FRONTAL LOBE

DR PRADEEP LALWANI
SR NEUROLOGY
MDM
 Location • Anterior to the parietal lobe (separated by central sulcus)
• Superior and anterior to the temporal lobe (separated by lateral
sulcus - Sylvian fissure)

Principal gyri • Precentral gyrus, superior frontal gyrus, middle frontal gyrus and
inferior frontal gyrus

Functional units • Prefrontal cortex (superior frontal gyrus, middle frontal gyrus and
inferior frontal gyrus)
• Motor cortex (precentral gyrus)
• Broca’s area (pars opercularis and pars triangularis of inferior
frontal gyrus)

Function • Prefrontal cortex: management of higher cognitive functions such

as planning, organizing, motivation, discipline, problem-solving,
self-control and emotional regulation.
• Motor cortex: Control of voluntary movement, spatial orientation
• Broca’s area: Speech production
 Location and structure
• The frontal lobe lies largely in the anterior cranial fossa of
the skull leaning on the orbital plate of the frontal bone. It
occupies one-third of the cerebral hemisphere, extending
from its most anterior part (frontal pole) posteriorly to
the central sulcus, which separates it from the parietal lobe.
• Posterior and inferior to the frontal lobe is the temporal lobe,
separated from it by the lateral sulcus (Sylvian fissure). The central
sulcus demarcates the posterior border of the frontal lobe, while the
Sylvian fissure demarcates its inferior border
 SURFACES
• The frontal lobe exhibits three cortical surfaces
• Lateral, medial and inferior surfaces
• The convexity of the lateral surface presents four important
convolutions (gyri), which are the precentral gyrus, superior frontal
gyrus, middle frontal gyrus and inferior frontal gyrus.
 MEDIAL SURFACE
• On the medial (interhemispheric) surface, the frontal lobe extends
down to the cingulate sulcus. From posteriorly to anteriorly, it consists
mainly of the paracentral lobule (an extension of the precentral and
postcentral gyri), and the medial extension of the superior frontal
gyrus.
 INFERIOR SURFACE
• The inferior surface of the frontal lobe (or frontobasal, or orbital) is
the smallest cortical surface, lying on the floor of the anterior cranial
fossa.
• The medial part of the inferior surface is traversed by the
deep olfactory sulcus, which contains the
olfactory tract and olfactory bulb
• The olfactory sulcus separates the straight gyrus
(a long and narrow gyrus) and the orbital gyri.
• There are four orbital gyri, divided by the
H-shaped orbital sulcus into the anterior and
posterior orbital gyri superiorly, and
the medial and lateral orbital gyri inferiorly.
 Gyri of the frontal lobe

• The four principal convolutions on the convexity of the frontal lobe

are the precentral gyrus, the superior frontal gyrus, middle frontal
gyrus and inferior frontal gyrus.
 PRECENTRAL GYRUS
• The precentral gyrus is the most posterior part of the frontal lobe,
situated between the central sulcus posteriorly and the precentral
sulcus anteriorly. Inferiorly, it is bordered by the lateral sulcus (Sylvian
fissure).
• The precentral gyrus contains the primary motor cortex (Brodmann’s
area 4), which is responsible for integrating signals from different
brain regions to modulate motor function: each primary motor cortex
sends instructions for voluntary movement to the contralateral
(opposite) side of the body.

• The primary motor cortex contains pyramidal cells, which are types of
multipolar neurons found in several other areas of the brain.
• A portion of the primary motor cortex contains characteristic giant
pyramidal cells called Betz cells, whose axons form the
corticospinal and corticobulbar tracts. The Betz cells and their axons
are referred to as the upper motor neurons in these tracts. The
pyramidal neurons and the Betz cells are arranged somatotopically,
which means that, depending on where in the precentral gyrus they
originate, they will supply different regions of the body.
• Anterior to the primary motor cortex in the precentral gyrus is the
premotor area, or premotor cortex (Brodmann’s area 6), and
the supplemental motor cortex.
• These regions of the cortex occupy the anterior part of the precentral
gyrus and the posterior parts of the superior, middle, and inferior
frontal gyri.
• These regions receive input from the sensory cortex, thalamus, and
basal ganglia, and thus play an important role in the initiation and
sequencing of movements.
Functional Frontal Lobe
Anatomy
Premotor area Primary motor area
B6 B4

Central sulcus
Supplementary
motor area
(medially)

