed. Statistical significance was considered at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, and very significant at p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 (2-sided; β-1 power\u0026thinsp;\u0026ge;\u0026thinsp;0.80). Data were examined for normality using the Kolmogorov Smirnov test. Nonparametric tests (Kruskal Wallis and Mann-Whitney for post hoc), were used to compare the ER performance between groups of TLE and with the control group. Partial Epsilon squared was calculated to determine de effect size of comparisons. To compare qualitative variables a Chi square test was performed. Spearman\u0026rsquo;s ρ correlation coefficients were calculated considering very strong correlation, ρ = \u0026ge; 0.8, strong correlation, ρ = \u0026ge; 0.6\u0026thinsp;\u0026le;\u0026thinsp;0.79, moderate correlation ρ = \u0026ge; 0.4\u0026thinsp;\u0026le;\u0026thinsp;0.59, weak correlation, ρ =\u0026ge; 0.39\u0026thinsp;\u0026le;\u0026thinsp;0.2. Secondly with the subpopulation of TLE patients (n\u0026thinsp;=\u0026thinsp;73), a multiple regression linear analysis was performed when the model satisfied the assumptions of independence (Durbin Test), the homogeneity of the variance (Levene\u0026acute;s Test) and the normality of residuals distribution (Kolmogorov Smirnov test for one sample).\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003eDuring January 2019 to July 2021, 147 patients were consecutively admitted to the VEEG unit of El Cruce Hospital. Of these, 37 patients were excluded from this analysis because functional dissociative seizures and/or intellectual disability and 16 patients were excluded because the inconclusive results of the VEEG, to determine the epileptogenic zone.\u003c/p\u003e\n\u003cp\u003eNinety-four patients were included, 73 (66.4%) had temporal lobe epilepsy (TLE) and 21 (19.1%) had extratemporal focal epilepsy (ETE) (16 were frontal, 4 were parietal, and 1 insular). In addition, 58 healthy control subjects, without psychiatric neither neurological comorbidity, with similar sociodemographic characteristics, matched for age (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) and sex (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) were included.\u003c/p\u003e\n\u003cp\u003eIn a first analysis, the clinical variables of epilepsy and the frequency of psychiatric disorders were compared between both groups of patients with ELT and ETE (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). Patients with ETE showed a higher seizure frequency compared to ELT (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, Chi Square test). In relation to the psychiatric evaluation, a total of 45 patients (61.6%) in TLE group and 13 patients (61.9%) in the ETE group met criteria for at least one present or past psychiatry disorder coded on Axis I of DSM-IV. The most frequent disorder was depression in both groups of patients, and no significant differences were found between them. Twelve patients (12.8%) met criteria for more than one diagnosis. Regarding the evaluation of personality disorders (Axis II of DSM-IV), 30 (41%) in TLE group and 8 (38%) in ETE group met criteria for at least one personality disorder subtype. Regarding impulsivity (BIS II score), the ETE group presented higher total scale scores compared to the TLE group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eEpileptic and psychiatric variables in patients with Temporal (TLE) and Extratemporal (ETE) lobe epilepsy\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTLE\u003c/p\u003e\n\u003cp\u003eTemporal\u003c/p\u003e\n\u003cp\u003e\u003csub\u003e(n= 73)\u003c/sub\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eETE\u003c/p\u003e\n\u003cp\u003eExtratemporal\u003c/p\u003e\n\u003cp\u003e\u003csub\u003e(n= 21)\u003c/sub\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ep\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\" align=\"left\"\u003e\n\u003cp\u003eNeurological variables\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eEpilepsy duration(years) \u003csub\u003e\u003cem\u003e[X (SD)]\u003c/em\u003e\u003c/sub\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e19.2 (\u0026plusmn;12)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18 (\u0026plusmn;14)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003e0.589\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eSeizures onset (years) \u003csub\u003e\u003cem\u003e[X (SD)]\u003c/em\u003e\u003c/sub\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15.4 (\u0026plusmn;10)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14.3 (\u0026plusmn;9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003e0.692\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eLateralization of epileptic zone\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLeft\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e38 (52%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12 (57.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003e0.812\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRight\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e34 (46.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9 (42.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eSeizure frequency\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLow\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e45 (61.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5 (23.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.002**\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHigh\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28 (38.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e16 (76.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eNeurologic History\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFebrile seizures\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10 (13.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (4.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e0.615\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTraumatic injury\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 (4.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (4.