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Tema 1. Neuroanatomia dels sistemes

frontals Síndromes frontals
Emoció i conducta social
Tema 2. Funcions cognitives prefrontals
Tema 3. Síndromes frontals, emoció i
conducta social

PSEUDODEPRESSION

Frontal syndromes Pseudodepression

apathy, lack of motivation
Pseudodepression inability to plan the future
Pseudopsychopathy without autocritic
Alien hand decrement of activity
Utilization behavior do not initiate conversation
Imitation behavior Without true depression

Environmental dependency syndrome

Bilateral anterior cingulate lesions Blumer D, Benson DF. Personality changes with
Bifrontal lesions frontal and temporal lobe lesions. In: D.F. Benson,
D. Blumer (ED). Psychiatric aspectes of neurologic
Left dorsolateral prefrontal lesion disease. Nueva York: Grune & Stratton, 1975

PSEUDOPSYCHOPATHY

Reduced self
self--generated behaviour
behaviour::
Pseudopsychopathy Reduced self-
self-generated voluntary and purposeful behaviour;
behaviour; lack of
spontaneous behaviour.
behaviour.
Increased aggressiveness, impulsivity abulia for the cognitive and behavioural disturbance and apathy for
the lack of an emotional response.
Sexual disinhibition, hunger, addictive reduced self-
self-generated behaviour has been found in patients with
habits lesions in the anterior cingulate cortex (Brodmann’s area 24) and
in the interconnected medial and Lateral orbitofrontal cortex
Inadequate social behaviors (Brodmann’s areas 10, 11, 47)
Criminal acts, euphoria
Puerility, hyperactivity, distractibility Dissocial behaviour
behaviour::
Damage to the ventromedial orbitofrontal cortex appears to
Disinhibition of instincts disrupt social behaviour with abnormal emotional processing.
Professional and personal irresponsibility The individuals show little emotional engagement (Bechara
(Bechara et al.,
2000) and possible aggressive behaviour and environmental
dependency
Blumer D, Benson DF. Personality changes with
frontal and temporal lobe lesions. In: D.F. Benson,
D. Blumer (ED). Psychiatric aspectes of neurologic
Krause et al. Dysexecutive behaviour following deep brain lesions--a different
Bilateral orbital lesion disease. Nueva York: Grune & Stratton, 1975
type of disconnection syndrome? Cortex. 2012 Jan;48(1):97-119.

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ALIEN HAND

Alien hand
autonomous complex movements
against the patient’s will

Specific alien-hand signs, not seen in all patients:

intermanual conflict
mirror movements and writing
enabling synkinesis (one hand can perform an action only in unison with the other)
grasp reflex (flexion of the fingers or toes on stimulation of the palm or sole, normal only in
infancy (agarrar). Reflejo de prensión palmar)

impulsive groping toward objects or magnetic apraxia “La fotografía ha causado gran sensación en
Internet. Una bebé que agarra el dedo del médico
utilization behavior or compulsive manipulation of tools. que estaba trabajando para ayudarla a nacer,
tiene lo suficiente de insólito y de curioso como
Scepkowski LA, Cronin-Golomb A. The Alien Hand:
Cases, Categorizations, and Anatomical Correlates.
para convertirse en la foto de la semana”.
Behav Cog Neurosci Rev. 2003; 2:261-277 Enero, 2013

ALIEN HAND

Alien hand
Variants of alien hand syndrome

Figure. MRI of the brain DWI and

FLAIR showing the acute stroke
in the right parietal lobe and
anterior cc. Espinosa et al. 2006

Frontal alien hand: dominant hand; associated with reflexive

grasping, groping, and compulsive manipulation of tools.
Lesion: supplementary motor area, anterior cingulate, and
medial prefrontal cortex of the LH and anterior corpus callosum
Callosal alien hand: non dominant hand; intermanual conflict
Lesion: anterior corpus callosum

Feinberg TE, et al., Two alien hand Sarva et al. Pathophysiology and treatment of alien hand syndrome.
syndromes. Neurology 1992; 42:19-24 Tremor Other Hyperkinet Mov (N Y). 2014 Dec 5;4:241.

