Some cognitive effects of frontal-lobe lesions in man.

The study of patients undergoing unilateral frontal-lobe excisions for the relief of focal epilepsy has revealed specific cognitive disorders that appear against a background of normal functioning on many intellectual, perceptual and memory tasks. Lesions that invade the frontal eye field cause subtle impairments of voluntary oculomotor control, which reveal themselves as an inability to suppress an initial glance at a potentially distracting stimulus. After frontal lobectomy in either hemisphere, deficits are found quite consistently on motor-differentiation tasks (Konorski 1972) in which the subject must learn to produce different responses to different, randomly presented, environmental signals. More directly related to the concept of planning are those sequential tasks in which the subject is free to choose his own order of responding, but must not make the same response twice. Here the left frontal lobe plays the major role, a finding consistent with the notion of left-hemisphere dominance for the programming of voluntary actions. In contrast, the right frontal lobe appears to be more critically involved in monitoring the temporal sequence of externally ordered events, although the verbal or non-verbal nature of the stimuli remains a relevant factor.