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eStatus epilepticus\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (1.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMeningitis\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4 (5.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\" align=\"left\"\u003e\n\u003cp\u003ePsychiatric Variables\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eAxis I\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e45 (61.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13 (61.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.983\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eDepression\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e29 (39.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12 (57.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.156\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eAnxiety\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8 (11%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (4.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.172\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003ePsychosis\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5 (6.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (9.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.681\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eOther\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13 (17.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 (14.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.705\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eAxis II\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30 (41%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8 (38%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.805\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eGAF \u003csub\u003e\u003cem\u003e[X (SD)]\u003c/em\u003e\u003c/sub\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e61.2 (\u0026plusmn;\u0026thinsp;10)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e60.7 (\u0026plusmn;\u0026thinsp;12)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.861\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eBDI-II \u003csub\u003e\u003cem\u003e[X (SD)]\u003c/em\u003e\u003c/sub\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14.7 (\u0026plusmn;\u0026thinsp;12)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15.3 (\u0026plusmn;\u0026thinsp;8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.361\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eBIS II total \u003csub\u003e\u003cem\u003e[X (SD)]\u003c/em\u003e\u003c/sub\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e68,41(\u0026plusmn;\u0026thinsp;12)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e74,76 (\u0026plusmn;\u0026thinsp;11)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.030*\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\"\u003e* p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, ** p\u0026thinsp;\u0026lt;\u0026thinsp;0.01 (Chi square for qualitative variables, Mann-Whitney for quantitative variables). [X (SD)]: Mean and Standard deviation. Low seizure frequency (\u0026thinsp;\u0026lt;\u0026thinsp;=\u0026thinsp;1 seizure by month), high seizure frequency (\u0026gt;\u0026thinsp;1 seizure by month).\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eIn a second analysis impulsivity scores were compared between the groups of patients (TLE and ETE) and with a healthy control group. The second-order factors of impulsivity considered were: Attention (Attention\u0026thinsp;+\u0026thinsp;Cognitive instability), Motor (Motor\u0026thinsp;+\u0026thinsp;Perseverance), Non-planning (Self-control\u0026thinsp;+\u0026thinsp;Cognitive complexity). The TLE group presented higher score of impulsivity in Attention, in Non-planning, and in the Total Score compared to the group control (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) (Kruskal Wallis). The ETE group presented higher scores in Attention, in Motor, in Non-planning and in the total score (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), compared to the control group. ELT and ETE showed no differences in impulsivity factors except for a tendency to a higher level in the motor factor in the ETE group compared to ELT (p\u0026thinsp;=\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e and Graphic 1).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eImpulsivity levels (BIS-11 score) in patients with Temporal (TLE), Extratemporal (ETE) lobe epilepsy and healthy controls\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eBIS \u0026minus;\u0026thinsp;11\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTemporal\u003c/p\u003e\n\u003cp\u003e\u003csub\u003e[X (SD)](n= 73)\u003c/sub\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eExtratemporal\u003c/p\u003e\n\u003cp\u003e\u003csub\u003e\u003cem\u003e[X (SD)]\u003c/em\u003e(n= 21)\u003c/sub\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eControl\u003c/p\u003e\n\u003cp\u003e\u003csub\u003e\u003cem\u003e[X (SD)]\u003c/em\u003e(n= 58)\u003c/sub\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eH\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eƐ\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTotal Score\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003e68.41 (\u0026plusmn;12)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003e74.76 (\u0026plusmn;12)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e60,90\u003cem\u003e\u0026plusmn;12\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21.15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0,0001**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.37\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAttention\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18.75 (\u0026plusmn;4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e19.19 (\u0026plusmn;4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e16.17 (\u0026plusmn;4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11.95\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.003**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.28\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMotor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e22.75 (\u0026plusmn;5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e25.76 (\u0026plusmn;4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21.34 (\u0026plusmn;5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13.37\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.004\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.29\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNon-planning\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e26.9 (\u0026plusmn;6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e29.81 (\u0026plusmn;6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e23.38 (\u0026plusmn;6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e20.02\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.0001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.36\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"7\"\u003e[X (SD)]: Mean and Standard deviation. H: Kruskal Wallis, ** p\u0026thinsp;\u0026lt;\u0026thinsp;0.01, Ɛ\u003csup\u003e2\u003c/sup\u003e : partial Epsilon Squared (Effect size).\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"7\"\u003eGraphic 1. Box Plot graphic showing the scores of impulsivity levels (BIS-11 second order factors) in patients with Temporal (TLE), Extratemporal (ETE) and controls\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eFinally, in TLE group (n\u0026thinsp;=\u0026thinsp;73) we explored the influence of psychiatric and epileptic variables on impulsivity levels in a multiple regression linear model. We explored the variables of interest according to the statistical assumptions mentioned in \u003cspan class=\"InternalRef\"\u003emethods\u003c/span\u003e section and to the significance in the univariate analysis. We included as independent variables; the laterality of the epileptic foci, the presence of Axis I and II disorder, the presence of depression, the Beck Depression Inventory, and the GAF score. Main results are resumed in Table\u0026nbsp;3. We found that the presence of an Axis I disorder, depression comorbidity and a lower GAF were significantly associated with higher impulsivity in the total score (R2\u0026thinsp;=\u0026thinsp;0,29, F (6,64)\u0026thinsp;=\u0026thinsp;4.1, p\u0026thinsp;=\u0026thinsp;0.002) and in the Non-planning factor (R2\u0026thinsp;=\u0026thinsp;0,21, F (6,64)\u0026thinsp;=\u0026thinsp;2.64, p\u0026thinsp;=\u0026thinsp;0.025). Regarding epileptic variables, a left laterality of the epileptogenic zone was associated with higher impulsivity in the motor factor (R2\u0026thinsp;=\u0026thinsp;0,24, F (6,64)\u0026thinsp;=\u0026thinsp;3.2, p\u0026thinsp;=\u0026thinsp;0.009). No significant differences were found in the ETE group however the sample was very small (n\u0026thinsp;=\u0026thinsp;21).\u003c/p\u003e\n\u003cp\u003eTable 3. Lineal regression analysis of psychiatric and epileptic variables in relation to impulsivity in patients with ELT epilepsy\u003c/p\u003e\n\u003ctable style=\"width: 941px;\" border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 93px;\" colspan=\"2\" valign=\"bottom\"\u003e\n\u003cp\u003eDependent Variable\u003c/p\u003e\n\u003cp\u003eImpulsivity\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 194px;\" colspan=\"6\" valign=\"bottom\"\u003e\n\u003cp\u003eTotal BIS II Score\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 199px;\" colspan=\"5\" valign=\"bottom\"\u003e\n\u003cp\u003eAttention\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 188px;\" colspan=\"6\" valign=\"bottom\"\u003e\n\u003cp\u003eMotor\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 234px;\" colspan=\"6\" valign=\"bottom\"\u003e\n\u003cp\u003eNon-planning\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 93px;\" colspan=\"2\" valign=\"bottom\"\u003e\n\u003cp\u003eIndependent\u003c/p\u003e\n\u003cp\u003eVariable\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 82px;\" colspan=\"2\" valign=\"bottom\"\u003e\n\u003cp\u003eStandardized\u003c/p\u003e\n\u003cp\u003eBeta\u003c/p\u003e\n\u003cp\u003ecoefficient\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 43px;\" colspan=\"2\" valign=\"bottom\"\u003e\n\u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 69px;\" colspan=\"2\" valign=\"bottom\"\u003e\n\u003cp\u003eConfidence interval\u003c/p\u003e\n\u003cp\u003e95%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 82px;\" colspan=\"2\" valign=\"bottom\"\u003e\n\u003cp\u003eStandardized\u003c/p\u003e\n\u003cp\u003eBeta\u003c/p\u003e\n\u003cp\u003ecoefficient\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 37px;\" valign=\"bottom\"\u003e\n\u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 80px;\" colspan=\"2\" valign=\"bottom\"\u003e\n\u003cp\u003eConfidence interval 95%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 63px;\" colspan=\"2\" valign=\"bottom\"\u003e\n\u003cp\u003eBeta coefficient\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 48px;\" colspan=\"2\" valign=\"bottom\"\u003e\n\u003cp\u003e\u003cstrong\u003eP\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 77px;\" colspan=\"2\" valign=\"bottom\"\u003e\n\u003cp\u003eConfidence interval 95%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 86px;\" colspan=\"2\" valign=\"bottom\"\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp;Standardized\u003c/p\u003e\n\u003cp\u003eBeta\u003c/p\u003e\n\u003cp\u003ecoefficient\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 61px;\" colspan=\"2\" valign=\"bottom\"\u003e\n\u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 87px;\" colspan=\"2\" valign=\"bottom\"\u003e\n\u003cp\u003eConfidence interval 95%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 9px;\" rowspan=\"6\" valign=\"top\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 94px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003eAxis I Disorders\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 74px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp; \u0026nbsp;- \u0026nbsp;0.35\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 