Frontal eye field

B8

Prefrontal area
B 9, 10, 11, 12 Motor cortex
Lateral sulcus/ 1. Primary
Sylvian fissure 2. Premotor
Prefrontal cortex
1. Dorsolateral
Motor speech 3. Supplementary
2. Medial area of Broca 4. Frontal eye field
3. Orbitofrontal B 44, 45 5. Broca’s area
 Primary Motor Cortex (M1,
Brodmann area 4):
• Located on the precentral gyrus just rostral to the central sulcus.
• It is the source of cortical neurons that will project to the brainstem and spinal cord
to activate neurons involved in the control of voluntary movements.
• It receives input from the neighboring primary somatosensory area and premotor
cortex, as well as from the ventral lateral nucleus of the thalamus.
• These inputs modulate the output of by providing information about the
positioning, timing, and coordination of voluntary movements.
• The output goes by way of the internal capsule to synapse in the brainstem (the
projection referred to as the corticobulbar tract) or the spinal cord (the
corticospinal tract).
• Damage will cause contralatereral motor deficits, initially a flaccid
hemiplegia/hemiparesis and later a spastic hemiplegia/hemiparesis.
 Premotor Cortex (BA6)
• Located immediately rostral to M1.
• Its primary function is to assist in integration of sensory and motor information for the
performance of an action (praxis).
• Thus, it receives input from secondary somatosensory area and the ventral anterior thalamic
nucleus.
• The output of premotor cortex is to M1 and contralateral premotor area (by way of the
corpus callosum).
• Damage to premotor cortex may result in
(1) apraxia, an acquired inability to carry out skilled actions that could previously be
performed (but without paralysis);
(2) deficits in contralateral fine motor control, such as the performance of complex serial
movements; and
(3) difficulty in using sensory feedback for the control and performance of movements.
Cingulate Cortex/Supplementary
motor area
• Located in the medial portion of the cortex just superior to the corpus callosum.
• These regions of the brain have functions that are involved with drive and motivation
along with environmental exploration.
• Their connections are with deep limbic structures of the brain (ie. basal forebrain
structures such as the nucleus accumbens).
• Dysfunction in the cingulate/SMA are associated with several uniquely bizarre
characteristics, including apathy and akinetic mutism (reflecting a loss of drive and
motivation) along with complex attentional deficits and delayed habituation to external
stimuli.
• The alien hand syndrome may also be present, whereby patients report experiencing a
loss of conscious control over the movements and actions of their hand, which proceeds
to “explore” the surrounding environment by, for instance, unbuttoning clothes.
 Frontal eye fields (BA8)
• Located rostral to premotor cortex.
• Their primary function is associated with control of voluntary eye
movements in the contralateral visual field for processes such as
active visual search.
• Damage to the frontal eye fields will cause deficits in voluntary eye
movement to the contralateral visual field (leading to active visual
search deficits) but preserved passive eye movement (as in the
following of a moving object).
 Dorsolateral prefrontal cortex
• It makes up the largest proportion of frontal cortex, located rostral to
the frontal eye fields and superior to orbitofrontal cortex.
• The functions of this region of the brain fall under the heading of
“executive” processes, which in a general sense involves the ability to
utilize sensory input from multiple modalities (ie. visual, auditory) in
generation of appropriate responses.
 Medial prefrontal cortex
• Connections:
• temporal cortex
• parietal cortex
• thalamus, caudate, GP, substantia nigra,
• cingulate cortex

• Functions:
• motivation, initiation of activity

• Lesions:
• Paucity of spontaneous movement and gesture,
• Sparse verbal output (repetition may be preserved),
• Lower extremity weakness and loss of sensation,
• Incontinence
 Orbitofrontal Cortex
• Located inferior to dorsolateral prefrontal cortex in the most rostral portion of the
frontal lobe.
• It has several functions, including the modulation of affective and social behavior,
working memory for feature information, and smell discrimination.
• The orbitofrontal cortex receives input from limbic and olfactory systems, along with
inferotemporal lobe areas (memory formation), and ventral visual pathways (analysis of
form and color of visual input).
• Its output is to autonomic musculature and the basal forebrain cholinergic system
(both targets are involved in regulation of behavior).
• General observation of patients exhibiting behavioral disinhibition or socially
inappropriate actions might suggest orbitofrontal deficits, particularly if on neurological
exam the patient also exhibits anosmia (an inability to discriminate smells).
Five ‘frontal subcortical circuits’
1. Supplementary motor area Motor cortex
2. Frontal eye field

Two of these have primarily motor functions: one originates in the

supplemental motor accessory area and is involved in the planning of
movement; the other originates in the frontal eye fields and is
involved in eye motion.
3. Dorsolateral prefrontal Lateral
4. Lateral orbitofrontal Inferior Prefrontal cortex

5. Anterior cingulate Medial

• Functionally, these circuits serve some aspect of executive function, the set of
“cognitive skills responsible for the planning, initiation, sequencing, and monitoring
of complex goal-directed behavior

• The anterior cingulum circuit appears to be central to the motivation of behavior.

