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Friedberg A, Pasquini L, Diggs R, Glaubitz EA, Lopez L, Illán-Gala I, Iaccarino L, La Joie R, Mundada N, Knudtson M, Neylan K, Brown J, Allen IE, Rankin KP, Bonham LW, Yokoyama JS, Ramos EM, Geschwind DH, Spina S, Grinberg LT, Miller ZA, Kramer JH, Rosen H, Gorno-Tempini ML, Rabinovici G, Seeley WW, Miller BL. Prevalence, Timing, and Network Localization of Emergent Visual Creativity in Frontotemporal Dementia. JAMA Neurol 2023; 80:377-387. [PMID: 36848111 PMCID: PMC9972248 DOI: 10.1001/jamaneurol.2023.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/28/2022] [Indexed: 03/01/2023]
Abstract
Importance The neurological substrates of visual artistic creativity (VAC) are unknown. VAC is demonstrated here to occur early in frontotemporal dementia (FTD), and multimodal neuroimaging is used to generate a novel mechanistic hypothesis involving dorsomedial occipital cortex enhancement. These findings may illuminate a novel mechanism underlying human visual creativity. Objective To determine the anatomical and physiological underpinnings of VAC in FTD. Design, Setting, and Participants This case-control study analyzed records of 689 patients who met research criteria for an FTD spectrum disorder between 2002 and 2019. Individuals with FTD and emergence of visual artistic creativity (VAC-FTD) were matched to 2 control groups based on demographic and clinical parameters: (1) not visually artistic FTD (NVA-FTD) and (2) healthy controls (HC). Analysis took place between September 2019 to December 2021. Main Outcomes and Measures Clinical, neuropsychological, genetic, and neuroimaging data were analyzed to characterize VAC-FTD and compare VAC-FTD with control groups. Results Of 689 patients with FTD, 17 (2.5%) met VAC-FTD inclusion criteria (mean [SD] age, 65 [9.7] years; 10 [58.8%] female). NVA-FTD (n = 51; mean [SD] age, 64.8 [7] years; 25 [49.0%] female) and HC (n = 51; mean [SD] age, 64.5 [7.2] years; 25 [49%] female) groups were well matched to VAC-FTD demographically. Emergence of VAC occurred around the time of onset of symptoms and was disproportionately seen in patients with temporal lobe predominant degeneration (8 of 17 [47.1%]). Atrophy network mapping identified a dorsomedial occipital region whose activity inversely correlated, in healthy brains, with activity in regions found within the patient-specific atrophy patterns in VAC-FTD (17 of 17) and NVA-FTD (45 of 51 [88.2%]). Structural covariance analysis revealed that the volume of this dorsal occipital region was strongly correlated in VAC-FTD, but not in NVA-FTD or HC, with a volume in the primary motor cortex corresponding to the right-hand representation. Conclusions and Relevance This study generated a novel hypothesis about the mechanisms underlying the emergence of VAC in FTD. These findings suggest that early lesion-induced activation of dorsal visual association areas may predispose some patients to the emergence of VAC under certain environmental or genetic conditions. This work sets the stage for further exploration of enhanced capacities arising early in the course of neurodegeneration.
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Affiliation(s)
- Adit Friedberg
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
- Global Brain Health Institute, University of California, San Francisco, and Trinity College Dublin, Dublin, Ireland
| | - Lorenzo Pasquini
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
- Neuroscape, University of California, San Francisco
| | - Ryan Diggs
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | - Erika A. Glaubitz
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | - Lucia Lopez
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | - Ignacio Illán-Gala
- Global Brain Health Institute, University of California, San Francisco, and Trinity College Dublin, Dublin, Ireland
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Leonardo Iaccarino
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
- now with Eli Lilly and Company, Philadelphia, Pennsylvania
| | - Renaud La Joie
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | - Nidhi Mundada
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | - Marguerite Knudtson
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | - Kyra Neylan
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | - Jesse Brown
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | - Isabel Elaine Allen
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
- Global Brain Health Institute, University of California, San Francisco, and Trinity College Dublin, Dublin, Ireland
| | - Katherine P. Rankin
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
- Global Brain Health Institute, University of California, San Francisco, and Trinity College Dublin, Dublin, Ireland
| | - Luke W. Bonham
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Jennifer S. Yokoyama
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Eliana M. Ramos
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles
| | - Daniel H. Geschwind
- Program in Neurogenetics, Center for Autism Research and Treatment Semel Institute for Neuroscience and Human Behavior, Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles
- Institute for Precision Health, University of California, Los Angeles
| | - Salvatore Spina
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | - Lea T. Grinberg
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
- Department of Pathology, University of California, San Francisco
| | - Zachary A. Miller
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | - Joel H. Kramer
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | - Howard Rosen