52px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.021*\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 61px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e-16.64 /- 1.38\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 79px;\" valign=\"top\"\u003e\n\u003cp\u003e\u0026nbsp; - 0.23\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 47px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;0.15\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 77px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp;- 4.9 / 0.78\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 58px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp;- 0.22\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 56px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;0.16\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 74px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; -5.42 / 0.96\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 81px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u0026nbsp; - 0.37\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 69px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp; 0.021*\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 77px;\" valign=\"top\"\u003e\n\u003cp\u003e\u0026nbsp;- 8.70 / - 0.72\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 94px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003eDepression\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 74px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp;0.38\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 52px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.011*\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 61px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u0026nbsp; 2.29 / 17.34\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 79px;\" valign=\"top\"\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; 0.22\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 47px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;0.17\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 77px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp;- 0.87 / 4.74\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 58px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; 0.22\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 56px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;0.14\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 74px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; -0.81/5.48\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 81px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; 0.43\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 69px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp; 0.007**\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 77px;\" valign=\"top\"\u003e\n\u003cp\u003e\u0026nbsp;1.60 / 9.48\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 94px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003eBECK\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 74px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 0.010\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 52px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.94\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 61px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e- 0.28 / 0.30\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 79px;\" valign=\"top\"\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; 0.081\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 47px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;0.59\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 77px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp;- 0.08 / 0.14\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 58px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; 0.11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 56px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;0.44\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 74px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; -0.076/ 0.17\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 81px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp;-0.12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 69px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp; 0.39\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 77px;\" valign=\"top\"\u003e\n\u003cp\u003e-0.22/0.088\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 94px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003eGAF\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 74px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; - 0,32\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 52px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.020*\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 61px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u0026nbsp;- 0.73 / - 0.06\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 79px;\" valign=\"top\"\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp;- 0.19\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 47px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;0.18\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 77px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp;- 0.20 /- 0.04\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 58px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u0026nbsp; - 0.21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 56px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;0.12\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 74px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; -0.24 / - 0.032\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 81px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp;-0.34\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 69px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp; 0.020*\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 77px;\" valign=\"top\"\u003e\n\u003cp\u003e\u0026nbsp;-0.38 /-0.035\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 94px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003ePersonality\u003c/p\u003e\n\u003cp\u003eDisorder (Axis II)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 74px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp;0.10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 52px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.46\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 61px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u0026nbsp;- 4.71 / 10.16\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 79px;\" valign=\"top\"\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;0.055\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 47px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;0.73\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 77px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp;-3.19/4.59\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 58px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; 0.15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 56px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;0.32\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 74px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; -1.57/4.65\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 81px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; 0.056\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 69px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;0.72\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 77px;\" valign=\"top\"\u003e\n\u003cp\u003e\u0026nbsp;-3.19/4.59\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 94px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003eLaterality\u003c/p\u003e\n\u003cp\u003eEpileptogenic zone\u003c/p\u003e\n\u003cp\u003e(right/left)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 74px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;- \u0026nbsp;0.21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 52px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp; 0.063\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 61px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u0026nbsp; - 10.84 / 0.29\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 79px;\" valign=\"top\"\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp;- 0.23\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 47px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;0.060\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 77px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u0026nbsp; -1.92/ 0.060\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 58px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp;- 0.24\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 56px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;0.039*\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 74px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; -4.78 / - 0.12\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 81px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; -0.06\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 69px;\" colspan=\"2\" valign=\"top\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;0.57\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 77px;\" valign=\"top\"\u003e\n\u003cp\u003e\u0026nbsp;-3.74 / 2.08\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA left laterality of the epileptic zone in patients with TLE was associated with higher impulsivity in the motor factor (*p\u0026lt;0.05, **p\u0026lt;0.01).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eIn the present study we performed a complete neurological and psychiatric evaluation of a cohort of patients with epilepsy who were admitted to the VEEG monitoring unit and compared the psychiatric profile and the impulsivity levels in two sub groups of patients with clearly defined temporal lobe (ELT) and extratemporal lobe (ETE) resistant epilepsy. Both groups of patients with TLE and ETE group presented significantly higher impulsivity values compared to the control group. As well higher values of impulsivity were found in ETE group when were compared with TLE group, no significant differences were found when the control group was incorporated to the analysis. However, patients with ETE presented a tendency but not significant to have a higher impulsivity in the motor factor (p\u0026thinsp;=\u0026thinsp;0.05) compared to TLE.\u003c/p\u003e \u003cp\u003eIn this study we used the most cited instrument to measure impulsivity, which has been developed by Ernest S. Barratt (1925\u0026ndash;2005). Barratt have been worked on this scale during more than 40 and defined impulsivity as the predisposition to rapid and unexpected reactions to internal or external stimuli without regard to the negative consequences of these reactions [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Similar to our results, other authors [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] studied temporal lobe epilepsy (TLE) and frontal lobe epilepsy (FLE) patients, using Iowa Gamble Game test, and found that both patients with ELT and FLE were more impulsive than controls, with no significant differences between them [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Other studies were reported among patients with juvenile myoclonic epilepsy [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. These studies showed that these patients have higher impulsivity scores [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Indeed, an overlap in prefrontal, striatal, and limbic networks involved in both JME and impulse control has been proposed to explain these findings [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Recently, other study showed higher impulsivity levels among patients with generalized epilepsy and in patients with frontal lobe epilepsy, similar to our results. However, they found the contrary among TLE patients[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Nevertheless, in our study we included patients with drug-resistant epilepsy, who are specially associated with comorbid psychiatric disorders and impulsivity.