Nine case descriptions illustrate the three major prefrontal syndromes
seen in clinical practice: disorganized type, disinhibited type, and
apathetic type. A mixture of symptoms from each subtype is usually seen,
but dysfunction in one prefrontal system often dominates. A careful history
and examination are essential for accurate diagnosis. A complete history
can rarely be elicited from the patient alone. Structural brain imaging,
especially MRI, and neuropsychological testing are key to the diagnostic
workup. EEG, video-EEG, and functional brain imaging can be valuable in the
evaluation of possible partial complex seizures of frontal lobe origin and
other atypical frontal lobe disorders. Effective treatment requires
educating the patient and the family about the illness and modulating
environmental factors that influence the patient's behavior. Judicious use
of psychoactive medication may be helpful, but adverse effects are
common.
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