Clinical Scorecard: e-Motions: A New Intraoperative Assessment Tool for Mapping Social Cognition with Triple Validation Across Normative, Schizophrenia, and Autism Spectrum Disorder Groups

At a Glance

Key Highlights

• Social cognition deficits significantly impact quality of life and interpersonal functioning in brain tumor, schizophrenia, and ASD populations.
• Existing social cognition tests (e.g., Ekman-60F, BART, RMET) have limitations including lack of ecological validity and static stimuli.
• The e-Motions tool uses 34 four-second videos of hyper-realistic avatars displaying dynamic complex emotions, validated across normative, schizophrenia, and ASD groups.

Guideline-Based Recommendations

Diagnosis

• Use validated tools adapted to the intraoperative setting to assess social cognition beyond basic facial emotion recognition.
• Include dynamic and ecologically valid stimuli for more accurate evaluation of social cognition components.

Management

• Preserve social cognition during brain tumor surgery to improve postoperative quality of life and social reintegration.
• Incorporate comprehensive mapping of multiple social cognition subprocesses (low- and high-level mentalizing, social perception, emotion regulation) during awake surgery.

Monitoring & Follow-up

• Monitor social cognition intraoperatively using tools like e-Motions to detect and prevent long-term deficits.
• Consider fatigue and time constraints during awake procedures when planning social cognition assessments.

Risks

• Potential long-term social cognition deficits in up to 30% of brain tumor surgery patients if not properly mapped and preserved.
• Risk of seizures during direct electrical stimulation necessitates short stimulation periods and alternating on/off protocols.

Patient & Prescribing Data

Spanish-speaking adults aged 18–65 years including healthy individuals, schizophrenia patients (>5 years diagnosis), and ASD level 1 patients.

The e-Motions test is feasible and validated for intraoperative use, offering a more ecological and realistic assessment of social cognition compared to static tests.

Clinical Best Practices

• Employ dynamic, AI-generated facial emotion stimuli for intraoperative social cognition mapping.
• Adapt social cognition assessments to operating room constraints including head fixation, time limits, and patient fatigue.
• Use comprehensive social cognition evaluation encompassing multiple subprocesses rather than focusing solely on low-level mentalizing.
• Validate assessment tools across normative and clinical populations to ensure broad applicability.

References

• Declaration of Helsinki