\u003c/p\u003e \u003cp\u003eOur results also coincide with previous researchers that reported an exacerbation of impulsivity in patients who suffered traumatic brain lesions [\u003cspan additionalcitationids=\"CR31 CR32\" citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Frontal lobe regions compromise, particularly orbital and left ventrolateral lesions have been classically related to higher impulsivity and engaging in risk-taking behaviors [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Such risk behaviors have also been described in patients with frontal lobe epilepsies, and could be due to the alteration in the normal functioning of frontal structures due to the epileptogenic network [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. It has been postulated that prefrontal cortex areas can act as a brake on impulsive tendencies, exerting inhibitory control over subcortical structures and favoring optimal decision-making, while striatal structures without such adequate braking would stimulate the occurrence of impulsive behaviors [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. This hypothesis is known as the \"brake-and-throttle\", consider also the temporal function and suggest that the frontal lobe could be regulated in turn by temporal structures, which would add a hierarchically superior instance in the control of impulsive behavior [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Indeed, it can explain why we also found higher impulsivity in both groups of patients with temporal and extratemporal epilepsy (most of them were frontal lobe epilepsies). In both frontal and temporal lobe epilepsies, the frontal-hippocampal networks are involved in the epileptogenic zone and/or in the propagation zone of the epileptic discharges [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. It has been postulated that temporal structures could exert a regulatory function on frontal structures and in turn on subcortical structures to control impulsive behavior. These structures (frontal lobe and temporal lobe) are highly connected through the uncinate fasciculus, which unites the orbitofrontal lobe with the anterior temporal lobe [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAs expected, we found that the most frequent psychiatric comorbidity was depression in both groups of patients. It was followed by anxiety disorders and psychosis. This is in line with the international literature [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Similarly, to our findings other researchers endorsed significantly more depressive symptoms in both ELT and ELF groups, than in the control group without epilepsy [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. The high prevalence of depression in both TLE and ETE has been related to the high epileptic activity in the temporal lobe, which may have distal effects on the frontal lobe and vice versa [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRegarding TLE group analysis, we observed that greater impulsivity was associated with psychiatric disorders and with comorbid depression. The importance of depression in TLE patients has emerged in the last years and the ILAE (International League Against Epilepsy) recognize depression as a main comorbid disorder in patients with epilepsy [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. A bidirectional relationship between depression and TLE has been postulated [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], mainly based on epidemiological [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] experimental studies [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] and histopathological studies [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. It is estimated that 30\u0026ndash;50% of epilepsy patients suffer from comorbid depression at some point during life. It has been described that epilepsy may favor the development of depression by activating pathophysiological mechanisms associated with stress [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e], but depression can also may favor the development of epilepsy (a positive history of depression was associated with an increased risk of developing epilepsy)[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Particularly in TLE, hippocampal involvement has been linked to an increased risk of depression [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Epilepsy would act synergistically increasing the susceptibility of the hippocampus to stressors that favor a state of increased vulnerability and risk of depression [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. It has been postulated that epileptic discharges could affect neurobiological pathogenic mechanisms of depressive disorders, and in turn depressive disorders, which have been associated with lower GABAergic activity and higher glutamatergic activity in the brain, could potentiate cortical hyperexcitability and/or facilitate the development of treatment-resistant epilepsy [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. In 2012, Butler et al. [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e] described different neuroanatomical substrates for depression with and without temporal lobe epilepsy and suggested an important role for the orbitofrontal cortex (OFC) (a limbic region that exerts a fundamental role in emotional processing and is strongly interconnected with medial temporal structures). In the group of patients without TLE, higher levels of depressive symptoms were associated with thinning of the left lateral orbito frontal cortex, somewhat opposite to what was found in patients with TLE [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. Limbic areas usually affected in TLE such as the amygdala, and the hippocampus, are involved in social behaviors, including impulse control, anxiety, and emotional memory [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In addition, the temporal pole (TP) which has been considered a paralimbic region may be affected in TLE. Furthermore, the association between depression and impulsivity has been previously described by several authors, who have established a direct relationship between both manifestations in patients with psychiatric