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | - Maria Luisa Gorno-Tempini
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | - Gil Rabinovici
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
- Associate Editor, JAMA Neurology
| | - William W. Seeley
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
- Department of Pathology, University of California, San Francisco
| | - Bruce L. Miller
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
- Global Brain Health Institute, University of California, San Francisco, and Trinity College Dublin, Dublin, Ireland
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Current Understanding of the Involvement of the Insular Cortex in Neuropathic Pain: A Narrative Review. Int J Mol Sci 2021; 22:ijms22052648. [PMID: 33808020 PMCID: PMC7961886 DOI: 10.3390/ijms22052648] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 12/22/2022] Open
Abstract
Neuropathic pain is difficult to cure and is often accompanied by emotional and psychological changes. Exploring the mechanisms underlying neuropathic pain will help to identify a better treatment for this condition. The insular cortex is an important information integration center. Numerous imaging studies have documented increased activity of the insular cortex in the presence of neuropathic pain; however, the specific role of this region remains controversial. Early studies suggested that the insular lobe is mainly involved in the processing of the emotional motivation dimension of pain. However, increasing evidence suggests that the role of the insular cortex is more complex and may even be related to the neural plasticity, cognitive evaluation, and psychosocial aspects of neuropathic pain. These effects contribute not only to the development of neuropathic pain, but also to its comorbidity with neuropsychiatric diseases. In this review, we summarize the changes that occur in the insular cortex in the presence of neuropathic pain and analgesia, as well as the molecular mechanisms that may underlie these conditions. We also discuss potential sex-based differences in these processes. Further exploration of the involvement of the insular lobe will contribute to the development of new pharmacotherapy and psychotherapy treatments for neuropathic pain.
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Clinical presentation of strokes confined to the insula: a systematic review of literature. Neurol Sci 2021; 42:1697-1704. [PMID: 33575921 PMCID: PMC8043872 DOI: 10.1007/s10072-021-05109-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/31/2021] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND PURPOSE The insular cortex serves a wide variety of functions in humans, ranging from sensory and affective processing to high-level cognition. Hence, insular dysfunction may result in several different presentations. Ischemic strokes limited to the insular territory are rare and deserve a better characterization, to be quickly recognized and to receive the appropriate treatment (e.g. thrombolysis). METHODS We reviewed studies on patients with a first-ever acute stroke restricted to the insula. We searched in the Medline database the keywords "insular stroke" and "insular infarction", to identify previously published cases. Afterwards, the results were divided depending on the specific insular region affected by the stroke: anterior insular cortex (AIC), posterior insular cortex (PIC) or total insula cortex (TIC). Finally, a review of the clinical correlates associated with each region was performed. RESULTS We identified 25 reports including a total of 49 patients (59.7 ± 15.5 years, 48% male) from systematic review of the literature. The most common clinical phenotypes were motor and somatosensory deficits, dysarthria, aphasia and a vestibular-like syndrome. Atypical presentations were also common and included dysphagia, awareness deficits, gustatory disturbances, dysautonomia, neuropsychiatric or auditory disturbances and headache. CONCLUSIONS The clinical presentation of insular strokes is heterogeneous; however, an insular stroke should be suspected when vestibular-like, somatosensory, speech or language disturbances are combined in the same patient. Further studies are needed to improve our understanding of more atypical presentations.
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Imoto M, Katanazaka K, Kitaguchi K, Shirakawa M, Okuda S. [Improved instrumental activities of daily living in acquired savant syndrome patient after developing interest in drawing]. Rinsho Shinkeigaku 2020; 60:321-327. [PMID: 32307391 DOI: 10.5692/clinicalneurol.cn-001336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
We performed examinations of a 73-year-old, right-handed man who developed herpes simplex encephalitis, with cognitive dysfunction including severe Wernicke's aphasia. Although he had never previously been interested in arts, use of a coloring book, recommended by his wife, led him to start drawing. A few years after the onset of brain disease, the patient began to copy pictures of landscapes. The lesion was in the left hemisphere and his work showed a strongly realistic tendency, thus we think that this case demonstrated characteristics of acquired savant syndrome. Along with the increase in drawing ability, instrumental activities of daily living (IADL), such as shopping and use of public transport, were also considerably improved in this patient. On the other hand, results of neuropsychological tests, such as the Standard Language Test of Aphasia, were not improved. We concluded that a sense of accomplishment from the drawing activity and communication with supporters might have led to improvement of IADL in this case.