ALIEN HAND UTILIZATION BEHAVIOR

Alien hand Utilization Behavior

The vision of the object implies the order of using it

Jang et al. Callosal Disconnection Syndrome after Corpus Callosum Infarct: A Diffusion Tensor Tractography Study. Lhermitte F. Utilization behavior and its relation to
J Stroke Cerebrovas Dis, 2013; e240 - e244. http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2012.10.015 lesions of the frontal lobes. Brain 1983; 106:237-255

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IMITATION BEHAVIOR ENVIRONMENTAL DEPENDENCY SYNDROME

Imitation behavior Environmental dependency syndrome

dependence in complex situations of everyday life

it implies a loss of personal autonomy

Doctor’s office
Car
Garden
apartment
Gift shop

A release of parietal lobe activities resulting from an

impairment of frontal lobe inhibition
The vision of the movement implies the order of imitating it

Lhermitte F, Pillon B, Serdaru M. Human autonomy and the frontal Lhermitte F, Pillon B, Serdaru M. Human autonomy and the frontal lobes.
lobes. Part I: Imitation and utilization behavior: a neuropsychological Part II: Patient behavior in complex and social situations: the "environmental
study of 75 patients. Ann Neurol. 1986 Apr;19(4):326-34. dependency syndrome".Ann Neurol. 1986 Apr;19(4):335-43.

MOTOR RELEASE PHENOMENA

Associated lesions Dysexecutive behaviour following
deep brain lesions

Archibald SJ, Mateer CA, Kerns KA. Utilization behavior: Krause et al. Dysexecutive behaviour following deep brain lesions--a
clinical manifestations and neurological mechanisms.
different type of disconnection syndrome? Cortex. 2012 Jan;48(1):97-119.
Neuropsychol Rev 2001;11(3):117-130

Brain structures implicated in emotion

Síndromes frontals,
Emoció i conducta social

Fig. 1. Some of the key brain structures implicated

in emotion. The amygdala, orbitofrontal cortex and
cingulate cortex are shown

Kringelbarch ML, Rolls ET. The functional neuroanatomy of

the human orbitofrontal cortex: evidence from neuroimaging
and neuropsychology. Prog Neurobiol 2004; 72: 341-372

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Orbitofrontal cortex Theories of the functional role

of the orbitofrontal cortex
In humans, orbitofrontal damage causes major
changes in:
Inhibition (Dias et al., 1996)
Somatic marker hypothesis (Damasio, 1994)
Emotion
Personality
Representations of reward and punishment
(Rolls, 1990, 1999)
Behaviour
Social conduct

Kringelbarch ML, Rolls ET. The functional neuroanatomy of Kringelbarch ML, Rolls ET. The functional neuroanatomy of
the human orbitofrontal cortex: evidence from neuroimaging the human orbitofrontal cortex: evidence from neuroimaging
and neuropsychology. Prog Neurobiol 2004; 72: 341-372 and neuropsychology. Prog Neurobiol 2004; 72: 341-372

Orbitofrontal functions
Decision-making (gambling
Decision- (gambling task)task) (Bechara et al.,1994) casos
Learning and reversal of stimulus-
stimulus-reinforcement
associations (reversal learning) (Rolls et al. 1994)
Extinction tasks (Butter, 1969)
Facial expression interpretation (Hornak et al., 1996)

