Lesion Studies: Recent Trends

A couple weeks ago I blogged hard about a problem presented by lesion studies of the anterior cingulate cortex (ACC), a broad swath of cortex shown to be involved in aspects of cognitive control such as conflict monitoring (Botvinick et al, 2001) and predicting error likelihood (Brown & Braver, 2005). Put simply: The annihilation of this region, either through strokes, infarctions, bullet wounds, or other cerebral insults, does not result in a deficit of cognitive control, as measured through reaction time (RT) in response to a variety of tasks, such as Stroop tasks - a task that requires overriding prepotent responses to a word presented on a screen, as opposed to the color of the ink that the word is written in - and paradigms which involve task-switching.

In particular, a lesion study by Fellows & Farah (2005) did not find a significant RT interaction of group (either controls or lesion patients) by condition (either low or high conflict in a Stroop task; i.e., either the word and ink color matched or did not match), suggesting that the performance of the lesion patients was essentially the same as the performance of controls. This in turn prompted the question of whether the ACC was really necessary for cognitive control, since those without it seemed to do just fine, and were about a pound lighter to boot. (Rimshot)

However, a recent study by Sheth et al (2012) in Nature examined six lesion patients undergoing cingulotomy, a surgical procedure which removes a localized portion of the dorsal anterior cingulate (dACC) in order to alleviate severe obsessive-compulsive symptoms, such as the desire to compulsively check the amount of hits your blog gets every hour. Before the cingulotomy, the patients performed a multisource interference task designed to elicit cognitive control mechanisms associated with dACC activation. The resulting cingulotomy overlapped with the peak dACC activation observed in response to high-conflict as contrasted with low-conflict trials (Figure 1).

Figure 1 reproduced from Sheth et al (2012). d) dACC activation in response to conflict. e) arrow pointing to lesion site

Furthermore, the pattern of RTs before surgery followed a typical response pattern replicated over several studies using this task: RTs were faster for trials immediately following trials of a similar type - such as congruent trials following congruent trials, or incongruent trials following incongruent trials - and RTs were slower for trials which immediately followed trials of a different type, a pattern known as the Gratton effect.

The authors found that global error rates and RTs were similar before and after the surgery, dovetailing with the results reported by Fellows & Farah (2005); however, the modulation of RT based on previous trial congruency or incongruency was abolished. These results suggest that the ACC functions as a continuous updating mechanism modulating responses based on the weighted past and on trial-by-trial cognitive demands, which fits into the framework posited by Dosenbach (2007, 2008) that outlines the ACC as part of a rapid-updating cingulo-opercular network necessary for quick and flexible changes in performance based on task demands and performance history.

a) Pre-surgical RTs in response to trials of increasing conflict. b, c) Post-surgical RTs showing no difference between low-conflict trials preceded by either similar or different trial types (b), and no RT difference between high-conflict trials preceded by either similar or different trial types (c).


Above all, this experiment illustrates how lesion studies ought to be conducted. First, the authors identified a small population of subjects about to undergo a localized surgical procedure to lesion a specific area of the brain known to be involved in cognitive control; the same subjects were tested before the surgery using fMRI and during surgery using single-cell recordings; and interactions were tested which had been overlooked by previous lesion studies. It is an elegant and simple design; although I imagine that testing subjects while they had their skulls split open and electrodes jammed into their brains was disgusting. The things that these sickos will do for high-profile papers.

(This study may be profitably read in conjunction with a recent meta-analysis of lesion subjects (Gläscher et al, 2012; PNAS) dissociating cortical structures involved in cognitive control as opposed to decision-making and evaluation tasks. I recommend giving both of these studies a read.)

A 21st Century Phineas Gage

Is it wrong that I feel a little rill of excitement traveling down my spine when something like this happens? That I have some morbid curiosity to find out exactly how this young man's terrible misfortune will translate into interesting scientific findings? We have prohibited ourselves from conducting so-called impossible experiments, such as willingly depriving children of any social contact to see the effects on their development, or subjecting someone to a marathon of Jersey Shore reruns, because these would be monstrous and unethical things to do; however, whenever someone has a stroke or injury which destroys part of their brain, we can't help but feel an odd mixture of sympathy for their plight, and the giddy sensation that we have hit a case study jackpot.

The story: A Brazilian construction worker named Eduardo was minding his own business, constructing stuff and whistling at those ripe Brazilian hunnies walking past his construction site, when he was struck by a falling metal rod which impaled the top of his head and partially exited between his eyes.

CT scan showing the metal rod in Eduardo's skull.
Eduardo, being a total boss, remained calm and was able to explain the situation to the doctors. Seeing their shocked expressions, he was even able to joke, "What, do I have something on my face?"

After a five-hour-long surgery, the rod was extracted, and Eduardo did not appear to show any signs of distress, pain, or malfunctioning. The head neurosurgeon also had this to say:

[The head neurosurgeon] said the bar entered a "non-eloquent" area of the brain that doesn't have a specific, major known function. [Eduardo] Leite is expected to remain in hospital for at least two weeks.

I'm not sure what "non-eloquent" means, exactly, but the fact is, that piece of metal took out a large chunk of real estate, and there actually are some specific, major known functions for that part of the brain that just got obliterated. The reason this case is so intriguing is because it closely mirrors an accident which occurred over a century and a half ago: The famous case of Phineas Gage.

Like Eduardo, Phineas was minding his own business, constructing railroads and shouting at those white breezeys, when a small explosion sent a tamping iron through the bottom of his skull and out the top of his head.

Reconstruction of the tamping iron's path through Gage's skull. Given the time period, scientists hypothesize that Phineas' first words were, "Egad!"
The injury blew out most of Gage's left inferior frontal lobe, and observers noted several dramatic changes in his behavior following the incident: He had become more irritable, more impulsive, and appeared unable to manage his day-to-day life as he had done before, supposedly due to an impaired ability to properly evaluate the consequences of his actions. Given this, neuroscientist Antonio Damasio hypothesized that the frontal lobes were necessary for interpreting and regulating emotional states, and for responding to more abstract aspects of decision-making (e.g., the amount of money one would be willing to pay for a given option; Croxson et al, 2009).

In any case, an MRI will be needed to determine the location and extent of the damage, and I am sure that Eduardo will be undergoing a battery of tests to examine any changes in his cognitive or emotional capacities; it will be interesting to see if this adds anything new to what the current lesion studies and non-invasive procedures have revealed about this region (or, more likely, regions). I also propose that, since he has taken one for the team, so to speak, Eduardo should be well-compensated by the scientific community; fifteen dollars an hour for his study participation, perhaps; a swimming pool filled with Nutella; and a harem of the world's finest chicas. It is only right that we give something back to those who have suffered the vicissitudes of fate and have given us something in the bargain.

Link: Iron Bar Removed from Builder's Head