• The dorsolateral prefrontal circuit serves organizational aspects of executive
functioning by integrating information, focusing attention, and deciding on response.
• The lateral orbitofrontal circuit is critical to the integration of limbic and emotional
information into context appropriate behavioral responses.
1. Frontal subcortical Motor Circuit

SMA,
Premotor,Motor

Hypo-thalamus Putamen

Thalamus Globus Pallidus

• Supplementary Motor & Premotor : planning, initiation & storage of

motor programs; fine-tuning of movements
• Motor : final station for execution of the movement according to the
design
[Link] Oculomotor Circuit
Frontal
Eye field

Central
Thalamus
Caudate

Globus Pallidus
&
Substantia Nigra

• Voluntary scanning eye movement

• Independent of visual stimuli
 Frontal lobe function

Motor Cognitive Behavior Arousal

Voluntary Memory Personality Attention
movements
Planning, Initiation Problem solving Social and sexual

Spontaneity Judgment Impulse control

Language Abstract Mood and affect

Expression thinking
Eye movements
 Frontal executive functions and
dysfunctions
• Executive functions are a constellation of cognitive abilities which
enable a person to generate thoughts, formulate plans and guide
behaviour according to these plans, inhibiting what is irrelevant and
shifting cognitive sets as and when needed.
• The term executive function was initially circumscribed to planning, goal
setting, action initiation, inhibition, shifting, and verification.
• Recently, social cognition, (ability to understand that others have
beliefs, desires, intentions, and perspectives that are different from
one's own), episodic memory, insight, and metacognition (the ability to
control our own thoughts) have been variably incorporated into the
domain of executive functions
 The main components of
executive function are:
1. Planning
2. Initiation
3. Response inhibition
4. Mental flexibility
5. Working memory
6. Fluency
 Planning
• Planning is the the ability to identify and organize the necessary steps
required to achieve a goal.
• The ability to develop steps, identify material needed and set
completion date for the project are considered as essential parts of
planning.
• Damage to the dorsolateral prefrontal cortex (DLPFC) has been
associated with impairments in planning and hypothesis generation.
• The anterior DLPFC has been implicated in maintaining goals in
working memory, which allows for the manipulation and control of
information.
 INITIATION
• Initiation is the ability to begin a task.

RESPONSE INHIBITION
• is the ability to stop one's own behaviour at the appropriate time,
including stopping actions and thoughts.
• Problems with response inhibition can be evident as the patient's
failure to inhibit inappropriate verbal or behavioural responses.
 Mental flexibility (set shifting)
• Mental flexibility (set shifting) is the ability to move freely from one
situation to another and think flexibly in order to respond
appropriately to the situation.
• It is the capacity to respond rapidly to unanticipated environmental
situations.
• When it is abnormal there will be failure to adjust behaviour
appropriately in response to situations.
 Working memory

The process of temporarily holding and manipulating new visual or auditory

information in mind is called working memory.
It is a system for temporarily holding and managing the information required to carry
out complex cognitive tasks.
For example, if a question is asked, the question is kept in mind as the person searches
the memory files for the answer.

Fluency
 Fluency is the amount of material and information a person can generate in a fixed
time.
A few examples of the change in performance
of cooking due to the executive dysfunction
May not collect all the necessary ingredients to make an item.
Unable to judge the correct quantity of food required for a fixed
number of persons. The quantity may be less or in excess.
Unable to judge the correct proportion of the ingredients to make a
tasty dish. Thus, the dish prepared may have excess salt or spice.
May not add the ingredients in the correct sequence.
May not be able to use an alternative ingredient, if an essential
ingredient is lacking, for example using jaggery instead of cane sugar.
Unable to handle an unforeseen situation for example, if the cooking
gas is over, they may stop cooking, rather than using an electric
heater which is available.
May not check the taste of the item before finishing cooking.
Unable to prioritize. May waste time preparing a salad, ignoring the
main course.
May not start cooking in time.
Unable to calculate the time needed for cooking the item.
May not finish cooking in time
 overview of the executive dysfunction produced by the
defects in the different components of executive function
 Disinhibitory syndrome of orbito frontal
cortex

• A variety of disinhibitory syndromes are produced by lesions affecting the

orbitofrontal cortex.
• The characteristic of this syndrome are:
1. Socially inappropriate behaviour - Inappropriately approaching, touching
or kissing strangers. - Verbal or physical aggressive or criminal behaviour. -
Inappropriate sexual acts.
2. Loss of manners or decorum - Inappropriate laughter, jokes and opinion
that is offensive to others. - Lack of etiquette. - Poor hygiene. -
Inappropriate physical behaviour.
3. Impulsive rash and careless actions - Reckless driving - New onset gambling
- Buying and selling objects without regards for consequences.
 Apathetic syndrome of medial
frontal lobe
• The features of this syndrome are:

1. Lack of initiative and reduced motivation.

2. Ceasing to engage in activities or previous hobbies.
3. Social isolation
4. Needs prompting to initiate and continue routine activities.
5. Does not initiate or sustain a conversation
 Role of prefrontal cortex in
motor programming
• For the proper functions of motor system, it has to be guided by
proper programs.
• There are two types of motor programs
Praxic and intentional
• The praxic system provides the corticospinal system with the
knowledge of how to make learned skilled movements and is the
function of dominant parietal lobe
• The intentional motor program provides the corticospinal system with
information about when to move and is a function of prefrontal lobe.
• There are four types of intentional motor programs

When to start a moment

When not to start a movement
When to continue a movement
When to stop a movement
The inability to start a movement is akinesia
The inability to withhold a movement to stimulus is
echopraxia (defective response inhibition)
Inability to sustain or continue a movement is motor
impersistence
Inability to stop a movement is motor perservation
THANK YOU