Brenda Milner: Pioneer of the Study of the Human Frontal Lobes

Although the behavioral effects of damage to the frontal lobes date back to at least the late 19th century even midway through the 20th century very little was known about human frontal lobe function and there was a general consensus that the frontal lobe did not play a key role in cognition. This all changed when Brenda Milner published a chapter in a 1964 volume entitled: The Frontal Granular Cortex and Behavior. Milner’s chapter, “Some effects of frontal lobectomy in man,” was the first systematic study of the effect of frontal lobe excisions on cognition in human patients. Milner had access to a unique population of frontal excision patients at the Montreal Neurological Institute that were being treated by Wilder Penfield and his associates for a wide range of neurological disorders, including intractable epilepsy. Milner and her colleagues engaged in a more than 50-year study that has had a formidable impact on our understanding of frontal lobe function. Paralleling studies of frontal lobe function in non-humans they influence on understanding the evolution and function of the prefrontal cortex of mammals. Thus, although Brenda Milner is best known for her studies of human memory, she has had an equally important contribution to our understanding of the frontal lobes.

Effects of an Agro-healing Program on Promoting Mental Health of the Middle-aged

Background and objective: This study was conducted with 10 men and women in their 50s-60s to investigate the effect of agro-healing activities on the improvement of mental health.Methods: The experimental group participated in total 8 sessions of agro-healing activities, once a week for 2 hours each, at a care farm in Wanju-gun. Physiological measurements were taken with an electroencephalogram (EEG), Salivettes samples, and blood pressure before and after the activities.Results: As a result of analyzing the changes in brainwaves of the experimental group before and after agro-healing activities, relative slow alpha (RSA), relative fast alpha (RFA), and ratio of alpha to high beta (RAHB), the indices of stability and relaxation, increased after the program with statistical significance. Also, the ratio of SMR to theta (RST) of the attention index increased on the right frontal lobes, temporal lobes, and left occipital lobes, and relative low beta (RLB) increasd on the frontal lobes, temporal lobes, and occipital lobes after the program with statistical significance. The sympathetic nervous system activity, which is a stress index, decreased after the program, whereas the parasympathetic nervous system activity, which is a relaxation index, increased, showing statistical significance (p < .05). As a result of analyzing the changes in blood pressure after the program, systolic blood pressure and diastolic blood pressure decreased from prehypertension to normal blood pressure, showing statistical significance. SThese results indicate that participating in agro-healing activities at a care farm for the 50-60s helps reduce stress and improve stability and relaxation as well as attention.Conclusion: Thus, developing and applying customized agro-healing programs for participants will have a positive effect on brain activity and psychophysiological improvement by relieving tension and stress. However, there are limitations in generalizing the results of this study since most of agro-healing farms have low accessibility that leads to a low level of participants.

Diffusion tension imaging is a good tool for assessing patients with dementia and behavioral problems and discriminating them from other dementia patients

Background Dementia is one of the leading public health concerns as the world’s population ages. Although Alzheimer’s disease (AD) is the most common dementia diagnosis among older patients, some patients have additional behavioral symptoms. It is therefore important to provide an exact diagnosis, both to provide the best possible treatment for patients and to facilitate better understanding. Purpose To investigate whether magnetic resonance imaging (MRI) with fractional anisotropy (FA) can accurately find patients with behavioral symptoms within a group of AD patients. Material and Methods Forty-five patients from the geriatric outpatient clinic were recruited consecutively to form a group of patients with AD and behavioral symptoms (AD + BS) and a control group of 50 patients with established AD. All patients had a full assessment for dementia to establish the diagnosis according to ICD-10. MRI included 3D anatomical recordings for morphometric measurements, DTI for fiber tracking, and quantitative assessment of regional white matter integrity. The DTI analyses included computing of the diffusion tensor and its derived FA index. Results We found a significant difference in FA values between the patient groups’ frontal lobes. The FA was greater in the study group in both left (0.39 vs 0.09, p < 0.05) and right (0.40 vs 0.16, p < 0.05) frontal lobes. Conclusion MRI with FA will find damage in frontal tracts and may be used as a diagnostic tool and be considered a robust tool for the recognizing different types of dementia in the future.

