Brain, Vol. 112, No. 3, 699-725, 1989
© 1989 Guarantors of Brain
research-article |
OBSESSIVE-COMPULSIVE AND OTHER BEHAVIOURAL CHANGES WITH BILATERAL BASAL GANGLIA LESIONS
A NEUROPSYCHOLOGICAL, MAGNETIC RESONANCE IMAGING AND POSITRON TOMOGRAPHY STUDY
1Clinique des Maladies du Système Nerveux, CHU Pitié-Salpêtrière Paris 2CEA, Département de Biologie, Service Hospitalier Frédéric Joliot Orsay 3Clinique de Neurologie et de Neuropsychologie, CHU Pitié-Salpêtrière Paris 4CIERM, Hôspital Bicêtre, Le Kremlin-Bicétre France 5Etablissements Helio-marins, Berck/Mer France
Correspondence to:
Correspondence to Professor D. Laplane, Clinique des Maladies du Systeme Nerveux, CHU Pitie-Salpetriere, 47 Bd de l'Hopital, 75651 Paris cedex 13, France
SUMMARY
Eight patients are reported who shared the combination of bilateral basal ganglia lesions and a frontal lobe-like syndrome. The main features were inertia and loss of drive, with preservation of intellectual function. Some patients showed stereotyped activities with compulsive and obsessive behaviour which were sometimes highly elaborate in pattern. Extrapyramidal clinical signs were absent or mild. Brain damage, related to anoxic or toxic encephalopathy, was demonstrated by CT scans and MRI. The lesions appeared to be confined to the lentiform nuclei, particularly affecting the pallidum, although there was generalized brain atrophy in 2 cases. Positron emission tomography (PET) in 7 patients revealed hypometabolism of the prefrontal cortex relative to other parts of the brain. The PET studies suggest dysfunction of the prefrontal cortex as a result of damage to the lentiform nuclei These clinical, anatomical and functional observations emphasize the role of the circuits linking the prefrontal associative cortex and some specific areas of the neostriatum, including the pallidum. The existence of distinct nonoverlapping circuits in the motor field or in the associative field can explain the fact that basal ganglia lesions may give rise to a clinical picture that is either purely motor, purely behavioural (as in some of our patients), or both. Similarities existed between some symptoms found in our patients and certain features of major psychiatric illnesses such as severe depression, catatonic schizophrenia, and obsessive-compulsive disorder. This raises the hypothesis that some aspects of these psychiatric disorders could be related to structural and physiological disturbances in the systems linking the frontal associative cortex and the basal ganglia.
Received November 16, 1988. Revised June 8, 1988. Accepted August 3, 1988.
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