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Affiliation(s)
- Makiko Imoto
- Department of Neurology, Hyogo Prefectural Rehabilitation Central Hospital
| | - Kimitaka Katanazaka
- Department of Neurology, Hyogo Prefectural Rehabilitation Central Hospital
- Division of Neurology, Kobe University Graduate School of Medicine
| | - Kyoko Kitaguchi
- Department of Rehabilitation, Hyogo Prefectural Rehabilitation Central Hospital
| | - Masayuki Shirakawa
- Department of Rehabilitation, Hyogo Prefectural Rehabilitation Central Hospital
| | - Shiho Okuda
- Department of Neurology, Hyogo Prefectural Rehabilitation Central Hospital
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Weston CSE. Four Social Brain Regions, Their Dysfunctions, and Sequelae, Extensively Explain Autism Spectrum Disorder Symptomatology. Brain Sci 2019; 9:E130. [PMID: 31167459 PMCID: PMC6627615 DOI: 10.3390/brainsci9060130] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 05/31/2019] [Accepted: 06/03/2019] [Indexed: 12/13/2022] Open
Abstract
Autism spectrum disorder (ASD) is a challenging neurodevelopmental disorder with symptoms in social, language, sensory, motor, cognitive, emotional, repetitive behavior, and self-sufficient living domains. The important research question examined is the elucidation of the pathogenic neurocircuitry that underlies ASD symptomatology in all its richness and heterogeneity. The presented model builds on earlier social brain research, and hypothesizes that four social brain regions largely drive ASD symptomatology: amygdala, orbitofrontal cortex (OFC), temporoparietal cortex (TPC), and insula. The amygdala's contributions to ASD largely derive from its major involvement in fine-grained intangible knowledge representations and high-level guidance of gaze. In addition, disrupted brain regions can drive disturbance of strongly interconnected brain regions to produce further symptoms. These and related effects are proposed to underlie abnormalities of the visual cortex, inferior frontal gyrus (IFG), caudate nucleus, and hippocampus as well as associated symptoms. The model is supported by neuroimaging, neuropsychological, neuroanatomical, cellular, physiological, and behavioral evidence. Collectively, the model proposes a novel, parsimonious, and empirically testable account of the pathogenic neurocircuitry of ASD, an extensive account of its symptomatology, a novel physiological biomarker with potential for earlier diagnosis, and novel experiments to further elucidate the mechanisms of brain abnormalities and symptomatology in ASD.
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Weston CSE. Amygdala Represents Diverse Forms of Intangible Knowledge, That Illuminate Social Processing and Major Clinical Disorders. Front Hum Neurosci 2018; 12:336. [PMID: 30186129 PMCID: PMC6113401 DOI: 10.3389/fnhum.2018.00336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 08/02/2018] [Indexed: 01/21/2023] Open
Abstract
Amygdala is an intensively researched brain structure involved in social processing and multiple major clinical disorders, but its functions are not well understood. The functions of a brain structure are best hypothesized on the basis of neuroanatomical connectivity findings, and of behavioral, neuroimaging, neuropsychological and physiological findings. Among the heaviest neuroanatomical interconnections of amygdala are those with perirhinal cortex (PRC), but these are little considered in the theoretical literature. PRC integrates complex, multimodal, meaningful and fine-grained distributed representations of objects and conspecifics. Consistent with this connectivity, amygdala is hypothesized to contribute meaningful and fine-grained representations of intangible knowledge for integration by PRC. Behavioral, neuroimaging, neuropsychological and physiological findings further support amygdala mediation of a diversity of such representations. These representations include subjective valence, impact, economic value, noxiousness, importance, ingroup membership, social status, popularity, trustworthiness and moral features. Further, the formation of amygdala representations is little understood, and is proposed to be often implemented through embodied cognition mechanisms. The hypothesis builds on earlier work, and makes multiple novel contributions to the literature. It highlights intangible knowledge, which is an influential but insufficiently researched factor in social and other behaviors. It contributes to understanding the heavy but neglected amygdala-PRC interconnections, and the diversity of amygdala-mediated intangible knowledge representations. Amygdala is a social brain region, but it does not represent species-typical social behaviors. A novel proposal to clarify its role is postulated. The hypothesis is also suggested to illuminate amygdala's involvement in several core symptoms of autism spectrum disorder (ASD). Specifically, novel and testable explanations are proposed for the ASD symptoms of disorganized visual scanpaths, apparent social disinterest, preference for concrete cognition, aspects of the disorder's heterogeneity, and impairment in some activities of daily living. Together, the presented hypothesis demonstrates substantial explanatory potential in the neuroscience, social and clinical domains.
