The Frontal Lobes

This volume provides a comprehensive review of historical and current research on the function of the frontal lobes and frontal systems of the brain. The content spans frontal lobe functions from birth to old age, from biochemistry and anatomy to rehabilitation, and from normal to disrupted function. The book is intended to be a standard reference work on the frontal lobes for researchers, clinicians, and students in the field of neurology, neuroscience, psychiatry, psychology, and health care.

The cognitive and behavioral functions of the frontal lobes have been of great interest to neuroscientists, neurologists, psychologists and psychiatrists. Recent technical advances have made it possible to trace their neuroanatomical connections more precisely and to conduct evoked potentialand neuroimaging studies in patients. This book presents a broad and authoritative synthesis of research progress in this field. It encompasses neuroanatomical studies; experiments involving temporal organization and working memory tasks in non-human primates; clinical studies of patients followingfrontal lobe excisions for intractable epilepsy; metabolic imaging in schizophrenia and affective disorder; neurobehavioral studies of patients with dementia, frontal lobe tumors, and head injuries; magnetic resonance imaging methods for studying human frontal lobe anatomy; theoretical approaches todescribing frontal lobe functions; and rehabilitation of patients with frontal lobe damage including their core problem of diminished awareness. Written by a distinguished group of neuroscientists, psychologists and clinicians, Frontal Lobe Function and Dysfunction provides the best current sourceof information on this region of the brain and its role in cognition, behavior and clinical disorders.

The human frontal lobes are crucial to mental functioning, yet ongoing research is still uncovering their mechanisms. This text, written by leaders in frontal lobe research, provides a state-of-the-art update of patient and neuroimaging research.

This book presents an argument rather than a review: that the frontal lobes as a whole are specialized for voluntary action. For each area within the frontal lobes, a specific role in the execution of voluntary action is proposed. Topics covered include the control of movement in the motor cortex and premotor areas, decision-making in the pre-frontal cortex, response learning in the basal ganglia, and the mental trial and error that forms the basis of future responses. This analysis is based on the author's own work using the most up-to-date imaging techniques. Controversial and thought-provoking, it will serve as the basis for future work and debate on the subject.

This exciting volume brings together the latest work of 26 recognized experts in clinical neuropsychiatry, neuropsychology, neuroscience, and neuroimaging. Its chapters are organized into sections that cover a broad range of topics related to advances in our understanding of normal and abnormal frontal lobe functions. Part 1 introduces frontal lobe dysfunction as a common pathway leading to social and occupational disability, arguing that our aging population with its decline in executive cognitive abilities mandates corresponding eligibility and treatment changes in public and private health disability policies. Part 2 delineates the anatomy and neurochemistry of the extended frontal systems underlying neuropsychiatric illness, including colorful illustrations of three key prefrontal-subcortical circuits; a description of the functional anatomy of the orbitofrontal cortex and its relationship to obsessive-compulsive disorder (OCD); the intricate pharmacology of working memory systems and how they apply to schizophrenia; the lateralization of prefrontal cognitive functions; and a framework for understanding the role played by the prefrontal cortex in consciousness and self-awareness. Part 3 clarifies the overused diagnosis "frontal lobe syndrome" seen in clinical practice, identifying three prefrontal syndromes for further study -- dorsolateral dysexecutive syndrome, orbitofrontal disinhibited syndrome, and mesial frontal apathetic syndrome -- that align with the anatomical systems described in Part 2 of this volume. Also included are common problems -- and suggested solutions -- in diagnosis and treatment, a practical overview of the assessment of frontal lobe functions with guidelines for bedside and formal neuropsychological examination, and comprehensive treatment strategies. Part 4 covers the role of the frontal lobes in major neuropsychiatric illnesses, discussing evidence that shows prefrontal and anterior temporal hypometabolism in primary and secondary depression; reviewing anatomical, imaging, and neurochemical studies in schizophrenia; describing the neuropsychological and neuropsychiatric sequelae of closed head injury; summarizing the neurological substrates related to interesting and often dramatic cases of content-specific delusions; and concluding with a report on the stereotactic neurosurgical treatment of refractory OCD and its implications for understanding frontal lobe function. This remarkable work is intended for psychiatrists, neurologists, psychologists, basic and clinical neuroscientists, and trainees from each of these disciplines, who will welcome it as a valuable tool in understanding the complexities of what was once considered the terra incognita of the brain.

Katrina Firlik is a neurosurgeon, one of only two hundred or so women among the alpha males who dominate this high-pressure, high-prestige medical specialty. She is also a superbly gifted writer–witty, insightful, at once deeply humane and refreshingly wry. In Another Day in the Frontal Lobe, Dr. Firlik draws on this rare combination to create a neurosurgeon’s Kitchen Confidential–a unique insider’s memoir of a fascinating profession. Neurosurgeons are renowned for their big egos and aggressive self-confidence, and Dr. Firlik confirms that timidity is indeed rare in the field. “They’re the kids who never lost at musical chairs,” she writes. A brain surgeon is not only a highly trained scientist and clinician but also a mechanic who of necessity develops an intimate, hands-on familiarity with the gray matter inside our skulls. It’s the balance between cutting-edge medical technology and manual dexterity, between instinct and expertise, that Firlik finds so appealing–and so difficult to master. Firlik recounts how her background as a surgeon’s daughter with a strong stomach and a keen interest in the brain led her to this rarefied specialty, and she describes her challenging, atypical trek from medical student to fully qualified surgeon. Among Firlik’s more memorable cases: a young roofer who walked into the hospital with a three-inch-long barbed nail driven into his forehead, the result of an accident with his partner’s nail gun, and a sweet little seven-year-old boy whose untreated earache had become a raging, potentially fatal infection of the brain lining. From OR theatrics to thorny ethical questions, from the surprisingly primitive tools in a neurosurgeon’s kit to glimpses of future techniques like the “brain lift,” Firlik cracks open medicine’s most prestigious and secretive specialty. Candid, smart, clear-eyed, and unfailingly engaging, Another Day in the Frontal Lobe is a mesmerizing behind-the-scenes glimpse into a world of incredible competition and incalculable rewards.