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The prefrontal lobes also have connections with three limbic systems (6): (1) corticolimbic regions (including subiculum, entorhinal area, and parahippocampal structures); (2) subcortical limbic regions (such as thalamic and hypothalamic nuclei); and (3) visceral-endocrine peripheral nervous system (via a series of ill-defined pathways in spinal cord and lower brain stem).
Nauta (7) stressed that the prefrontal cortex is the only area in the nervous system that receives and integrates information from both the somatosensory and the limbic-sensory systems, a factor of tantalizing significance in the study of the influence of epilepsy on cognition and behavior.
Few subjects have proven as elusive and fascinating as the behavioral and cognitive consequences of injury to prefrontal cortex.
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Sinai Comprehensive Epilepsy Center, 560 First Avenue, Rivergate Fourth Floor, New York, NY 10016. It is the goal of this review to outline the unique contributions of the frontal lobes to the ictal and interictal aspects of epilepsy in general, to temporal lobe epilepsy (TLE), and to the varied manifestations of frontal lobe epilepsy (FLE).
FRONTAL LOBE ANATOMY AND CLINICOPATHOLOGICAL CORRELATIONS The frontal lobes are massive, usually estimated at between 24 and 30% of the total cortical surface in humans (1).
In one type, that of being "disinhibited," harkening back to the classic case of Phineas Gage, the patient displays dramatic impulsivity, loss of judgment, an inability to foresee the consequences of one’s actions, increased motor activity, and a puerile, jocular affect.
In a second type, best described as "abulic," the patient shows apathy, lethargy, emotional blunting, little sexual interest, loss of initiative, and poor planning.Premotor: The larger area of frontal tissue anterior to the motor strip that acts as motor association cortex including supplementary motor area (medial BA 6), supplementary eye fields (BA 6), and parts of Broca’s area (BA 44).Prefrontal: The vast prefrontal regions may be further subdivided into the following three topographically segregated groups (4): (i) dorsolateral cortex (BA 46 and rostromedial BA 9), (ii) most of orbitofrontal cortex (BA 11 and rostral BA 12), and (iii) paralimbic zones (the ventral and medial part of the frontal lobe including the anterior cingulate cortex (BA 23, 32), the paraolfactory gyrus (BA25), and posterior orbitofrontal regions (BA 11–13).The frontal lobes, by contrast, were deemed relatively "silent" because focal lesions produced no obvious defect in sensation, motor performance, or cognitive function.The presumed "silence" To whom correspondence should be addressed at NYU–Mt. of the frontal lobes now has been replaced by a deafening chorus of information related to functional anatomical localization and correlates with behavior.Data supporting the case that the frontal regions are preferentially affected in TLE are presented.Tags: Adult Dating, affair dating, sex dating