Ambiguous Decision-Making in Adults with Epilepsy

Introduction: There is a high prevalence of autism spectrum disorders (ASD) inepilepsy. ASDs are characterised by a deficit of social interaction, social communication,and restricted, repetitive behaviours. Previous research by Wakeford and colleaguesreported higher autistic characteristics in adults with epilepsy who had no diagnosis ofan ASD. A subsequent study found that while sameness behaviours were unimpaired,adults with epilepsy reported poor reciprocal social interaction, revealing difficultiesin social interactions, a characteristic of autism. The Somatic Marker Hypothesisproposes that neural systems supporting decision-making overlap with componentsof a neural circuitry which guide social behaviour. Impaired decision-making abilitiesunder ambiguity may indicate compromised somatic marker formation, crucial forsocial cognition. The present paper aims to investigate ambiguous decision making,and whether the Somatic Marker Hypothesis is a valid explanatory model for thesecognitive features of epilepsy.Method: Our experiment investigated ambiguous decision-making abilitymeasured by the IOWA Gambling Task in adults with epilepsy.Results: Adults with epilepsy demonstrated impaired decision-making abilitiescompared to adults without epilepsy, likely to result from compromised somatic markerformation.Conclusion: The somatic marker hypothesis contributes a neurobiological plausibleaccount of the underlying impairment of decision-making in epilepsy. Given that intactsomatic marker formation is important for social cognitive function, this model providesa mechanism for linking somatic function to decision-making and social behaviours inepilepsy, suggesting that disrupted neurobiological factors may be implicated in both.