From phineas gage and monsieur leborgne to H.M.: Revisiting disconnection syndromes
Cereb. Cortex. 2015-08-12; 25(12): 4812-4827
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1. Cereb Cortex. 2015 Dec;25(12):4812-27. doi: 10.1093/cercor/bhv173. Epub 2015 Aug
From Phineas Gage and Monsieur Leborgne to H.M.: Revisiting Disconnection
Thiebaut de Schotten M(1), Dell’Acqua F(2), Ratiu P(3), Leslie A(2), Howells
H(2), Cabanis E(4), Iba-Zizen MT(4), Plaisant O(5), Simmons A(6), Dronkers NF(7),
Corkin S(8), Catani M(2).
(1)Natbrainlab, Department of FANS, Institute of Psychiatry, Psychology and
Neuroscience and Brain Connectivity and Behaviour, Brain and Spine Institute,
Paris, France Inserm U 1127; UPMC-Paris6, UMR_S 1127; CNRS UMR 7225, CRICM, GH
Pitié-Salpêtrière, 75013 Paris, France.
(2)Natbrainlab, Department of FANS, Institute of Psychiatry, Psychology and
Neuroscience and Department of Neuroimaging, Institute of Psychiatry, King’s
College London, London, UK.
(3)Natbrainlab, Department of FANS, Institute of Psychiatry, Psychology and
(4)Centre Hospitalier National d’Ophtalmologie des Quinze-Vingts, Paris, France.
(5)University of Paris-Descartes, GH Pitié-Salpêtrière, URDIA, EA4465, Paris,
(6)Department of Neuroimaging, Institute of Psychiatry, King’s College London,
(7)VA Northern California Health Care System, Martinez, CA, USA Department of
Neurology, University of California, Davis, CA, USA National Research University
Higher School of Economics, Russian Federation.
(8)Department of Brain and Cognitive Sciences, Massachusetts Institute of
Technology, Cambridge, MA, USA.
On the 50th anniversary of Norman Geschwind’s seminal paper entitled
‘Disconnexion syndrome in animal and man’, we pay tribute to his ideas by
applying contemporary tractography methods to understand white matter
disconnection in 3 classic cases that made history in behavioral neurology. We
first documented the locus and extent of the brain lesion from the computerized
tomography of Phineas Gage’s skull and the magnetic resonance images of Louis
Victor Leborgne’s brain, Broca’s first patient, and Henry Gustave Molaison. We
then applied the reconstructed lesions to an atlas of white matter connections
obtained from diffusion tractography of 129 healthy adults. Our results showed
that in all 3 patients, disruption extended to connections projecting to areas
distant from the lesion. We confirmed that the damaged tracts link areas that in
contemporary neuroscience are considered functionally engaged for tasks related
to emotion and decision-making (Gage), language production (Leborgne), and
declarative memory (Molaison). Our findings suggest that even historic cases
should be reappraised within a disconnection framework whose principles were
plainly established by the associationist schools in the last 2 centuries.
© The Author 2015. Published by Oxford University Press.
PMID: 26271113 [Indexed for MEDLINE]