Frontal brain syndrome involves lesions of the frontal brain. Lesions in this area of the brain usually manifest as cognitive and behavioral disorders such as pseudopsychopathy. Treatment depends on the primary cause of damage.
What is frontal brain syndrome?
Cognition and character reside in the frontal brain of humans. The brain area is also called the prefrontal cortex and is involved in all monitoring and analytical functions. The brain area thus plays a crucial role in human behavior. The frontal brain has interconnections to all other brain areas and enables a fast and effective exchange of information. Due to its numerous connections to the limbic system, the basal ganglia, the cerebellum and the thalamus, the frontal brain is able to adapt human behavior ideally to the current situation. Frontal brain syndrome is known as damage to the frontal parts of the brain. Similar to dysexecutive syndrome, frontal brain syndrome mainly disturbs the executive functions of the brain. The term of dysexecutive syndrome in itself indicates symptoms: so mainly the disturbance of the executive functions of the brain. In contrast, the term frontal brain syndrome does not specify any concrete symptoms, but merely refers to the localization of a brain lesion. Executive functions are not always impaired in frontal brain syndrome. Thus, although frontal brain syndrome can theoretically manifest itself as a dysexecutive syndrome, it does not necessarily have to appear as a dysexecutive syndrome. Thus, the two terms are not synonyms.
Causes
Frontal brain syndrome results from damage to the anterior frontal brain. This damage can be hemorrhage-related in the context of accidents, occur in the context of strokes, be related to inflammation, or be caused by degeneration. Malperfusion or tumors can also trigger frontal brain syndrome. Depending on the exact localization, the syndrome is associated with different disorders, such as cognitive impairment, behavioral changes, or even pseudopsychopathy. Basically, the prefrontal cortex is divided into a dorsolateral prefrontal cortex and an orbito-frontal cortex. In the former portion are mainly cognitive functions, such as problem solving, planning ahead, and goal-directed action. The orbito-frontal part contains personality traits and emotion regulation. In the case of lesions of any kind in the frontal brain, the person can no longer adapt his behavior flexibly and sensibly to new circumstances. The type and exact localization determines the symptoms of frontal brain syndrome. This means that two people with frontal brain syndrome may suffer from fundamentally different symptoms depending on the lesion.
Symptoms, complaints, and signs
When a lesion occurs in the cognitive portions of the frontal brain, cognitive dysfunction occurs. In addition to problem analysis disorders and disorders of idea production, linguistic reduction may occur. The ability to rearrange decreases and the patient tends to perseveration. In some cases, patients find it difficult to follow and break rules. Routine actions are not used purposefully. The plausibility of actions is no longer checked. Patients develop alternative plans hardly or not at all. They have difficulties when they have to consider several pieces of information at the same time. They do not foresee consequences of actions. Furthermore, they do not learn from mistakes and act impulsively. Their willpower often declines. Frontal brain syndrome may also manifest primarily in behavioral disorders. In pseudodepression following frontal brain injury, motor slowing and speech impoverishment may occur. At the sensory level, a lack of responsiveness up to apathy is conceivable. Emotional-affective symptoms such as a depressed mood with low self-worth, self-rejection or emotional indifference are conceivable. Loss of drive and interest, loss of initiative and a reduction in sexual desire occur. In addition to a neglect of one’s own appearance, social withdrawal occurs. On the cognitive level, in addition to an inability to make decisions, there is above all a disturbance of attention and concentration. Sleep disturbances and fatigue characterize the biocycle.Pseudopsychopathy after frontal brain damage is to be distinguished from pseudodepression. Motor hyperactivity meets sensory hallucinations. A manic euphoric mood may be present as well as paranoid delusions and outbursts of aggression. Emotions such as laughing and crying are no longer appropriate. In addition to hypersexuality, there is a lack of tact, social lack of convention, lack of ability to distance oneself, disinhibition, vulgar language and confabulations. Cognitively, patients are often ideation-addicted, wit-addicted, or attention- and concentration-disordered. The biocyclic need for sleep declines.
Diagnosis and course
Frontal brain syndrome is diagnosed by neurologist using imaging. Depending on the symptoms and the location of the lesion on imaging, the neurologist fleshes out his diagnosis as dysexecutive syndrome, pseudodepression, or pseudopsychopathy. The prognosis is usually unfavorable for patients with frontal brain syndrome, as brain damage in most cases leaves function-impairing scars. The most unfavorable prognosis is for degeneration. Benign tumors have the most favorable prognosis. With removal of the tumor, all symptoms usually resolve in this case.
When should you see a doctor?
