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PubMed1988

Sonographic assessment of the fetal frontal lobe: a potential tool for prenatal diagnosis of microcephaly.

A prospective ultrasound evaluation of 150 normal pregnant women was conducted between 15 and 40 weeks' gestation. A variety of biometric measurements were obtained that included measurements of the frontal lobe distance (the anterior edge of the frontal horns of the lateral ventricles to the frontal bone) and the thalamic frontal lobe distance (measured from the posterior edge of the thalami to the frontal bone). Analysis of these data revealed a high degree of correlation between the gestational age and the frontal lobe distance (R2 = 0.89, p less than 0.0001), and between the gestational age and thalamic frontal lobe distance (R2 = 0.93, p less than 0.0001). Similarly, a high degree of correlation was also found between the biparietal diameter and the frontal lobe distance (R2 = 0.95; p less than 0.0001), between the biparietal diameter and the thalamic frontal lobe distance (R2 = 0.90, p less than 0.0001), and between the frontal lobe distance and the thalamic frontal lobe distance (R2 = 0.92, p less than 0.0001). The relationships between femur length and frontal lobe distance (R2 = 0.89, p less than 0.0001) and between the femur length and the thalamic frontal lobe distance (R2 = 0.945, p less than 0.0001) were also evaluated. Nomograms for the relationships between gestational age and frontal lobe distance and thalamic frontal lobe distance were generated and included the mean +/- SD and the percentile distributions. Growth of the frontal lobe was best described by a first-degree linear equation. The results of this study demonstrate the pattern of growth of the frontal lobe and the high rate of correlation between growth of the frontal lobe and the gestational age and the biparietal diameter. These findings offer a potential method by which the decreasing size of the frontal lobe, as shown in three cases described herein, can be evaluated prenatally and thus serve as a useful tool in the prenatal diagnosis of microcephaly.

Female↗
PubMed1998

Lateral frontal lobe seizures.

On the basis of cytoarchitectural and functional studies, the frontal lobe can be subdivided into the primary motor cortex, premotor cortex, prefrontal cortex, and the limbic and paralimbic cortices. However, we are still a long way from clearly identifying individual frontal lobe epilepsies. Instead, we are limited to a discussion of frontal lobe seizures arising from various regions of the frontal lobe. Supplementary motor area epilepsy and perirolandic epilepsy have been quite well defined, in contrast to syndromes involving other regions of the frontal lobe. Recent technological advances in neuroimaging, electroencephalography, magnetoencephalography and detailed videotape analysis of seizure semiology may enable us to delineate these frontal lobe syndromes with better accuracy, thereby improving outcome after epilepsy surgery.

Epilepsy, Frontal Lobe↗
PubMed2000

Disorders of frontal lobe functioning.

The neurology of frontal lobe disorders can be summarized in descriptions of behavioral problems (apathy, etc.), of cognitive impairments (poor planning, etc.), and of motor deficits (grasp reflex, etc.). Reviews of this sort do not indicate, however, any regional specificity to the deficit profiles or identify any of the component processes of the complex deficits-what exactly is "poor planning"? In this review we present specific steps that assist in overcoming the limitations: (1) identify weaknesses in current understanding, (2) operationally define the processes to be analyzed, (3) review some methodologies that allow parsing of discreet processes into specific frontal regions, (4) review the unique advantages and disadvantages of the various neurological disorders that provide us with subjects for study, and (5) propose approaches to advance further a useful clinical neurology of frontal lobe disorders as well as a more finely grained scientific description of core frontal processes.

Aphasia↗
PubMed2002

Frontal lobe epilepsy: diagnosis and surgical treatment.

Frontal lobe epilepsy has been better understood during the past two decades with the advent of technologies with improved localizing capabilities. Major technological advances in the ability to delineate structural and functional brain regions have led to a resurgence of interest in epilepsy surgery. Neuroimaging modalities have broadened the scope of what are now considered surgically remediable syndromes. In the following article, we attempt to review the current concepts regarding diagnosis and surgical management of frontal lobe epilepsy.

Epilepsy, Frontal Lobe↗
PubMed2002

Neuropsychologic effects of frontal lobe epilepsy in children.