Q-EEG map of parietal and frontal lobes out of brain waves recording during dental hypnosis practice

Introduction: A patient with fear and anxiety is a common case to deal with for a dentist, therefore, dental hypnosis has been widely used to ease this situation. In a hypnotized state, the human brain may easily accept any suggestion. This is projected in the brain waves. Electroencephalograph (EEG) is a brain wave recording device, reflecting several states of consciousness. Beta for conscious, alpha and theta for subconscious, and delta for sleep. Dental hypnosis puts down beta waves to alpha or theta. Quantitative Electroencephalography (Q-EEG) or brain mapping is a comprehensive analysis of (Electroencephalography, EEG) in a colored topographic map, reflecting the brain's electrical activity. The objective of this article was reporting the parietal and frontal lobes activity during dental hypnosis based on the Q-EEG mapping. Methods: The research applied a quantitative research method using observatory study. The sample was taken with an accidental sampling method, with inclusion criteria, patients with dental anxiety and exclusion criteria was patients with special need and high level of dental anxiety. Data of the EEG records was taken in January-March 2018, and processed after in Pramita laboratorium Bandung. Results: Parietal lobe affected more during the inducement than temporal lobe. During dental hypnosis, the hypnotic markers (theta and alpha states) observed from the EEG were found to be more reactive. Conclusion: Dental hypnosis effects can be observed easily using Quantitative Electroencephalography method. Dental hypnosis affects brainwaves and brain mapping which indicate relaxations of brain waves especially on parietal lobes.

Brain Substrates for Distinct Spatial Processing Components Contributing to Hemineglect in Humans

Several cortical and sub-cortical regions in the right hemisphere, particularly in the parietal and frontal lobes, but also in the temporal lobe and thalamus, are part of neural networks critically implicated in spatial and attentional functions. Damage to different sites within these networks can cause hemispatial neglect. The aim of this study was to identify the neural substrates of different spatial processing components that are known to contribute to neglect symptoms. Firstly, three different spatial tasks (visual search, bisection, and visual memory) were tested in 26 healthy controls. The fMRI results showed a differential activation of regions in the parietal and frontal lobes during bisection and visual search, respectively. Secondly, fMRI was used in 27 patients with focal right brain damage. Voxel-based lesion–symptom mapping was used to determine the relationships between specific sites of damage and the severity of deficits in these three spatial tasks. In the patients, we confirmed a critical role of the right lateral parietal cortex in bisection, but lesions in the frontal and temporal lobes were critical for visual search. These data support the existence of distinct components in spatial attentional processes that might be damaged to different degrees in neglect patients.

Limb-shaking syndrome derived from the contralateral hemisphere following unilateral revascularisation for moyamoya disease

Background: Moyamoya disease is a rare chronic steno-occlusive cerebrovascular disease. It may have variable clinical symptoms associated with cerebral stroke, including motor paralysis, sensory disturbances, seizures, or headaches. However, patients with moyamoya disease rarely present with involuntary movement disorders, including limb-shaking syndrome, with no previous reports of limb-shaking syndrome occurring after revascularization procedures for this disease. Although watershed shifts can elicit transient neurological deterioration after revascularisation, symptoms originating from the contralateral hemisphere following the revascularization procedure are rare. Here, we report the case of moyamoya disease wherein the patient developed limb-shaking syndrome derived from the contralateral hemisphere after unilateral revascularisation. Case Description: A 16-year-old girl presented with transient left upper and lower limb numbness and headache. Based on digital subtraction angiography, she was diagnosed with symptomatic moyamoya disease. Single-photon emission computed tomography (SPECT) showed decreased cerebral blood flow (CBF) on the right side, and she underwent direct and indirect bypasses on this side. Involuntary movements appeared in her right upper limb immediately postoperatively. SPECT showed decreased CBF to the bilateral frontal lobes. Subsequently, the patient was diagnosed with limb-shaking syndrome. After performing left-hemispheric revascularisation, the patient’s symptoms resolved, and SPECT imaging confirmed improvements in CBF to the bilateral frontal lobes. Conclusion: Revascularization for moyamoya disease can lead to watershed shifts, which can induce limb-shaking syndrome derived from abnormalities in the contralateral hemisphere of the revascularized side. For patients with new-onset limb-shaking syndrome after moyamoya revascularisation procedures, additional revascularization may be warranted for treatment of low perfusion areas.

