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C103 - Early bifrontal lesions in the developping human brain: clinical

and structural plasticity issues in a case study.


Valeria Vianello Dri 1
1
APSS Trento, Mental Health Deparment UOC1 Child and Adolescent
Neuropsychiatry, Trento, Italy
Valeria Vianello Dri 2
2
Agalma Foundation, Clinical Neuroscience, Geneva, Switzerland
Luce Bolomey 3
3
Agalma Foundation, Clinical Neuroscience, Geneva, Switzerland
Bogdan Draganski 4
4
CHUV- Lausanne University UNIL, LREN Clinical Neurosciences, Lausanne,
Switzerland
Franois Ansermet 5
5
Agalma Foundation, Clinical Neuroscience, Geneva, Switzerland
Franois Ansermet 6
6
Geneva University Hospital- Geneva University, SPEA- Child and Adolescent
Psychiatry, Geneva, Switzerland
Introduction
Frontal Lobe Syndrome (FLS) is a post lesional syndrome characterized by
different emotional/behavioural patterns combined with specific
neuropsychological features. In 1848, John Harlow first described FLS; later it
was investigated in adults (Bechara, Damasio & Damasio, 2000), rarely in young
children.
Aims and Methods
Our aim is to investigate the impact of early aquired prefrontal lesions on
development, seldom recognized in children (Andersen, Damasio et al, 2000).
We describe a paradigmatic patient with massive bilateral prefrontal lesions
acquired at 14 months of age; perspective evolution up to age 22 years.
Protocol from age 2ys to 22ys includes: 1) every 6 months: neuropsychiatric
assessments and video recording. 2) Periodic specific neuropsychological
assessment with testing adapted to age. 3) EEG and Brain MRI (including
Tractography in DTI)
Results
MRI: maximized connectivity of the residual frontal areas with the posterior
brain.

EEG: abnormalities observed from age 18 years with clinical manifestation.


Clinics: Early development preserved, later neuropsychological dysfunctions,
cognitive and behavioral alterations. None of the effects of this bilateral frontal
damage is comparable to the severe clinical features that the same injury would
have induced in adult patients.
Discussion
A different phenotype emerged from the clinical picture of adults homologues
acquired lesions, probably due to higher rates of structural brain plasticity and
the maturation of pre-frontal networks/functions. This case adds datas for a
better insight on the brain prefrontal cortex influence over human cognitive and
behavioural development. It also points out the need for a specific treatment,
because neurological, psychic, behavioral and neuropsychological aspects are
all present and connected.

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