Most published neuropsychologic studies on frontal lobe epilepsy have been performed on mixed groups of adults and adolescents with epilepsies of varying etiology. The cognitive profile of frontal lobe epilepsy in children has not been defined. The purpose of this study was to assess neuropsychologic performance in children with frontal lobe epilepsy. Intelligence and executive functions were examined in eight children (age 6 7/12 years to 13 11/12 years) with frontal lobe epilepsy. Performance was related to the focus side, seizure frequency, and age of epilepsy onset. Frontal lobe epilepsy was associated with a range of frontal dysfunctions, but IQ was generally spared. Left focus was associated with deficits in categorization, verbal long-term memory, and detailed visuospatial analysis. Frequent seizures correlated with attention difficulties and inability to inhibit impulsive responses. Children whose epilepsy appeared before age 6 years had reduced ability to change behavioral strategies. Frontal epileptic activity alone can cause selective frontal deficits, the severity and nature of which are related to side, seizure frequency, and age of epilepsy onset. These findings require confirmation on larger series of selected children.

Adolescent↗
PubMed1999

Synopsis of function and dysfunction of the frontal lobe.

The cortex of the frontal lobe reaches maximum phylogenetic development in the brain of the human. It is cortex devoted to the organization of action in all neurobiological and cognitive domains - skeletal movement, eye movement, speech and logical reasoning. Thus the frontal cortex may be called 'motor cortex' in the widest sense. The association cortex of the frontal lobe, commonly called prefrontal cortex, is in charge of the temporal organization of behaviour, speech and thinking. Prefrontal lesions frequently lead to disorders of temporal organization, especially in thinking and the spoken language. The prefrontal cortex serves temporal organization by coordinating three cognitive operations that are essential for the formation of 'gestalts' in the time domain: (i) preparatory set; (ii) working memory; and (iii) inhibitory control of interference. Temporal organization is disturbed in the schizophrenic patient, probably because of a functional disorder of the connectivity between the prefrontal cortex and other cortical areas, as well as limbic and striatal structures (a 'disconnection syndrome').

Animals↗
PubMed1998

Neuropsychological consequences of epilepsy surgery in frontal lobe epilepsy.

The present study investigated the effect of frontal lobe surgery on "cognitive functions", which have previously been shown to be discriminative in the evaluation of non-resected patients with frontal lobe epilepsy (FLE). The cognitive outcome was evaluated with particular consideration of the side (left/right), the site (lateral, orbital, mesial, premotor/SMA), the type of surgery (resections vs resections plus Multiple Subpial Transections), and seizure outcome. The evaluation is based on 33 patients with left (n = 17) or right (n = 16) frontal surgery. Forty-five patients who underwent successful left (n = 21) or right (n = 24) temporal lobectomy served as controls. The neuropsychological examination covered speed/attention, motor sequencing/coordination, response maintenance/inhibition, short-term memory, and language. With the exception of short term memory, the chosen tests were discriminative in determining preoperative frontal lobe dysfunctions but they did not differentiate patients with a different lateralization or localization of the frontal focus. At the three month follow-up examination, patients with temporal lobectomy had improved frontal functions, while patients with frontal lobe surgery showed a mild deterioration. Within the frontally resected group, completely seizure free patients had significantly improved short-term memory. Further consideration of the side, site and the type of the frontal resection indicated that patients with premotor/SMA surgery and patients with precentral/central MST had additional impairment after surgery. Premotor/SMA resections led to a deterioration in response maintenance/inhibition and if performed left sided also to deteriorated language functions. The latter impairment could be clearly related to transient aphasia directly after surgery. Irrespective of pareses observed immediately after surgery, patients with MST's of precentral/central areas displayed additional problems in motor coordination at the follow-up examination. In this group the seizure outcome was also less favorable. In summing up, frontal lobe surgery does not cause any considerable additional impairment in the short term follow-up. However, caution is recommended when surgery or MST affect functional relevant cortex (here the prefrontal/SMA and precentral/central area). Finally, a release of functions associated to frontal areas not affected by surgery is suggested, when seizures are successfully controlled by surgery.

Adolescent↗
PubMed1995

Abnormal frontal lobe phosphorous metabolism in bipolar disorder.