Rolls ET. The functions of the orbitofrontal cortex. Brain Cog

2004; 55: 11-29

Dysexecutive behaviour following Dysexecutive behaviour following

deep brain lesions deep brain lesions
Case 7
15-year-old female
ADEM (Acute disseminated encephalomyelitis) Case 9
Onset unclear (weeks?) 71-year-old female unknown aetiology
Incomplete recovery over 2 years
Abulia
Severe abulia Grasping and groping
Apathy Visual grasping (forced visual
Severe grasping and groping following)
Visual grasping (forced visual Imitation behaviour
following) Clonic perseveration
Utilization behaviour Environmental dependency
Optical ataxia Utilization behaviour
Pseudoathetosis Ideomotor apraxia
Ataxia Posterior aspect of parietal lobe, posterior Parkinsonism
thalamus, hippocampus, occipital optic tract, GPi,
caudate Putamen, fasciculus occipito-frontalis
Krause et al. Dysexecutive behaviour following deep brain lesions--a Krause et al. Dysexecutive behaviour following deep brain lesions--a
different type of disconnection syndrome? Cortex. 2012 different type of disconnection syndrome? Cortex. 2012
Jan;48(1):97-119. Jan;48(1):97-119.

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Dysexecutive behaviour following Dysexecutive behaviour following

deep brain lesions deep brain lesions
3.12. Case 12
14-year-old female developed in childhood primary cerebral tumour
Case 10
57-year-old female ischaemic stroke Severe hemi-grasping
Left homonymous hemianopia
Clonic perseveration Left facial weakness
Abulia
Environmental dependency
Parkinsonian gait Right anterior
Progressive memory loss thalamus, putamen,
and globus pallidus

Right caudate
head
Krause et al. Dysexecutive behaviour following deep brain lesions--a Krause et al. Dysexecutive behaviour following deep brain lesions--a
different type of disconnection syndrome? Cortex. 2012 different type of disconnection syndrome? Cortex. 2012
Jan;48(1):97-119. Jan;48(1):97-119.

Casos de la literatura de les lesions frontals

Van Horn JD, Irimia A, Torgerson CM, Chambers MC, Kikinis R, Toga AW. Mapping
connectivity damage in the case of Phineas Gage. PLoS One. 2012;7(5):e37454.

JGR

Mataró M, Jurado MA, García C,

Barraquer L, Costa-Jussa F; Junqué C.
Long-term effects of bilateral frontal brain
lesion: Sixty years after injury with an iron
bar. Arch Neurol 2001; 58(7):1139-42

Wilgus J & Wilgus B. Face to Face with Phineas Gage. Journal

of the history of the neurosciences 2009; 18 (3):340-345.

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EVR
Successful resection of an orbitofrontal meningioma involving a
bilateral excision of the orbital and lower mesial cortices
Normal performance on WCST, 97th percentile on IQ tests, but
Lost his job and wife as a consequence of his complete change
in personality and general irresponsibility
Eslinger PJ, Damasio AR. Severe disturbance of higher cognition after
bilateral frontal lobe ablation. Patient EVR. Neurology 1985; 35:1731-1741
GK and MH
Two adult patients described:
Perinatal frontal lesion
Frontal lesion at 4 years old
Came to psychiatric attention because of aberrant
behavior.
Social and moral development of these 2 patients
were arrested at an immature stage
Price BH, Daffenr KR, Stowe RM, Mesulam MM. The comportmental
learning disabilities of early frontal damage. Brain 1990; 113:1383-1393.
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Carolyn Wilson
She suffered from schizophrenia for at least 11 years
She received two prefrontal lobotomies (1946, 1947)
Disturbances of organized, goal directed behavior
Profound emotional changes (any prolonged emotional
reaction)
IQ tests in the normal or superior range
Symptomatology clearly attributable to the frontal
lesion sustained in 1946-
1946-47
Psychosurgery did result in an enormous reduction of
her psychiatric symptoms, but at the cost of cognitive
losses
Mirsky AF, Rosvold HE. The case of Carolyn Wilson—a 38-year follow-up of a
schizophrenic patient with two prefrontal lobotomies.The Frontal Lobes: A
Luria/Pribram Reaprochement. New York, NY: Plenum Publishing Corp; 1990: 51-75.
Neuroeconomics and
social cognition
Neuroeconomics
Social cognition
Social decision making
Social behavior
Social exclusion, altruism; cooperation and
competition; revenge; punishment; regret; frustration;
trust; fear; reputation; admiration and compassion;
guilt; envy; …