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Orjuela-Rojas JM, Sosa-Ortiz AL, Díaz-Victoria AR, Marrufo Melendez OR, Leyva Townsend N. The painter from Sinaloa: artistic analysis of a case of spatial agnosia and neglect of visual shapes. Neurocase 2017; 23:304-313. [PMID: 29185377 DOI: 10.1080/13554794.2017.1408842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Paintings produced spontaneously by patients with neurological lesions represent a fascinating opportunity to analyze some aspects of the underlying disease and involved brain mechanisms. Many cases of artists who have suffered spatial neglect following a neurological disease have been reported in the literature. However, only a few studies evaluating the different subtypes of graphic neglect and aspects related to the construction of perspective (three dimensionality) in works of art have been published. In the present article, we present the case of an artist who, after resection of a central neurocytoma that affected the right thalamo-parietal connections, suffered an impairment of the ability to create perspective in his paintings and involuntary omission of only shapes in the left side of his paintings, although colors and contours were preserved.
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Affiliation(s)
| | - Ana Luisa Sosa-Ortiz
- b Laboratory of Dementias , National Institute of Neurology and Neurosurgery , Mexico City , Mexico
| | - Ana Ruth Díaz-Victoria
- c Cognitive and Behavior Unit , National Institute of Neurology and Neurosurgery , Mexico City , Mexico
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8
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Thomas-Antérion C. C’est chaud, c’est froid. Rev Neurol (Paris) 2016. [DOI: 10.1016/j.neurol.2016.01.362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
Although humans have long valued creativity, the generation of such innovation is still incompletely understood. Looking at the healthy brain, researchers have localized certain parts for a basic understanding of these mechanisms. By researching the brain affected by neurological disease, scientists have observed unique manifestations of creativity, such as in frontotemporal lobar degeneration, Alzheimer's disease, Parkinson's disease and parkinsonian spectrum disorders, and stroke, which help clarify these creative underpinnings. Incorporating both healthy and disease models of cerebral functioning, neurological and neuroscientific research from recent years has built on established theories and expanded current knowledge.
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Affiliation(s)
- Lealani Mae Y Acosta
- Department of Neurology, Vanderbilt University, 2525 West End Avenue, Suite 1200, Nashville, TN, 37203-8684, USA,
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10
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Abstract
In this study, the case of a patient who developed artistic ability following a traumatic brain injury is reported. The subject was a 49-year-old male who suffered brain injury at the age of 44 due to an accidental fall. At age 48, he began drawing with great enthusiasm and quickly developed a personal style with his own biomorphic iconography. At first, his drawing was restricted to realistic reproductions of photographs of buildings, but his style of drawing changed and became more personal and expressionistic over the following 6 months.
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Affiliation(s)
- Akira Midorikawa
- a Department of Psychology, Faculty of Letters , Chuo University , Tokyo 192-0393 , Japan
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Feinstein JS, Khalsa SS, Salomons TV, Prkachin KM, Frey-Law LA, Lee JE, Tranel D, Rudrauf D. Preserved emotional awareness of pain in a patient with extensive bilateral damage to the insula, anterior cingulate, and amygdala. Brain Struct Funct 2015; 221:1499-511. [PMID: 25577137 PMCID: PMC4734900 DOI: 10.1007/s00429-014-0986-3] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 12/30/2014] [Indexed: 12/30/2022]
Abstract
Functional neuroimaging investigations of pain have discovered a reliable pattern of activation within limbic regions of a putative "pain matrix" that has been theorized to reflect the affective dimension of pain. To test this theory, we evaluated the experience of pain in a rare neurological patient with extensive bilateral lesions encompassing core limbic structures of the pain matrix, including the insula, anterior cingulate, and amygdala. Despite widespread damage to these regions, the patient's expression and experience of pain was intact, and at times excessive in nature. This finding was consistent across multiple pain measures including self-report, facial expression, vocalization, withdrawal reaction, and autonomic response. These results challenge the notion of a "pain matrix" and provide direct evidence that the insula, anterior cingulate, and amygdala are not necessary for feeling the suffering inherent to pain. The patient's heightened degree of pain affect further suggests that these regions may be more important for the regulation of pain rather than providing the decisive substrate for pain's conscious experience.