disorders [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan additionalcitationids=\"CR51 CR52\" citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. This relationship could help to interpret the existing link between temporal lobe, depression, and impulsivity [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn relation to EZ laterality, in this study a left laterality of the epileptogenic zone in the ELT group, was associated with higher impulsivity scores on the motor factor. These results contrast with one of the few studies about impulsivity and epilepsy and laterality, the study of McIntyre et al. in 1973 [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e], in which it was found that adult patients with right-sided lesions were more impulsive. Although, these authors measured impulsivity with a different instrument (the familiar figure test). On the contrary, other previous studies using VBM in psychiatric patients with impulsivity found that a lower left lateral orbito frontal cortex volume was associated with greater attention impulsivity. Also, a lower volume in the left superior temporal gyrus was associated with greater impulsivity [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]. Also in this line, orbital and left ventrolateral lesions have been associated with increased risk behaviors in the general population and in patients with psychiatric disorders [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan additionalcitationids=\"CR57 CR58 CR59 CR60 CR61\" citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e]. However, there is only very few information in the literature about epilepsy clinical variables and impulsivity.\u003c/p\u003e"},{"header":"5. Conclusions","content":"\u003cp\u003eOur results have allowed us to conclude that impulsivity is an important issue to consider in clinical evaluation of patients with focal epilepsies. High levels of impulsivity interfere with different aspects of daily life that hinder the subject's social integration and integrity, such as correct planning of activities, efficient management of resources, control of emotional responses in different situations, substance use and self-injury, and suicide attempts. In view of this, we strongly believe that the evaluation and follow-up particularly in patients with drug-resistant epilepsy by an adequately trained interdisciplinary mental health team should be considered routine, because manifestations of high impulsivity can hinder adherence to epilepsy treatment, worsen adverse situations experienced by patients, and put their own lives at risk.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eEGS, CW and MS evaluated patients with mental health protocol, BG, SO and SL studied and analyzed Video-EEG diagnosed, SK and GK supervised the study and methodology, EGS and LD wrote the main manuscript, text and figures, and analyzed data.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHingray C, McGonigal A, Kotwas I, Micoulaud-Franchi J-A (2019) The Relationship Between Epilepsy and Anxiety Disorders. 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Cerebellum. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s12311-021-01337-5\u003c/span\u003e\u003cspan address=\"10.1007/s12311-021-01337-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eN.d.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"focal epilepsy, left laterality, epileptogenic zone, psychiatric disorders, personality disorders","lastPublishedDoi":"10.21203/rs.3.rs-3822397/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3822397/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003ePurpose: To analyze patients with clearly and defined focal epilepsy from temporal (ELT) and extra-temporal lobe origin (ETE), and a control group, and to compare the prevalence of psychiatric comorbid disorders and the levels of impulsivity between them.\u003c/p\u003e\n\u003cp\u003eMethods: Consecutive patients who met criteria of drug-resistant focal epilepsy of temporal and/or extra-temporal origin, clearly defined and confirmed by VEEG (Video-EEG), were included. Psychiatric assessment was conducted using the Structured Clinical Interview for Axis I and II diagnose of DSM-IV (SCID I-II), the Barrat-11 scale for measure impulsivity, and Beck inventory for depression.\u003c/p\u003e\n\u003cp\u003eResults: 73 patients with drug-resistant temporal lobe epilepsy (TLE), 21 with extra-temporal focal epilepsy (ETE) and 58 healthy control subjects were included. A total of 45 patients (61.6%) in TLE group and 13 patients (61.9%) in ETE group met criteria for at least one present or past psychiatry disorder coded on Axis I of DSM-IV. Both ELT and ETE groups presented higher Barrat-11 scores compared to the control group (p\u0026lt;0.01). ETE showed a tendency to a higher impulsivity level, particularly in the motor factor compared to ELT (p=0.05). A left laterality of the epileptogenic zone, and the presence of psychiatric disorders (depression) were associated with higher impulsivity among patients with ELT (p\u0026lt;0.05).\u003c/p\u003e\n\u003cp\u003eConclusion: Impulsivity and psychiatric comorbidity are important issues to consider in clinical evaluation of patients with drug-resistant focal epilepsies. The evaluation by an adequately mental health team should be considered routine among these patients.\u003c/p\u003e","manuscriptTitle":"Higher levels of impulsivity and depression are present in patients with temporal and extra- temporal focal epilepsy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-03 18:22:08","doi":"10.21203/rs.3.rs-3822397/v1","editorialEvents":[{"type":"communityComments","content":1}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7c80cf18-396e-4465-b911-fd14944e1c5f","owner":[],"postedDate":"January 3rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-01-16T11:44:17+00:00","versionOfRecord":[],"versionCreatedAt":"2024-01-03 18:22:08","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3822397","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3822397","identity":"rs-3822397","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}