Co-operative Behavior and Decision-making in Frontal Lobe Epilepsy
Condition: Frontal Lobe Epilepsies
MeSH terms: Epilepsy; Epilepsy, Frontal Lobe
Study type: Interventional

Summary: 
      Epilepsy is a frequent neurological disorder with about a third of patients having seizures
      despite treatment. At least some of these seizures can be linked to a low compliance and
      therapy adherence of patients. Compliance is defined as "the extent to which a person's
      behavior (in terms of taking medication, following diets, or executing life style changes)
      coincides with medical or health advice". Therapy adherence of patients suffering from
      epilepsy is low with reported rates between 30 and 50%, although adherence to anticonvulsive
      drug therapy is critical for effective disease management and low therapy adherence is
      associated to higher mortality in epilepsy. The reasons for low therapy adherence are still a
      matter of research. Some known factors influencing compliance in epilepsy are related to its
      chronic nature, but others seem to lie in a complex interaction between psychiatric
      comorbidity and an impairment of neural systems underlying behavior. Furthermore, therapy
      adherence rests a variable difficult to measure, especially in epileptic patients where
      classical tools such as questionnaires and electronic monitoring devices have been shown to
      be imprecise. It has been argued that the term 'compliance' should be replaced by
      'co-operative behavior' and non-compliance can therefore be interpreted as troubled
      co-operative behavior. This behavioral approach offers the potential of using tools and
      methods of the latest developments in behavioral neuroscience. Neuroeconomics, a scientific
      field on the border of psychology, economics and neuroscience, has used economic game
      paradigms in order to operationalize cooperative behavior and to identify several brain areas
      by functional brain imaging that have been linked to social co-operative behavior. The
      majority of these brain areas are located in the frontal cortex [ventromedial
      frontal/orbitofrontal cortex, and rostral anterior cingulate cortex. Epilepsies originating
      in the frontal lobe are subsumed under the term "frontal lobe epilepsy" (FLE) and represent
      20-30% of all partial seizures and 25% of all refractory focal epilepsies referred to
      epilepsy surgery.

      The investigator's project plans to study compliance and cooperative behavior of patients
      suffering from frontal lobe epilepsies through a neuroeconomic approach by (1) comparing the
      behavior of these patients in the prisoners' dilemma game to the behavior of age-, gender-,
      and education-matched healthy controls, (2) correlation of game behavior to brain activation
      measured by functional magnetic resonance imaging in both patients and healthy controls and
      (3) studying the link between cooperative behavior to compliance captured by pill counts and
      questionnaires.
    


Intervention name(s): functional magnetic resonance imaging exam
Intervention type(s): Radiation
Other intervention name(s): fMRI exam
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Basic Science
Keywords: cooperative behavior, therapy adherence, fMRI