**9. Conclusion**

ToM deficits may also provide some explanation for the complex psychosocial difficulties apparent in PWE. Such difficulties include the experience of stigma, unemployment or underemployment, anxiety and depression, poor self esteem, social isolation and difficulties in interpersonal relationships (Austin & de Boer, 1997; Collings, 1990; De Souza & Salgado, 2006; Fisher et al., 2000; Grabowska-Grzyb et al., 2006; Jacoby et al., 1996; McCagh et al., 2009; McCagh, 2010; Mensah et al., 2007; Morrell, 2002; Suurmeijer et al., 2001.).

Current quality of life measures rely on patients to self report improvements in functioning after surgery which may be problematic as this will rest on how well the patient has insight into their social difficulties. This could pose a particular problem for patients with RH lesions where sense of self may be impaired. (Kirsch, 2006) Discrepancies between self report and objective measures of social functioning reports by significant others and or carers of social functioning in PWE on quality of life measures have been evident Hays et al. (1995). This evidence and the findings of the authors study imply that self report measures are not reliable so clinicians need to consider alternative ways of measuring social functioning in PWE.

Presurgical neuropsychological evaluation plays a major role in determining potential outcomes and treatment intervention after surgery. Recent research have demonstrated that PWE have difficulties with socio cognitive functioning (Corcoran et al., 2000; Farrant et al., 2005; Fournier et al., 2008; Schacher et al., 2006; Schillbach et al., 2007; Walpole et al., 2008). It is becoming clear that neuropsychological assessment during clinical audit needs to consider assessing socio cognitive functioning in PWE and that such an assessment should be part of the pre and post surgical evaluation of potential surgical candidates. It is recommended that an instrument such as the TASITS which is more ecologically valid and

in epilepsy has been largely neglected. Future research needs to continue to explore the impact that socio-cognitive dysfunction has on social functioning and quality of life in FLE and TLE. This could be achieved by administering a wide range of measures that utilise different paradigms in social cognition. Future work should include objective ratings of social functioning to see if real life behaviour is related to socio cognitive task performance. Quality of life measures that fully explore the impact of epilepsy on social functioning that are not self report measures but objective measures completed by significant others need to be employed.

Future research which assesses social cognition before and after surgery is needed (Fournier et al., 2008). Surgery may help reduce seizures activity and reduce the amount of AEDs taken which in turn may improve social cognitive performance. Shaw et al. (2007) found improvements in social cognition (facial expression recognition) in people with left TLE after surgery. There is need for longitudinal research which establishes the impact of surgery on social cognition to establish whether epilepsy surgery is beneficial in improving

Further research should focus on trying to rehabilitate PWE after surgery where they may find themselves in new social situations that they have not previously experienced and may have difficulty adjusting (Bladin, 1992; Wilson, Bladin & Saling, 2004). PWE may have new found independence which can impact on interpersonal relationships, causing friction and resentment. This may be particularly problematic if parental over protectiveness was a

ToM deficits may also provide some explanation for the complex psychosocial difficulties apparent in PWE. Such difficulties include the experience of stigma, unemployment or underemployment, anxiety and depression, poor self esteem, social isolation and difficulties in interpersonal relationships (Austin & de Boer, 1997; Collings, 1990; De Souza & Salgado, 2006; Fisher et al., 2000; Grabowska-Grzyb et al., 2006; Jacoby et al., 1996; McCagh et al.,

Current quality of life measures rely on patients to self report improvements in functioning after surgery which may be problematic as this will rest on how well the patient has insight into their social difficulties. This could pose a particular problem for patients with RH lesions where sense of self may be impaired. (Kirsch, 2006) Discrepancies between self report and objective measures of social functioning reports by significant others and or carers of social functioning in PWE on quality of life measures have been evident Hays et al. (1995). This evidence and the findings of the authors study imply that self report measures are not reliable so clinicians need to consider alternative ways of measuring social

Presurgical neuropsychological evaluation plays a major role in determining potential outcomes and treatment intervention after surgery. Recent research have demonstrated that PWE have difficulties with socio cognitive functioning (Corcoran et al., 2000; Farrant et al., 2005; Fournier et al., 2008; Schacher et al., 2006; Schillbach et al., 2007; Walpole et al., 2008). It is becoming clear that neuropsychological assessment during clinical audit needs to consider assessing socio cognitive functioning in PWE and that such an assessment should be part of the pre and post surgical evaluation of potential surgical candidates. It is recommended that an instrument such as the TASITS which is more ecologically valid and

2009; McCagh, 2010; Mensah et al., 2007; Morrell, 2002; Suurmeijer et al., 2001.).

This may help resolve the difficulty of insight that appears to be apparent in FLE.

such skills.

feature before surgery.

**9. Conclusion** 

functioning in PWE.

likely to be more sensitive to socio cognitive impairment in real life, should be incorporated with more traditional measures to accurately establish the impairments of social perception in PWE. Such assessments should be complemented by an effective measure of the actual social difficulties that PWE experience in everyday life. A number of authors criticise current measures of social functioning used on PWE, currently these measures do not fully explore the impact that surgery has on interpersonal relationships or social competence (Kirsch, 2006; Schilbach et al., 2007). Therefore development of more appropriate measures is needed.

The authors' current research lateralises socio-cognitive dysfunction to the right frontal lobe and left temporal lobe, further study in this area may be able to support the lateralisation of these skills. If this is the case then socio-cognitive assessment may provide clinicians with a useful and inexpensive tool for lateralising the site of seizure foci in patients, particularly where anterior foci are suspected. This may be particularly valuable as there are few neuropsychological tests which can lateralise damage in the prefrontal cortex. The effects of lateralisation or localisation have not been found in studies which assess cognitive functioning in FLE (Helmstaedter et al., 1996; Upton & Thompson, 1996). Tests of social cognition may provide the clinician with an objective measure of deficits in social competence particularly as patients with FLE may lack insight into their impairments. Patients who are at risk of reduced social competence can be identified and may possibly benefit from treatment intervention. Future investigations should assess the efficacy of such interventions in epilepsy.

Social cognition is an important but neglected area of study in the field of epilepsy. The study of ToM in epilepsy will lead to a greater understanding of the social cognitive deficits of the epileptic condition. This may in turn lead to more effective psychological interventions to enable the smoother functioning of people with epilepsy in society.
