The frontal lobes make us who we are. It has been said that when you marry, you marry someone`s frontal lobes. When the frontal lobes are damaged significant personality changes may ensue.
Frontal lobe syndrome results from the following diseases:
1. Brain injury – trauma, infection, surgery, stroke
4. Alcohol and/or drug dependency
7. Personality Disorder
8. Obsessive-compulsive disorder
If one is unaware that the person has frontal lobe syndrome then one may presume the person is being awkward or stubborn or even evil.
What are the changes in brain structure in frontal lobe syndrome?
In order to understand some of the terms in this article some basic details are explained. There are several parts of neurons or nerve cells. These are
1. The synapses.
2. The dendrites.
3. The cell body.
4. The axon.
There are about 100 billion neurons in the brain. Dendrites are tree-shaped fibres which receive information from other neurons. Dendrite means tree in Ancient Greek.
Dendrites have protruberances upon them called dendritic spines rather like leaves on a tree. The spines or leaves have synapses on their surfaces which receive neurotransmitters e.g. dopamine and serotonin, from other neurons. Synapse means connection in Ancient Greek.
Axons transmit information to other neurons. Axon means to go in Ancient Greek.
The more spines or leaves there are the greater electrical firing rates of the dendrites.
In most psychiatric diseases there are changes in the shape of the neurons and in particular the dendritic spines or leaves. The dendritic spines or leaves are reduced in number and density. This may be compared to the reduction of the leaves on atree which occurs from summer to winter.
What are the changes in the immune system in frontal lobe syndrome?
Dendritic spine or leaf abnormalities are associated with immune system activation. The immune system seems to be regulated by white cells called regulatory T-cells or TREGS. (For more information check out “Mechanism of Disease: Evolving Role of Regulatory T-cell in Atherosclerosis: Tregs in human autoimmune disorders on medscape.com). The immune system of the brain is abnnormalin most psychiatric disorders and may be associated with abnormal TREG cell activity. This suggests that the changes in dendritic spines are inflammatory in nature.
What genetic abnormalities occur in the frontal lobe syndrome?
Genetic abnormalities are increasingly being discovered in psychiatric diseases perhaps explaining why identical twins often have the same psychiatric illness. Genetic abnormalities often result in abnormal substances being made by the brain which causes immune system activiation.
The inflamed dendrites are called “dendritis”, as in Medicine, inflammation of a structure is proceeded by the suffix “itis”. It is noted that dendritis precedes nerve cell death or apoptosis and that in most psychiatric disorders the nerve cells are still alive but not functioning normally due to the inflammation.
It is important to realise that up to 70% of the brain`s synapses on these spines change every day as described by Professor Travis. The spines or leaves can decrease in number over hours in response to stress as described by Professor Baram.
How does dendritis of the frontal lobes result in the clinical features of frontal lobe syndrome?
Reduced density/numbers of dendritic spines in the frontal lobes results in reduced firing rates or electrical activity of the dendrites. This is correlated with the development of increased sensitivity to excessive feelbad or negative thoughts and feelings of
1. Resentment i.e. hatred.
2. Self-pity i.e. “depression”.
3. Fear i.e. “anxiety”.
4. Dishonesty i.e. criminality.
There is often obsessive-compulsive behaviour.
What are theclinical features of frontal lobe syndrome?
Lack of self-control i.e. saying “you are really fat” to a fat person.
Impulsivity i.e. starting eating at the table before everyone else has their food.
Lack of empathy i.e. not understanding why a bereaved person cries.
Self-obsession i.e. no interests in people, places or things.
Changes in libido i.e. promiscuity or frigidity.
There are many ways of performing a functional examination of someone`s which will not be discussed here.
What makes the symptoms of frontal lobe syndrome worse?
Hunger, anger, loneliness, tiredness and being too serious.(the acronym HALTS)
The frontal lobes make us who we are. Frontal lobe syndrome results from immunological and structural changes in the frontal lobes (the dendritic spines in particular) often related to the person`s genetic predisposition.
In some cases the cause is clear i.e. alcohol, narcotics, head injury, infection, brain tumour and stroke. In some cases the frontal lobe syndrome is part of depression, anxiety, autism or schizophrenia,
Doctors generally do not examine the frontal lobes very well. One example is the stroke patient who goes home after recovering mobility but has an undiagnosed frontal lobe syndrome. Sometimes the diagnosis is delayed for months by which time the spouse of the patient has suffered greatly often without support.
This article hopes to highlight frontal lobe syndrome and make the public more aware in order that for example
1. When they see a child who is apparently misbehaving with repetitive behaviour he may have frontal lobe syndrome secondary to autism.
2. When they see an adult who is excessively stubborn and rude with no patience he may have frontal lobe syndrome secondary to a head injury even though he appears physically fit.
If someone with frontal lobe syndrome deteriorates due to HALTS (see above) try the following
1. Treat hunger with food
2, Pacify anger using distraction.
3. End loneliness with a cuddle or hug.
4. Encourage rest for tiredness.
5. Employ humor and reduce seriousness.
Tree Model of Brain Disease