Frontal lobe disorder

Frontal lobe disorder

 

 

Frontal lobe disorder, also frontal lobe syndrome, frontal network dysfunction, is an impairment of the frontal lobe that occurs due to disease or frontal lobe injury.

 

 

The frontal lobe of the brain plays a key role in executive functions such as motivation, planning, social behavior, and speech production. 

 

 

Frontal lobe syndrome can be caused by a range of conditions:  head trauma, tumors, neurodegenerative diseases, neurosurgery and cerebrovascular disease. 

 

 

The signs and symptoms of frontal lobe disorder indicated by the presence of the dysexecutive syndrome.

 

 

The dysexecutive syndrome symptoms fall into three main categories; cognitive- movement and speech, emotional or behavioral. 

 

 

Frontal network dysfunction causes significant changes in personality and behavior. 

 

 

The frontal-sub cortical circuitry carries projections from the thalami to the frontal lobes and  connects the frontal lobes to the basal ganglia.

 

 

Disruptions in frontal subcortical circuits are linked to apathy, disinhibition, and executive dysfunction.

 

 

Signs/symptoms:

 

 

Movement: 

 

 

Tremor

 

 

Apraxia

 

 

Dystonia

 

 

Gait abnormality

 

 

Clumsiness

 

 

Emotional::

 

 

Difficulty in inhibiting emotions, anger, excitement.

 

 

Depression

 

 

Difficulty in understanding others’ points of view.

 

 

Behavioral:

 

 

Utilization behavior

 

 

Perseveration behavior

 

 

Social inhibition

 

 

Compulsive eating

 

 

Language signs: 

 

 

Aphasia

 

 

Expressive aphasia

 

 

Accidents can cause damage to the orbitofrontal cortex area of the brain.

 

 

Cerebrovascular disease may cause a stroke in the frontal lobe,  meningiomas may present with a frontal lobe syndrome, and frontal lobe impairment is also a feature of Alzheimer’s disease, and frontotemporal dementia.

 

 

Frontal lobe disorders:

 

 

Foster Kennedy syndrome is caused due to tumor of frontal lobe and gives rise to ipsilateral optic atrophy and contralateral papilledema.

 

 

Frontal disinhibition syndrome, Rett syndrome and attention deficit hyperactivity disorder are 

 

produced from frontal lobe damage often due to tumors.

 

 

Antisocial behaviour is a characteristic feature of frontal disinhibition syndrome.

 

 

Frontal abulic syndrome is the loss of initiative, creativity and curiosity, 

 

emotional apathy and blandness.

 

 

The frontal lobe contains the precentral gyrus and prefrontal cortex and, the orbitofrontal cortex. 

 

 

These three areas are represented in both the left and the right cerebral hemispheres. 

 

 

The precentral gyrus or primary motor cortex is concerned with the planning, initiation and control of fine motor movements.

 

 

The precentral gyrus is located dorsolateral to each hemisphere.

 

 

The precentral gyrus is concerned with planning, strategy formation, and other executive functions. 

 

 

The prefrontal cortex in the left hemisphere is involved with verbal memory while the prefrontal cortex in the right hemisphere is involved in spatial memory. 

 

 

The left frontal region of the prefrontal cortex, or Broca’s area, is responsible for expressive language.

 

 

The orbitofrontal cortex of the brain is concerned with response inhibition, impulse control, and social behaviour.

 

 

Frontal lobe disorders may be recognized when there is a sudden and dramatic change in a person’s personality:  loss of social awareness, disinhibition, emotional instability, irritability or impulsiveness. 

 

 

Frontal lobe disorders may be recognized when there are 

 

mood changes such as depression, anxiety or apathy.

 

 

Frontal lobe damage may manifest as 

 

speech problems, with reduced verbal fluency, lack of insight and judgment.

 

 

Frontal lobe damage is not associated with marked cognitive abnormalities or memory impairment.

 

 

With severe frontal lobe dysfunction 

 

there may be echolalia or mutism.

 

 

Neurological examination may show primitive reflexes: frontal release signs such as the grasp reflex.

 

 

In more severe and advanced cases of frontal lobe disorder a lack of spontaneous movement will be present in more severe and advanced cases: Akinesia, the lack of spontaneous movement.

 

 

Neuropsychological tests are available for assess the nature and extent of frontal lobe dysfunction. 

 

 

Frontotemporal dementia can be demonstrated as atrophy of the frontal cortex on MRI.

 

 

Frontal impairment due to head injuries, tumors or cerebrovascular disease will also appear on brain imaging.

 

 

General supportive care is given for frontal lobe disorder.