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The vulnerable lobes

Medical students have always been fascinated by the story of Phineas Gage, a normal, hard working 26-year-old labourer. He became famous in 1848, when an iron rod pierced his skull and brain and exited on the opposite side. He survived this extensive trauma and was physically normal. His life aroused scientific curiosity as physicians suddenly realised that, contrary to popular opinion at that time, all parts of the brain where not essential for life.

The brain controls the physical functions of the body, determines our intelligence, memory, personality and ability to respond to change. It has four paired lobes. Of these, the parietal, temporal and occipital lobes have well elucidated mapped areas for functions like sight, speech, hearing and movement. The frontal lobes (through which the rod pierced Gage), situated just behind the forehead, are responsible for subtle psychological functions like mental maturity, recognition of social norms of behaviour, emotional development and appropriate responses to society.

The frontal area of the brain is protected to some extent by the skull bones. However, damage to the frontal lobes can occur as a result of accidents. Surgery may be performed on the frontal lobes to remove cysts or tumours, to treat intractable epilepsy, or very rarely for psychiatric disorders. The effects of injury to the frontal lobes are often subtle and difficult to pinpoint as the IQ (intelligence quotient) may remain normal. There may be weakness without actual paralysis, inability to perform sequential movement (like dressing for work), lack of flexibility and spontaneity, poor attention and difficulty in expressing thoughts lucidly despite increased talking. Sexual habits may change with promiscuity or disinterest or socially inappropriate behaviour. The entire personality of the individual may change, making him or her unpleasant, obnoxious and intolerable.

The brain fibres in the frontal lobes mature as we grow older and develop fully around the age of 25. Genetic defects or injury in the uterus, during birth or within this time frame, can result in faulty connections, inadequate development and poor release of brain chemicals like dopamine. This can cause learning disabilities, antisocial personalities and sometimes even major psychiatric illnesses like schizophrenia. Also the size of our brain, particularly of the frontal lobes, shrinks over time. This affects important human abilities such as planning, reasoning and problem solving.

Not all brains age or deteriorate at the same rate. Part of this process is genetic and the degeneration sets in at a certain chronological age triggered by an in-built biological alarm. This apparently inevitable mental decline is further influenced by environmental factors, which can be modified favourably.

The concept of retraining ageing brain circuits has been gaining popularity. There are DVDs and books available on brain exercises. The numbers game Sudoku is in almost every newspaper. Retraining the frontal lobes can also be done quite simply by memorising passages or poetry from books. Repetition of a task makes performance rapid and more efficient with less room for error, as the cascading chemical reactions in the brain then occur on accustomed pathways. Older adults who regularly participate in cognitive activity improve their memory, speed of thought and attention span. This helps them to efficiently manage their day-to-day activities and their finances. The benefits of brain training can be enhanced by regular physical activity.

Look after your brain as it is the only one you have.

* Protect it from injury by wearing seat belts and using helmets.

* Do not hit anyone on the head (this particularly includes corporal punishment).

* If anyone has had an accident or brain surgery, tolerate their idiosyncrasies, changes in personality, unreasonable anger and emotional outbursts.

Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in

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