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Jeffrey L. Cummings, MD

Arch Neurol. 1993;50(8):873-880.

Abstract
• Objective.
—This synthetic review was performed to demonstrate the utility of frontal-subcortical circuits in the explanation of a wide range of human behavioral disorders.

Data Sources.
—Reports of patients with degenerative disorders or focal lesions involving frontal lobe or linked subcortical structures were chosen from the English literature. Individual case reports and group investigations from peer-reviewed journals were evaluated.

Study Selection.
—Studies were included if they described patient behavior in detail or reported pertinent neuropsychological findings and had compelling evidence of a disorder affecting frontal-subcortical circuits.

Data Extraction.
—Information was used if the report from which it was taken met study selection criteria.

Data Synthesis.
—Five parallel segregated circuits link the frontal lobe and subcortical structures. Clinical syndromes observed with frontal lobe injury are recapitulated with lesions of subcortical member structures of the circuits. Each prefrontal circuit has a signature behavioral syndrome: executive function deficits occur with lesions of the dorsolateral prefrontal circuit, disinhibition with lesions of the orbitofrontal circuit, and apathy with injury to the anterior cingulate circuit. Depression, mania, and obsessivecompulsive disorder may also be mediated by frontalsubcortical circuits. Movement disorders identify involvement of the basal ganglia component of frontal-subcortical circuits.

Conclusions.
—Frontal-subcortical circuits mediate many aspects of human behavior.

Author Affiliations
From the Departments of Neurology and Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, Los Angeles, Calif, and the Behavioral Neuroscience Section, West Los Angeles Veterans Affairs Medical Center.

Footnotes
Accepted for publication January 7, 1993.

Reprint requests to Neurobehavior Unit, Bldg 256B (691 B/116AF), West Los Angeles VAMC, 11301 Wilshire Blvd, Los Angeles, CA 90073 (Dr Cummings).

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