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Affiliation(s)
- Justin S Feinstein
- Department of Neurology, University of Iowa, Iowa City, IA, 52242, USA. .,Department of Psychology, University of Iowa, Iowa City, IA, 52242, USA. .,Department of Psychology and School of Community Medicine, University of Tulsa, Tulsa, OK, 74104, USA. .,Laureate Institute for Brain Research, 6655 S. Yale Avenue, Tulsa, OK, 74136-3326, USA.
| | - Sahib S Khalsa
- Department of Neurology, University of Iowa, Iowa City, IA, 52242, USA.,Laureate Institute for Brain Research, 6655 S. Yale Avenue, Tulsa, OK, 74136-3326, USA.,Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Tim V Salomons
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, RG6 6AL, UK
| | - Kenneth M Prkachin
- Department of Psychology, University of Northern British Columbia, Prince George, BC, V2N 4Z9, Canada
| | - Laura A Frey-Law
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, 52242, USA
| | - Jennifer E Lee
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, 52242, USA
| | - Daniel Tranel
- Department of Neurology, University of Iowa, Iowa City, IA, 52242, USA.,Department of Psychology, University of Iowa, Iowa City, IA, 52242, USA
| | - David Rudrauf
- Department of Neurology, University of Iowa, Iowa City, IA, 52242, USA.,Laboratory of Functional Imaging, INSERM U678s/UPMC, 75013, Paris, France
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Mayseless N, Aharon-Peretz J, Shamay-Tsoory S. Unleashing creativity: The role of left temporoparietal regions in evaluating and inhibiting the generation of creative ideas. Neuropsychologia 2014; 64:157-68. [DOI: 10.1016/j.neuropsychologia.2014.09.022] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 09/08/2014] [Accepted: 09/13/2014] [Indexed: 11/17/2022]
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de Souza LC, Guimarães HC, Teixeira AL, Caramelli P, Levy R, Dubois B, Volle E. Frontal lobe neurology and the creative mind. Front Psychol 2014; 5:761. [PMID: 25101029 PMCID: PMC4107958 DOI: 10.3389/fpsyg.2014.00761] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 06/28/2014] [Indexed: 11/25/2022] Open
Abstract
Concepts from cognitive neuroscience strongly suggest that the prefrontal cortex (PFC) plays a crucial role in the cognitive functions necessary for creative thinking. Functional imaging studies have repeatedly demonstrated the involvement of PFC in creativity tasks. Patient studies have demonstrated that frontal damage due to focal lesions or neurodegenerative diseases are associated with impairments in various creativity tasks. However, against all odds, a series of clinical observations has reported the facilitation of artistic production in patients with neurodegenerative diseases affecting PFC, such as frontotemporal dementia (FTD). An exacerbation of creativity in frontal diseases would challenge neuroimaging findings in controls and patients, as well as the theoretical role of prefrontal functions in creativity processes. To explore this paradox, we reported the history of a FTD patient who exhibited the emergence of visual artistic productions during the course of the disease. The patient produced a large amount of drawings, which have been evaluated by a group of professional artists who were blind to the diagnosis. We also reviewed the published clinical cases reporting a change in the artistic abilities in patients with neurological diseases. We attempted to reconcile these clinical observations to previous experimental findings by addressing several questions raised by our review. For instance, to what extent can the cognitive, conative, and affective changes following frontal damage explain changes in artistic abilities? Does artistic exacerbation truly reflect increased creative capacities? These considerations could help to clarify the place of creativity—as it has been defined and explored by cognitive neuroscience—in artistic creation and may provide leads for future lesion studies.
