Treatment of Psychiatric Symptoms Associated With a Frontal Lobe Tumor Through Surgical Resection

Abstract

The frontal lobes of the brain underlie judgment, foresight, motivation, and personality and allow us to behave as socially appropriate human beings (1, 2). Our understanding of frontal lobe function comes from animal experiments (e.g., the chimpanzee experiments of Jacobsen and Fulton that were the impetus for Moniz’s human lobotomies) and human neuropsychological studies, as well as case reports involving traumatic brain injuries. These case reports have shown that frontal lobe damage often results in antisocial behavior, apathy, disinhibition, and emotional lability. Discrete prefrontal cortex lesions are sometimes associated with unique behavioral profiles. Although numerous exceptions exist, frontal lobe dysfunction exhibits laterality: left hemisphere lesions are more typically associated with depression, whereas right hemisphere lesions are associated with impulsivity and maniclike symptoms (3, 4). Brain tumors are a well-known cause of frontal lobe dysfunction. One type is the rare dysembryoplastic neuroepithelial tumor, a benign supratentorial neoplasm seen primarily in children and young adults (5, 6). Approximately one-third of dysembryoplastic neuroepithelial tumors occur in the frontal lobes, and some become large enough to compress regions of the cortex and white matter to the point of disrupting behavior (7–9). In addition to mass effects, dysembryoplastic neuroepithelial tumors are a source of epileptogenic activity, which may lead to neuropsychiatric sequelae when there is frontal lobe involvement (10, 11). Surgical resection, which characteristically yields an excellent prognosis, is the recommended treatment for these tumors (12, 13). Even with partial tumor removal, there is little evidence of recurrence, and most patients make a complete but slow neuropsychiatric recovery. This case study is one of a few to report the virtually instantaneous neurosurgical cure of a psychiatric illness in a patient with a frontal lobe dysembryoplastic neuroepithelial tumor. We also provide a summary and review of the literature on psychiatric disturbances associated with various frontal lobe lesions.