OBJECTIVE: Abnormalities in frontal lobe phosphorous metabolism in patients with bipolar disorder have been reported, but many of the patients studied were receiving lithium. In this study, medication-free bipolar patients were examined to determine abnormalities in frontal lobe high-energy phosphorous metabolism. METHOD: In vivo phosphorous-31 magnetic resonance spectroscopic imaging was performed on 12 unmedicated, euthymic bipolar patients and 16 healthy comparison subjects. The percentages of total phosphorous signal for phosphomonoesters, inorganic phosphate, phosphodiesters, phosphocreatine, and beta-ATP were calculated. RESULTS: In relation to the comparison group, the patients with bipolar disorder had significantly lower phosphomonoester values and higher phosphodiester values in both the left and right frontal lobes. The patients also had a significantly higher right-to-left ratio of frontal lobe phosphocreatine. No other differences in phosphorous metabolites or lateralized asymmetries were noted. CONCLUSIONS: This preliminary study provides support for abnormal frontal lobe phosphorous metabolism in bipolar disorder.

Adult↗
PubMed1994

A selective and critical review of neuropsychological deficits and the frontal lobes.

Presumptions about the functions of the frontal lobes, and the sensitivity and specificity of certain tests to measure frontal lobe functions, are having a substantial influence on both clinical and research conclusions. In this paper the authors examine the details of the studies that have contributed to these presumptions, and find that the evidence to support these conclusions is weak. A detailed evaluation of the evidence relating to the Wisconsin Card Sorting Test and the Thurstone Word Fluency Test is also presented. Finally, the development of the belief that frontal lobe functions can be specifically measured is reviewed. The authors of this paper conclude that the "bewildering array" of deficits attributed to frontal lesions still seems to prevail.

Attention Deficit Disorder with Hyperactivity↗
PubMed1988

Performance of schizophrenic patients on putative neuropsychological tests of frontal lobe function.

Though individual tests thought to assess frontal lobe function have been administered to patients with schizophrenia for many years, approaches in which a number of tests thought to tap a single function or brain region have rarely been used. Such an approach might define a critical test or a common dysfunctional cognitive process. In the present study four putative neuropsychological tests of frontal lobe integrity, namely, the Wisconsin Card Sorting Test, the Category Test, Trail Making B, and verbal fluency, were administered to 28 patients with schizophrenia. Seventy-five percent performed abnormally on at least one test. However, relationships among the test results were difficult to characterize, either by correlation or factor analysis. A hierarchical arrangement in which "higher order" tests proscribe performance on "lower order" tests did not appear to be present. Regarding sensitivity, Trails B, the only timed test, was most frequently impaired and verbal fluency was least frequently impaired. The results suggest that the tests assess somewhat different aspects of frontal lobe function, and that no single frontal lobe test is uniquely sensitive to cognitive impairment in schizophrenia.

Female↗
PubMed1997

Ictal regional cerebral blood flow in frontal lobe seizures.

99mTC (single photon emission computed tomography) (HMPAO SPECT) was carried out during 16 frontal-lobe seizures in 15 patients. Focal changes in regional cerebral blood flow were seen during all seizures. In 9 of 16 seizures SPECT showed hyperperfusion localized to one frontal lobe. In 1 of 16 seizures ictal hypoperfusion was seen in one frontal lobe. In 2 of 16 seizures there was hyperperfusion in both frontal lobes, and in 4 of 16 seizures hyperperfusion involved the frontal lobe or lobes plus other lobes of the brain. These changes were accompanied by hyperperfusion of subcortical structures in 13 seizures. SPECT thus localized to one frontal lobe in 10 of 16 seizures, and localized to the frontal lobes without lateralizing in two further seizures. No seizure showed a pattern of perfusion similar to that reported in mesial-temporal-lobe seizures. We conclude that ictal SPECT may provide useful localizing information in frontal-lobe seizures.

Adolescent↗
PubMed2006

A case of frontal lobe abscess as a complication of frontal sinus ossifying fibroma.

Sinonasal ossifying fibroma is a rare, slow-growing, benign bony tumour, frequently involving the maxilla and mandible in the head and neck region. Although it is known to be the second most frequent fibro-osseous tumour of paranasal sinus, to the best of our knowledge, ossifying fibroma of frontal sinus causing brain abscess has not been presented yet in the relevant literature. We present the clinical, pathological and radiological findings of ossifying fibroma of the frontal sinus associated with brain abscess.