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Affiliation(s)
- Leonardo C de Souza
- Neuropsychiatric Branch, Neurology Division, University Hospital, Universidade Federal de Minas Gerais Belo Horizonte, Brazil
| | - Henrique C Guimarães
- Neuropsychiatric Branch, Neurology Division, University Hospital, Universidade Federal de Minas Gerais Belo Horizonte, Brazil
| | - Antônio L Teixeira
- Neuropsychiatric Branch, Neurology Division, University Hospital, Universidade Federal de Minas Gerais Belo Horizonte, Brazil
| | - Paulo Caramelli
- Neuropsychiatric Branch, Neurology Division, University Hospital, Universidade Federal de Minas Gerais Belo Horizonte, Brazil
| | - Richard Levy
- Inserm, U 1127, ICM Frontlab Paris, France ; CNRS, UMR 7225, ICM Frontlab Paris, France ; Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127 Paris, France ; Institut du Cerveau et de la Moelle épinière, ICM Frontlab Paris, France ; AP-HP, Hôpital Saint-Antoine, Service de Neurologie Paris, France
| | - Bruno Dubois
- Inserm, U 1127, ICM Frontlab Paris, France ; CNRS, UMR 7225, ICM Frontlab Paris, France ; Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127 Paris, France ; Institut du Cerveau et de la Moelle épinière, ICM Frontlab Paris, France ; AP-HP, Hôpital de la Salpétrière, Neurology Department, Institut de la Mémoire et de la Maladie d'Alzheimer Paris, France
| | - Emmanuelle Volle
- Inserm, U 1127, ICM Frontlab Paris, France ; CNRS, UMR 7225, ICM Frontlab Paris, France ; Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127 Paris, France ; Institut du Cerveau et de la Moelle épinière, ICM Frontlab Paris, France
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Zaidel DW. Creativity, brain, and art: biological and neurological considerations. Front Hum Neurosci 2014; 8:389. [PMID: 24917807 PMCID: PMC4041074 DOI: 10.3389/fnhum.2014.00389] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Accepted: 05/15/2014] [Indexed: 01/08/2023] Open
Abstract
Creativity is commonly thought of as a positive advance for society that transcends the status quo knowledge. Humans display an inordinate capacity for it in a broad range of activities, with art being only one. Most work on creativity’s neural substrates measures general creativity, and that is done with laboratory tasks, whereas specific creativity in art is gleaned from acquired brain damage, largely in observing established visual artists, and some in visual de novo artists (became artists after the damage). The verb “to create” has been erroneously equated with creativity; creativity, in the classic sense, does not appear to be enhanced following brain damage, regardless of etiology. The turning to communication through art in lieu of language deficits reflects a biological survival strategy. Creativity in art, and in other domains, is most likely dependent on intact and healthy knowledge and semantic conceptual systems, which are represented in several pathways in the cortex. It is adversely affected when these systems are dysfunctional, for congenital reasons (savant autism) or because of acquired brain damage (stroke, dementia, Parkinson’s), whereas inherent artistic talent and skill appear less affected. Clues to the neural substrates of general creativity and specific art creativity can be gleaned from considering that art is produced spontaneously mainly by humans, that there are unique neuroanatomical and neurofunctional organizations in the human brain, and that there are biological antecedents of innovation in animals.
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Affiliation(s)
- Dahlia W Zaidel
- Department of Psychology, Behavioral Neuroscience, University of California at Los Angeles (UCLA) Los Angeles, CA, USA
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Baier B, zu Eulenburg P, Geber C, Rohde F, Rolke R, Maihöfner C, Birklein F, Dieterich M. Insula and sensory insular cortex and somatosensory control in patients with insular stroke. Eur J Pain 2014; 18:1385-93. [PMID: 24687886 DOI: 10.1002/j.1532-2149.2014.501.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2014] [Indexed: 12/28/2022]
Abstract
BACKGROUND In functional imaging studies, the insular cortex (IC) has been identified as an essential part of the processing of a whole spectrum of multimodal sensory input. However, there are no lesion studies including a sufficient number of patients, which would reinforce the functional imaging data obtained from healthy subjects. Such lesion studies should examine how damage to the IC affects sensory perception. We chose acute stroke patients with lesions affecting the IC in order to fill this gap. METHODS A comprehensive sensory profiling by applying a quantitative sensory testing protocol was performed and a voxel-lesion behaviour mapping analysis in 24 patients with acute unilateral cortical damage was applied. RESULTS Our data demonstrate that patients with lesions of the posterior IC have deficits in temperature perception, but did not show other sensory deficits such as hot or cold pain perception associated with specific lesion locations. CONCLUSION Our data allow the conclusion that the posterior IC may represent the major region responsible for encoding warm and cold perception in the brain. To what extent focal IC lesions may also impair pain processing or induce post-stroke pain has to be addressed in future studies including more patients.
