Medicine:Klüver–Bucy syndrome

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Short description: Syndrome resulting from lesions of the medial temporal lobe
Klüver-Bucy syndrome

Klüver–Bucy syndrome is a syndrome resulting from lesions of the medial temporal lobe, particularly Brodmann area 38,[1] causing compulsive eating, hypersexuality, a compulsive need to insert inappropriate objects in the mouth (hyperorality), visual agnosia, and docility. Klüver–Bucy syndrome is more commonly found in rhesus monkeys, where the condition was first documented, than in humans.[2] Pathology on the syndrome is still controversial with Norman Geschwind's theory and Muller theory offering different explanations for the condition.[2] Treatment for Klüver–Bucy syndrome is usually with mood stabilizers, anti-psychotics and anti-depressants.[3]

Symptoms

The list of symptoms generally include the following:

  • Docility, characterized by exhibiting diminished fear responses or reacting with unusually low aggression. This has also been termed "placidity" or "tameness".
  • Dietary changes and hyperphagia, characterized by eating inappropriate objects (pica), or overeating, or both.
  • Hyperorality, described by Ozawa et al. as "an oral tendency, or compulsion to examine objects by mouth".
  • Hypersexuality, characterized by a heightened libido or a tendency to seek sexual stimulation from unusual or inappropriate objects.
  • Visual agnosia, characterized by an inability to recognize familiar objects or people.

While this cluster of five syndromes is considered to be required by these three sources,[4][5][6] further symptoms are included or omitted in the diagnostic criteria depending on the authority. These include:

  • Hypermetamorphosis, characterized by Ozawa et al. as "an irresistible impulse to notice and react to everything within sight".[5] This is included under the classification systems described by The Neuropsychiatry of Limbic and Subcortical Disorders and "Single-Photon Emission CT and MR Findings in Klüver-Bucy".[4][5]
  • Lack of emotional response, diminished emotional affect. This is a symptom under The Neuropsychiatry of Limbic and Subcortical Disorders and is included under "Single-Photon Emission CT and MR Findings in Klüver-Bucy" along with apathy under docility.[5][6]
  • Amnesia, characterised by an inability to recall memories. This only occurs when the damage extends bilaterally into the hippocampus.

Pathology

There are a few theories that attempt to explain the processes behind Klüver–Bucy syndrome and its symptoms. This topic still remains controversial as complete Klüver–Bucy syndrome is rare in humans especially compared to monkeys.[2] Klüver–Bucy syndrome is thought to occur from damage to temporal sections of the limbic networks, which connects to other structures that regulate emotional behavior.[2] Norman Geschwind's theory states that Klüver–Bucy syndrome is caused by disconnect syndrome (a condition of the brain where the two hemispheres develop separately or at different rates) and that the initial contributor for this is the blockage of visual input to the limbic circuit.[2] Another theory, called Muller theory, attributes Klüver–Bucy syndrome to the disconnection of pathways used for emotional regulation and memory, such as those connecting the dorsomedial thalamus to the prefrontal cortex.[2] The medial temporal sections of the limbic system can be associated with more primitive functions such as reproduction, food, and defence.[2] This can be seen in the symptoms of increased hypersexuality, hyperorality, and general aggression.[2]

In rhesus monkeys

As part of an investigation by Heinrich Klüver in the 1930s into the area affected by mescaline, Klüver arranged to have the temporal lobes of a number of rhesus monkeys bilaterally removed by Paul Bucy, a neurosurgeon.[7] Klüver did not find the expected impact in response to mescaline, but did observe a series of changes in the subject animals. The six points of difference that Klüver recorded were visual agnosia, an increased tendency to explore items by mouth, hypermetamorphosis, dampening of emotional expression, altered sexual behavior and differences in diet.[7] Klüver later discovered similar observations by Sanger Brown and Edward Albert Sharpey-Schafer that had been published in 1881 and drew on these to substantiate his own observations.[7]

Monkeys in the Klüver-Bucy experiment evidently had normal vision and motor skills, but exhibited "psychic blindness", what Rusiko Bourtchouladze described in 2004 as an inability to recognize "the emotional importance of events".[8] They did not display fear for items that would ordinarily frighten members of their species; they displayed an appetite for improper foods such as rocks or live rats and sought intercourse with unusual partners, including members of other species.[8] They became extremely interested in exploring items in their environment and became placid when approached.[9]

In humans

Klüver–Bucy syndrome was first documented among certain humans who had experienced temporal lobectomy in 1955 by H. Terzian and G.D. Ore.[10] It was first noted in a human with meningoencephalitis in 1975 by Marlowe et al.[4][6] Klüver–Bucy syndrome can manifest after either of these (lobectomies can be medically required by such reasons as accidents or tumors), but may also appear in humans with acute herpes simplex encephalitis or following a stroke.[11] Other conditions may also contribute to a diagnosis of Klüver–Bucy syndrome, including Pick's disease, Alzheimer's disease, ischemia, anoxia, progressive subcortical gliosis, Rett syndrome, porphyria and carbon monoxide poisoning, among others.[4]

