What is Frontal Lobe Syndrome?
The frontal lobe is the largest part of the brain, located at the front just behind your forehead. It is divided into three main areas which are each responsible for different functions. One is the main control center for movement, another assists and prepares for movement, while the third part, known as the prefrontal cortex, is involved in higher thought processes like planning, personality, and complex social behavior.
Injury to the movement control and movement preparation parts can lead to weakness and problems with movement on the opposite side of the body. If damage occurs to certain areas handling speech formation (known as the Broca area), this leads to a type of language disorder where a person struggles to fluently express themselves verbally.
The term “Frontal lobe syndrome” describes a set of symptoms caused by damage to the prefrontal cortex, which can include change in motivation, alterations in planning ability, changes in social behavior, and problems with speech production. These issues can come from various causes, ranging from physical trauma to brain diseases.
The frontal lobes are very important and unique to us as humans. They manage our emotions, our social interactions, and our personality. They are crucial when we have to make hard decisions or interact in complex social situations. Past cases like the famous case of Phineas Gage, who had a traumatic accident and showed considerable personality and behavioral changes after brain injury, have confirmed that damage to the frontline can significantly affect personality and goal-directed behavior.
Research has pointed out some specific areas within the frontal lobe where injury or damage can cause changes in behavior. For instance, damage to the orbitofrontal area can lead to impulsivity, lack of judgment, emotional instability, and issues with social interactions. Another area in the frontal lobe, when damaged, can cause problems with working memory, planning, paying attention, and motivation. These areas are so critical that even a small injury can cause complex issues, such as attention deficits, decreased motivation, slowing down in behavior and spoken word, as well as issues with problem-solving and rule learning.
Interestingly, new research in this field has related the frontal lobes with developing “intuition”. It seems our frontal lobes communicate with emotional brain regions to make efficient or “intuitive” decisions quickly.
What Causes Frontal Lobe Syndrome?
Frontal lobe disorders can be caused by a number of different diseases. These can include conditions like a closed head injury, which can damage a part of the brain known as the ‘orbitofrontal cortex’; this part of the brain is critical for decision making and appropriate social behavior. Other causes are illnesses that affect the blood vessels in the brain (cerebrovascular disease), tumors that press on the frontal lobe, and diseases that cause the brain and its abilities to progressively deteriorate over time (neurodegenerative disease).
Frontal lobe disorders may also come from epilepsy centered in the frontal lobe, HIV, multiple sclerosis (a disorder where your immune system attacks the protective covering of your nerves), and dementia that starts early in life.
Risk Factors and Frequency for Frontal Lobe Syndrome
The occurrence and spread of frontal lobe syndrome, a brain condition, can vary depending on what causes it. But recent research suggests that brain degeneration may be an under-reported cause of this condition. A past study in Japan discovered at least 12,000 patients with FTLD (a type of frontal lobe syndrome), showing that the condition might not be as rare as it was once believed.
Signs and Symptoms of Frontal Lobe Syndrome
When testing patients with frontal lobe impairment, a thorough neurological examination is crucial. It’s also important to talk with family and close friends to better understand the patient’s lifestyle and behavior. During the examination, doctors should observe for behavioral changes including:
- Abulia (reduced motivation)
- Inappropriate jocularity, known as Witzelsucht
- Impaired insight
- Confabulation (creating imaginary experiences)
- Utilization behavior (irrelevant, automatic actions, such as putting on someone else’s glasses)
- Perseveration (repeated words, ideas, or actions)
- Persistent signs of spontaneous frontal release
- Incontinence
In addition to these behavioral changes, a mental status exam should be completed to assess:
- Attention (through tasks such as reciting digits or months forward and backward)
- Memory
- Ability to shift mental set (using tests such as Luria alternating sequencing, Trails B, and the Wisconsin card sorting test)
- Ability to suppress inappropriate responses (using auditory or visual go-no-go tasks or the Stroop test)
- Word generation (using the FAS word generation test)
- Abstract reasoning
- Judgment
- Language skills, and testing for hemineglect (failure to pay attention to one side of the body)
Further tests like examining a patient’s sense of smell, eye movement, muscle weakness or increased muscle tone, inability to maintain a pose, primitive reflexes, difficulty with walking, and skull shape can help. Any signs of past abuse, recent trauma, or psychiatric stress should be noted during the examination too.