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Affiliation(s)
- B Baier
- Department of Neurology, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany; Department of Neurology, German Center for Vertigo and Balance Disorders-IFBLMU, Ludwig-Maximilians-University, Munich, Germany; Munich Center for Systems Neurology (SyNergy), Germany
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16
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Takahata K, Saito F, Muramatsu T, Yamada M, Shirahase J, Tabuchi H, Suhara T, Mimura M, Kato M. Emergence of realism: Enhanced visual artistry and high accuracy of visual numerosity representation after left prefrontal damage. Neuropsychologia 2014; 57:38-49. [PMID: 24631259 DOI: 10.1016/j.neuropsychologia.2014.02.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 02/01/2014] [Accepted: 02/24/2014] [Indexed: 10/25/2022]
Abstract
Over the last two decades, evidence of enhancement of drawing and painting skills due to focal prefrontal damage has accumulated. It is of special interest that most artworks created by such patients were highly realistic ones, but the mechanism underlying this phenomenon remains to be understood. Our hypothesis is that enhanced tendency of realism was associated with accuracy of visual numerosity representation, which has been shown to be mediated predominantly by right parietal functions. Here, we report a case of left prefrontal stroke, where the patient showed enhancement of artistic skills of realistic painting after the onset of brain damage. We investigated cognitive, functional and esthetic characteristics of the patient׳s visual artistry and visual numerosity representation. Neuropsychological tests revealed impaired executive function after the stroke. Despite that, the patient׳s visual artistry related to realism was rather promoted across the onset of brain damage as demonstrated by blind evaluation of the paintings by professional art reviewers. On visual numerical cognition tasks, the patient showed higher performance in comparison with age-matched healthy controls. These results paralleled increased perfusion in the right parietal cortex including the precuneus and intraparietal sulcus. Our data provide new insight into mechanisms underlying change in artistic style due to focal prefrontal lesion.
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Affiliation(s)
- Keisuke Takahata
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan; Clinical Neuroimaging Team, Molecular Neuroimaging Program, Molecular Imaging Center, National Institute of Radiological Sciences, 4-9-1 Anagawa, Inage, Chiba, Chiba 263-8555, Japan.
| | - Fumie Saito
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan.
| | - Taro Muramatsu
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan.
| | - Makiko Yamada
- Clinical Neuroimaging Team, Molecular Neuroimaging Program, Molecular Imaging Center, National Institute of Radiological Sciences, 4-9-1 Anagawa, Inage, Chiba, Chiba 263-8555, Japan.
| | - Joichiro Shirahase
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan; Center for Stress Research (CSR), Keio University, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan.
| | - Hajime Tabuchi
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan.
| | - Tetsuya Suhara
- Clinical Neuroimaging Team, Molecular Neuroimaging Program, Molecular Imaging Center, National Institute of Radiological Sciences, 4-9-1 Anagawa, Inage, Chiba, Chiba 263-8555, Japan.
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan.
| | - Motoichiro Kato
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan; Center for Stress Research (CSR), Keio University, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan.
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17
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Simis M, Bravo GL, Boggio PS, Devido M, Gagliardi RJ, Fregni F. Transcranial Direct Current Stimulation inde novoArtistic Ability After Stroke. Neuromodulation 2013; 17:497-501. [DOI: 10.1111/ner.12140] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Revised: 10/18/2013] [Accepted: 10/21/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Marcel Simis
- Laboratory of Neuromodulation; Department of Physical Medicine & Rehabilitation; Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School; Boston MA USA
- Division of Neurology; Santa Casa Medical School; São Paulo Brazil
| | - Gabriela L. Bravo
- Laboratory of Neuromodulation; Department of Physical Medicine & Rehabilitation; Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School; Boston MA USA
| | - Paulo S. Boggio
- Social and Cognitive Neuroscience Laboratory and Developmental Disorders Program; Center for Health and Biological Sciences; Mackenzie Presbyterian University; São Paulo Brazil
| | - Michele Devido
- Division of Neurology; Santa Casa Medical School; São Paulo Brazil
| | | | - Felipe Fregni
- Laboratory of Neuromodulation; Department of Physical Medicine & Rehabilitation; Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School; Boston MA USA
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18
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Brogaard B. Serotonergic hyperactivity as a potential factor in developmental, acquired and drug-induced synesthesia. Front Hum Neurosci 2013; 7:657. [PMID: 24155703 PMCID: PMC3800812 DOI: 10.3389/fnhum.2013.00657] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 09/21/2013] [Indexed: 01/12/2023] Open
Abstract
Though synesthesia research has seen a huge growth in recent decades, and tremendous progress has been made in terms of understanding the mechanism and cause of synesthesia, we are still left mostly in the dark when it comes to the mechanistic commonalities (if any) among developmental, acquired and drug-induced synesthesia. We know that many forms of synesthesia involve aberrant structural or functional brain connectivity. Proposed mechanisms include direct projection and disinhibited feedback mechanisms, in which information from two otherwise structurally or functionally separate brain regions mix. We also know that synesthesia sometimes runs in families. However, it is unclear what causes its onset. Studies of psychedelic drugs, such as psilocybin, LSD and mescaline, reveal that exposure to these drugs can induce synesthesia. One neurotransmitter suspected to be central to the perceptual changes is serotonin. Excessive serotonin in the brain may cause many of the characteristics of psychedelic intoxication. Excessive serotonin levels may also play a role in synesthesia acquired after brain injury. In brain injury sudden cell death floods local brain regions with serotonin and glutamate. This neurotransmitter flooding could perhaps result in unusual feature binding. Finally, developmental synesthesia that occurs in individuals with autism may be a result of alterations in the serotonergic system, leading to a blockage of regular gating mechanisms. I conclude on these grounds that one commonality among at least some cases of acquired, developmental and drug-induced synesthesia may be the presence of excessive levels of serotonin, which increases the excitability and connectedness of sensory brain regions.