Anatomical and Topographical Variations in the Distribution of Brain Metastases Based on Primary Cancer Origin and Molecular Subtypes: A Systematic Review

Background While it has been suspected that different primary cancers have varying predilections for metastasis in certain brain regions, recent advances in neuro-imaging and spatial modeling analytics have facilitated further exploration into this field. Methods A systematic electronic database search for studies analyzing the distribution of brain metastases (BM) from any primary systematic cancer published January 1990-July 2020 was conducted using PRISMA guidelines. Results Two authors independently reviewed 1,957 abstracts, 46 of which underwent full-text analysis. A third author arbitrated both lists; 13 studies met inclusion/exclusion criteria. All were retrospective single- or multi-institution database reviews analyzing over 8,227 BMs from 2,599 patients with breast (8 studies), lung (7 studies), melanoma (5 studies), gastrointestinal (4 studies), renal (3 studies), and prostate (1 study) cancers. Breast, lung, and colorectal tended to metastasize to more posterior/caudal topographic and vascular neuroanatomical regions, particularly the cerebellum, with notable differences based on subtype and receptor expression. HER-2 positive breast cancers were less likely to arise in the frontal lobes or subcortical region, while ER-positive and PR-positive breast metastases were less likely to arise in the occipital lobe or cerebellum. BM from lung adenocarcinoma tended to arise in the frontal lobes, and squamous cell carcinoma in the cerebellum. Melanoma metastasized more to the frontal and temporal lobes. Conclusion The observed topographical distribution of BM likely develops based on primary cancer type, molecular subtype, and genetic profile. Further studies analyzing this association and relationships to vascular distribution are merited to potentially improve patient treatment and outcomes.

Evaluation of Age and Sex-Related Metabolic Changes in Healthy Subjects: An Italian Brain 18F-FDG PET Study

Background: 18F-fluorodeoxyglucose (18F-FDG) positron-emission-tomography (PET) allows detection of cerebral metabolic alterations in neurological diseases vs. normal aging. We assess age- and sex-related brain metabolic changes in healthy subjects, exploring impact of activity normalization methods. Methods: brain scans of Italian Association of Nuclear Medicine normative database (151 subjects, 67 Males, 84 Females, aged 20–84) were selected. Global mean, white matter, and pons activity were explored as normalization reference. We performed voxel-based and ROI analyses using SPM12 and IBM-SPSS software. Results: SPM proved a negative correlation between age and brain glucose metabolism involving frontal lobes, anterior-cingulate and insular cortices bilaterally. Narrower clusters were detected in lateral parietal lobes, precuneus, temporal pole and medial areas bilaterally. Normalizing on pons activity, we found a more significant negative correlation and no positive one. ROIs analysis confirmed SPM results. Moreover, a significant age × sex interaction effect was revealed, with worse metabolic reduction in posterior-cingulate cortices in females than males, especially in post-menopausal age. Conclusions: this study demonstrated an age-related metabolic reduction in frontal lobes and in some parieto-temporal areas more evident in females. Results suggested pons as the most appropriate normalization reference. Knowledge of age- and sex-related cerebral metabolic changes is critical to correctly interpreting brain 18F-FDG PET imaging.