Brain Abscess↗
PubMed1988

[Frontal lobe abscess as a complication of frontal sinus osteoma].

A frontal brain abscess was caused by an osteoma of the frontal sinus. This osteoma had destroyed the posterior wall and was blocking the infundibulum. Under these preconditions a sinusitis frontalis was followed by an intracranial infection and a brain abscess.

Adult↗
PubMed1983

[The regulation of pituitary gonadotropin release of the frontal lobe neocortex. (II). In relation to serotonergic neurons].

The dorsal region of the anterior frontal lobe neocortex has an inhibitory function in the secretion of luteinizing hormone (LH) and ovulation. It is suggested that the anterior frontal lobe neocortex regulates the secretion of LH through the nerve circuit composed of the anterior median limbic area, the thalamic dorsomedial nucleus and the basolateral amygdaloid nucleus which are innervated by serotonergic neurons. In the present study, the relationship between the inhibitory effect of the frontal lobe neocortex on LH secretion and serotonergic neurons from the brain stem raphe nuclei was studied in 4-day vaginal cycle female Wistar rats. Electrochemical stimulation (DC 120 microA, 30 sec.) of the anterior frontal lobe neocortex just before the critical period of ovulation on the day of proestrus blocked the preovulatory surge of LH and ovulation. Electrochemical stimulation of the anterior frontal lobe neocortex just before the critical period but 120 min. after administration of rho-chlorophenylalanine (PCPA, 150 mg/kg, i.p.) could not block the preovulatory surge of LH and ovulation. Electrochemical stimulation of the anterior frontal lobe neocortex just before the critical period but 120 min. after excision of the median raphe nucleus blocked the preovulatory surge of LH and ovulation. Electrochemical stimulation of the anterior frontal lobe neocortex just before the critical period but 120 min. after excision of the dorsal raphe nucleus could not block the preovulatory surge of LH and ovulation. These results suggest that serotonergic neurons ascending from the dorsal raphe nucleus are involved in the inhibition of LH secretion and ovulation caused by electrochemical stimulation of the anterior frontal lobe neocortex and that the secretion of serotonin is necessary for the inhibition of LH secretion.

Animals↗
PubMed1997

Intracranial ictal recordings in Mesial frontal lobe epilepsy.

Localization of ictal onset in patients with medically refractory frontal lobe epilepsy is challenging even with intracranial monitoring. We present a series of nine patients with presumed mesial frontal lobe epilepsy in whom successful localization of ictal onset was achieved in most cases. Intracranial electrodes were placed over cingulate and supplementary motor cortex bilaterally, with additional electrodes placed over lateral and inferior frontal lobes as part of an evaluation for epilepsy surgery. Localization of the ictal onset was clearly defined in seven of nine patients and was characterized by a pattern of lower amplitude beta/gamma range frequencies noted in one to four adjacent electrodes arising from cingulate cortex or supplementary motor cortex in six patients. In the remaining patient, ictal onset was characterized by periodic high amplitude spike and slow-wave discharges evolving into a higher voltage faster rhythm. Electrographic onset occurred coincident with or preceded clinical findings. Ictal pattern also did not demonstrate a widespread propagation pattern in most of the recordings in which ictal onset was well localized. Precise localization of ictal onset within the mesial frontal lobe is possible. Rapid propagation to regions within and outside the frontal lobe does not always occur.

Adolescent↗
PubMedDate not supplied

[Magnetoencephalography in cognitive disorders involving frontal lobes].

INTRODUCTION AND DEVELOPMENT: Frontal lobe, more specifically prefrontal cortex, is one of the brain regions that undergoes more protracted ongoing development. The wider the developmental window of one brain structure, the more vulnerable the functions related to it. Hence, executive functions, which are mediated by prefrontal networks, seems to be specially vulnerable during childhood. Attention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent neurodevelopmental disorders. Functional neuroimaging techniques have shown a dysfunction in a fronto-striatal network in this disorder, that is likely subserving deficits in executive processes, such as in response inhibition. DISCUSSION: This review focuses on contributions of neuroimaging techniques, with high spatial (SPECT, PET and fMRI), temporal (ERP) and spatio-temporal (MEG) resolution, to the neurofunctionality of ADHD.

Attention Deficit Disorder with Hyperactivity↗