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Affiliation(s)
- Berit Brogaard
- Department of Philosophy and Center for Neurodynamics, University of Missouri St. Louis, MO, USA
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19
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Synesthésies, un monde sensoriel augmenté : phénoménologie et revue de la littérature. Rev Neurol (Paris) 2013; 169:328-34. [DOI: 10.1016/j.neurol.2012.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Revised: 08/19/2012] [Accepted: 09/24/2012] [Indexed: 11/22/2022]
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20
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Borg C, Bedoin N, Peyron R, Bogey S, Laurent B, Thomas-Antérion C. Impaired emotional processing in a patient with a left posterior insula-SII lesion. Neurocase 2013; 19:592-603. [PMID: 22934884 DOI: 10.1080/13554794.2012.713491] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The present case-report investigated the influence of a lesion in the left posterior insula-SII cortices on the processing of emotions. MB and 16 normal controls explicitly rated the valence and the intensity of both facial expressions and emotional words. In addition, they had to perform a number comparison task and a lexical decision task without focusing their attention on emotional components of stimuli. MB identified the valence of emotional words as well as the control group. Nevertheless, she provided higher intensity scores for disgusted words and her responses in the lexical decision task were significantly delayed for these stimuli. In addition, MB's response times were not differently influenced by the presence of irrelevant emotional faces. However, she explicitly identified fewer facial expressions of disgust and she assessed them as significantly less intense. This pattern of results contributes to highlight the psychological and behavioral disorders observed after a left posterior insular stroke.
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Affiliation(s)
- Céline Borg
- a Neurology/Neuropsychology , CMRR Unit, Hospital Nord, 42270 , Saint-Priest-en-Jarez , France
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21
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Schott GD. Pictures as a neurological tool: lessons from enhanced and emergent artistry in brain disease. Brain 2012; 135:1947-63. [DOI: 10.1093/brain/awr314] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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22
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Garcia-Larrea L, Perchet C, Creac'h C, Convers P, Peyron R, Laurent B, Mauguière F, Magnin M. Operculo-insular pain (parasylvian pain): a distinct central pain syndrome. Brain 2010; 133:2528-39. [PMID: 20724291 DOI: 10.1093/brain/awq220] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Central pain with dissociated thermoalgesic sensory loss is common in spinal and brainstem syndromes but not in cortical lesions. Out of a series of 270 patients investigated because of somatosensory abnormalities, we identified five subjects presenting with central pain and pure thermoalgesic sensory loss contralateral to cortical stroke. All of the patients had involvement of the posterior insula and inner parietal operculum. Lemniscal sensory modalities (position sense, graphaestesia, stereognosis) and somatosensory evoked potentials to non-noxious inputs were always preserved, while thermal and pain sensations were profoundly altered, and laser-evoked potentials to thermo-nocoiceptive stimuli were always abnormal. Central pain resulting from posterior parasylvian lesions appears to be a distinct entity that can be identified unambiguously on the basis of clinical, radiological and electrophysiological data. It presents with predominant or isolated deficits for pain and temperature sensations, and is paradoxically closer to pain syndromes from brainstem lesions affecting selectively the spinothalamic pathways than to those caused by focal lesions of the posterior thalamus. The term 'pseudo-thalamic' is therefore inappropriate to describe it, and we propose parasylvian or operculo-insular pain as appropriate labels. Parasylvian pain may be extremely difficult to treat; the magnitude of pain-temperature sensory disturbances may be prognostic for its development, hence the importance of early sensory assessment with quantitative methods.
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Affiliation(s)
- Luis Garcia-Larrea
- Central Integration of Pain Unit, U879 INSERM & University Claude Bernard, Lyon 1, Neurological Hospital, Lyon, France.
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