@article{8e8245cd623d47569c9632bd115ab032,
title = "Early bilateral and massive compromise of the frontal lobes",
abstract = "The frontal lobes are one of the most complex brain structures involved in both domain-general and specific functions. The goal of this work was to assess the anatomical and cognitive affectations from a unique case with massive bilateral frontal affectation. We report the case of GC, an eight-year old child with nearly complete affectation of bilateral frontal structures and spared temporal, parietal, occipital, and cerebellar regions. We performed behavioral, neuropsychological, and imaging (MRI, DTI, fMRI) evaluations. Neurological and neuropsychological examinations revealed a mixed pattern of affected (executive control/abstraction capacity) and considerably preserved (consciousness, language, memory, spatial orientation, and socio-emotional) functions. Both structural (DTI) and functional (fMRI) connectivity evidenced abnormal anterior connections of the amygdala and parietal networks. In addition, brain structural connectivity analysis revealed almost complete loss of frontal connections, with atypical temporo-posterior pathways. Similarly, functional connectivity showed an aberrant frontoparietal network and relative preservation of the posterior part of the default mode network and the visual network. We discuss this multilevel pattern of behavioral, structural, and functional connectivity results. With its unique pattern of compromised and preserved structures and functions, this exceptional case offers new constraints and challenges for neurocognitive theories.",
keywords = "Attention, Consciousness, DTI, Executive function, Frontal lobe, Language, MRI, Neurodevelopmental disorders, Social cognition, fMRI",
author = "Agust{\'i}n Ib{\'a}{\~n}ez and M{\'a}ximo Zimerman and Lucas Sede{\~n}o and Nicolas Lori and Melina Rapacioli and Cardona, {Juan F.} and Suarez, {Diana M.A.} and Eduar Herrera and Garc{\'i}a, {Adolfo M.} and Facundo Manes",
note = "Funding Information: The authors thank the patient and her family for their kind disposition to participate in the multiple assessments, as well as Marsel Mesulam for his insightful suggestions of an earlier version of this work. This work was partially supported by grants from CONICET, CONICYT/FONDECYT Regular (1170010), FONDAP 15150012, and the INECO Foundation. Funding Information: Massive insults of the frontal lobes in early developmental stages can prove devastating for neurocognitive functions. This case demonstrates that even in the almost complete absence of frontal lobes, basic sensory, somatosensory, motor, emotional, and cognitive functions can be partially preserved. Conversely, critical frontal functions indexing domain-general skills (executive control and abstraction) were systematically affected. This profile of preserved and affected domains was supported by the specific pattern of brain structural and functional connections. Thus, even in the presence of functional compensation and neurodevelopmental plasticity, the frontal lobes seem critical for complex actions and thoughts demanding attention, abstraction, and control. Exceptional single cases like this one provide a challenge for current frameworks cutting across clinical science and current neuroscientific theories. Funding Information: This work was partially supported by grants from CONICET, CONICYT/FONDECYT Regular (1170010), FONCyT-PICT 2012-0412, FONCyT-PICT 2012-1309, FONDAP 15150012, and the INECO Foundation. Publisher Copyright: {\textcopyright} 2018 The Authors",
year = "2018",
doi = "10.1016/j.nicl.2018.02.026",
language = "English",
volume = "18",
pages = "543--552",
journal = "NeuroImage: Clinical",
issn = "2213-1582",
publisher = "Elsevier BV",
}