As soon as irregularities and noticeable changes in behavior, habitual thought patterns, or emotional processing occur, a doctor should be consulted. If thinking performance suddenly diminishes or there are problems with knowledge recall, there is reason for concern. If impulse control is defective, hyperactivity sets in, or severe listlessness and apathy develop, the symptoms should be investigated and treated. If there are problems with information processing, amnesia, and sporadic unusual memory lapses, a physician is needed. A check-up is needed as soon as the person’s personality changes significantly and he appears alienated. An aggressive appearance or a strongly tearful behavior, which was not shown before by the affected person, must be clarified. If everyday duties can no longer be performed or depressive moods develop, it is necessary to consult a doctor. If hallucinations or delusions set in, confused utterances are made or changes in speech occur, medical treatment must be initiated as soon as possible. Vulgar phrases, disinhibitions, or inappropriate euphoria must be investigated. If there are disturbances in concentration, sleep problems, and persistent fatigue, a physician is needed. Severe emotional indifference, lack of empathy or consideration, reduction of sexual desire, or self-destructive behavior, should be presented to a physician.
Treatment and therapy
Therapy depends on the primary cause in patients with frontal brain syndrome. If inflammation in the frontal brain area is responsible for the symptoms, this inflammation must be contained as soon as possible. In the case of bacterial inflammation, cortisone and antibiotics are given simultaneously so that the antibiotic can cross the blood-brain barrier. In autoimmunological inflammations, high cortisone therapy is given. Tumors are removed as much as possible or irradiated if necessary. Behavioral therapy and supportive therapy to enhance cognitive abilities may make sense to stimulate the transmission of certain brain functions to still intact brain areas. In many cases, however, this attempt remains unsuccessful and patients do not regain their original personality or behavior. In particular, degenerative diseases and the resulting damage are still difficult to treat. The relatives of those affected often receive psychotherapy to help them come to terms with the situation.
Outlook and prognosis
The prognosis of frontal brain syndrome is unfavorable in most cases. Nevertheless, an accurate outlook on the further course of the disease cannot be given until the causative reason for the disease has been determined. In addition, prognosis can only be made with extensive knowledge of existing damage as well as the patient’s general state of health. In the case of a benign tumor or mild circulatory disturbances located in an area of the frontal brain where few impairments are triggered, the patient has a good prospect of recovery.In individual cases, complete recovery is also not completely ruled out. With targeted medical treatment, there is the possibility of completely removing the diseased tissue. The larger the tumor or the circulatory disturbances are, the more likely are permanent and irreparable disturbances of the tissue. In the case of a malignant tumor, the chances of cure deteriorate considerably. Cancer therapy attempts to prevent further growth as well as reduce the size of the tumor. In addition, depending on the location of the diseased tissue, surgery is performed. Complications may arise or further damage to the brain tissue may occur due to scarring. If the growth of a tumor cannot be prevented or medical care is not sought, the disease is usually fatal.
Prevention
Frontal brain syndrome can be prevented only to the extent that lesions of the frontal brain can be prevented, such as diseases like Alzheimer’s disease, multiple sclerosis, or strokes, tumors, and brain hemorrhages. Accordingly, all-inclusive prevention is impossible.
Aftercare
The options for follow-up care are very limited in frontal brain syndrome. In this regard, the patient is primarily dependent on medical care to alleviate the symptoms of this syndrome, although a complete cure is no longer possible. The affected person is therefore dependent on lifelong therapy. Life expectancy is also limited by this syndrome, although this is also very much dependent on the exact cause that has led to the disease. In most cases, frontal brain syndrome is treated by the administration of antibiotics. The affected person is therefore dependent on the correct and regular intake of antibiotics, and possible interactions with other drugs must also be taken into account. A doctor should always be consulted if there is any doubt. Furthermore, when taking antibiotics, the intake of alcohol should be avoided if possible, as alcohol weakens the effect of the antibiotics. It is not uncommon for those affected by frontal brain syndrome to be dependent on the help and support of family and friends in everyday life. Very intensive and loving care in particular has a positive effect on the course of the disease. In some cases, the relatives of the affected person may also be dependent on psychological treatment.
What you can do yourself
The options for self-help are very limited in frontal brain syndrome. Normally, these are permanent damages of the brain, where the affected person has little or no possibility of influence. Patients are dependent on outside help and should therefore seek professional examination and treatment. Timely recourse to medical examination and therapy is necessary. Without medical care, there is a risk of spreading of the damaged brain areas. Individual measures of training for self-direction can be discussed within a treatment. As far as possible, a positive and affirmative attitude towards life helps with a disease. This is helpful to achieve progress in a therapy. Negative environmental influences should also be avoided as a matter of principle. These include the consumption of toxins and harmful substances, such as nicotine, alcohol or drugs. Brain training supports the existing functional capabilities. In the prefrontal cortex, the organism carries out monitoring and analysis activities. After imaging procedures have been used to determine which regions are damaged or impaired, targeted therapy can be carried out. In everyday life, the affected person should be attentive in order to be able to assess his or her own bodily functions well. If existing abilities diminish or there is a further loss of performance, it is advisable to seek help as quickly as possible. The better the self-reflection, the sooner a diagnosis can be made.