Testing for Frontal Lobe Syndrome
If your doctor believes that you might have a condition affecting the frontal lobe of your brain, they will first check to see if any other issues may be causing cognitive impairment. This could include running blood tests for deficiencies in vitamin B12 or thyroid function, or checking for the presence of diseases such as syphilis.
Imaging tests, such as an MRI scan, might also be performed. An MRI can reveal if brain shrinkage (atrophy) is occurring, if there are any blood collections (hematomas), or if there are any issues with the blood vessels in the brain. Although they may not be as accurate, a CT scan can be done to check for acute bleeding or a condition called hydrocephalus, which is an excessive buildup of fluid in the brain.
If your doctor specifically suspects that you may have frontotemporal dementia (FTD), they may consider doing a PET scan. A PET scan is an imaging test that can show how well your brain is working. In the case of FTD, the scan may reveal decreased activity in the frontal lobe (front part of the brain) with normal activity in the temporal-parietal areas (middle area of the brain).
Treatment Options for Frontal Lobe Syndrome
The treatment options for dementia vary depending on the specific type a person has. Medications like acetylcholinesterase inhibitors, which work by increasing the levels of a chemical messenger involved in memory and judgment, may help manage symptoms for some types of dementia, such as Lewy Body. However, these medicines are not found to be effective for Frontotemporal Dementia.
Non-drug treatments can also be helpful, including physical and occupational therapy, particularly for diseases like frontotemporal dementia. Speech therapy is another intervention that can be beneficial in managing issues like difficulties with speech (dysarthria), inability to carry out motor activities despite intact motor function (apraxia), or trouble with language (aphasia).
For instances of psychosis, which includes symptoms, like hallucinations or delusions experienced in synuclein-associated psychosis, a medication known as Pimavanserin, which works by blocking the action of a specific brain chemical that is believed to be linked to these symptoms, may be recommended.
As dementia progresses, it becomes even more critical to maintain a supportive environment. This may require the assistance of a caregiver, who can provide the necessary support for the patient at home as their cognitive abilities decline, impacting their executive functions, which are skills everyone uses to perform everyday activities like planning, remembering things, and managing time.
What else can Frontal Lobe Syndrome be?
Doctors always consider other possible causes of an illness. Below are the possible causes of conditions that could also affect the frontal part of the brain:
- Head injury or trauma
- Stroke or cerebrovascular accident
- Brain cancers or cerebral malignancies
- Frontal lobe seizures
- Build-up of fluid in the brain or hydrocephalus
- Binswanger’s disease, a form of dementia
- Damage due to lack of oxygen or anoxic injury
- Alzheimer’s disease
- Schizophrenia
- Parkinson’s disease
- Huntington disease
What to expect with Frontal Lobe Syndrome
The outcome for frontal lobe syndrome, a condition affecting a region of your brain, varies greatly depending on what’s causing it. If the cause is something that can be reversed or treated, like infections or tumors that can be surgically removed, then the outlook is generally more positive.
However, if the cause falls under the category of ongoing brain disorders such as frontotemporal dementia, then the outcome tends to be less favorable. In these situations, treatment focuses on managing the symptoms, but the patient will sadly eventually succumb to the illness.
Possible Complications When Diagnosed with Frontal Lobe Syndrome
The problems associated with frontal lobe syndromes depend on what’s causing them. Disorders that get worse over time can lead to social and behavioral challenges, which require a lot of support for the affected person and their relatives.
Complications could include:
- Various social issues
- Behavioural challenges
- Increased demand for support services for patients
- Additional strain on family members
Preventing Frontal Lobe Syndrome
The key to treating these syndromes is educating the patient and their family. These conditions often cause mental, behavioral, and physical symptoms. It’s crucial for patients and their families to understand the importance of creating a supportive and safe space for those likely to experience a progression in their physical and cognitive abilities over time. Connecting with professionals like social workers and other supportive services early on can be a great way to help manage the evolving needs of the patient.