It is rare for humans to manifest all of the identified symptoms of the syndrome; three or more are required for diagnosis.[4] Among humans, the most common symptoms include placidity, hyperorality and dietary changes.[4] They may also present with an inability to recognize objects or inability to recognize faces or other memory disorders. Social neurosciences research shows that changes in temporal lobe is identified as a cause for aberrant sexual and hyper-sexual behaviors.[12]

In children

Klüver–Bucy syndrome has been shown to occur more in adults than in children.[13] In children certain conditions such as herpes simplex encephalitis has the potential to manifest the syndrome.[13] Children exhibit many of the same symptoms as adults with Klüver–Bucy syndrome, however they display these symptoms in different ways than adults.[13] Hypersexuality, as a symptom of Klüver–Bucy syndrome in children is characterized by "frequent touching of genitals, intermittent pelvic thrusting movements, and rubbing of genitals on the bed while lying prone".[13] Observations of hypersexuality in children were recorded from children primarily under the age of 4.[13] It is thought that since these behaviors have yet to be learned by children that they display themselves in more ambiguous ways.[13] The underlying conditions that lead to Klüver–Bucy syndrome can have an effect on the pattern of symptoms observed.[13]

Treatment/management

Treatment for Klüver–Bucy syndrome focuses on controlling the present symptoms because no current intervention will cure the condition.[14] Medications used to treat the symptoms include carbamazepines and leuprolide, which help reduce sexual behavior associated with Klüver–Bucy syndrome.[14] For carbamazepines it has been shown to have the greatest effect when treating traumatic brain injury-derived Klüver–Bucy syndrome.[14] Other medications commonly utilized are mood stabilizers, antidepressants, and various antipsychotic drugs.[14]

In popular culture

Klüver–Bucy syndrome was featured in the Radiolab episode, "Blame". The lead story featured a man who developed Klüver–Bucy syndrome after his second neurosurgery for epilepsy.[15] The story was revisited by Radiolab in June 2017 (following parodious homage in Mac's turn when "The Gang Gets Analyzed" in season 8, episode 5 of It's Always Sunny In Philadelphia), augmented with further discussion with neurologist Dr. Robert Sapolsky, who addresses the syndrome and the associated legal significance of neurological defenses.[16] Klüver–Bucy syndrome was featured in the Black Box episode, "The Fear", the episode "Taboo" of the TV series Criminal Minds, the episode "Whistleblowers" of the TV series Blue Bloods, and the episode "Comfort's Overrated" of the TV series Royal Pains.[citation needed]

See also

Main Sources

External links

Classification
External resources

References

  1. ↑ Olson, IR; Plotzker, A; Ezzyat, Y (2007). "The enigmatic temporal poles: A review of findings on social and emotional processing". Brain 130 (7): 1718–1731. doi:10.1093/brain/awm052. PMID 17392317. 
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 M Das, Joe; Siddiqui, Waquar (2021), "Klüver Bucy Syndrome", StatPearls (Treasure Island (FL): StatPearls Publishing), PMID 31334941, http://www.ncbi.nlm.nih.gov/books/NBK544221/, retrieved 2021-09-18 
  3. ↑ "Klüver Bucy syndrome". National Organization for Rare Diseases. https://rarediseases.org/gard-rare-disease/kluver-bucy-syndrome/. 
  4. ↑ 4.0 4.1 4.2 4.3 4.4 4.5 Salloway, Stephen; Paul Malloy; Jeffrey L. Cummings (1997). The Neuropsychiatry of Limbic and Subcortical Disorders. American Psychiatric Pub. p. 125. ISBN 978-0-88048-942-3. https://books.google.com/books?id=DigRJI-MyY4C&q=%22Kl%C3%BCver-Bucy+syndrome%22&pg=PA125. 
  5. ↑ 5.0 5.1 5.2 5.3 Ozawa, H.; Sasaki, M.; Sugai, K.; Hashimoto, T.; Matsuda, H.; Takashima, S.; Uno, A.; Okawa, T. (1997). "Single-photon emission CT and MR findings in Klüver-Bucy syndrome after Reye syndrome". AJNR. American Journal of Neuroradiology 18 (3): 540–542. ISSN 0195-6108. PMID 9090419. 
  6. ↑ 6.0 6.1 6.2 Afifi, Adel K.; Ronald Arly Bergman (2005). Functional Neuroanatomy: Text and Atlas. McGraw-Hill Professional. p. 299. ISBN 978-0-07-140812-7. https://books.google.com/books?id=_cWKT9-P9LAC&q=%22Kl%C3%BCver-Bucy+syndrome%22+Marlowe&pg=PA299. 
  7. ↑ 7.0 7.1 7.2 Rockland, Kathleen S., ed (1997). Cerebral cortex. 12: Extrastriate cortex in primates / ed. by Kathleen S. Rockland. New York: Plenum Press. pp. 45–46. ISBN 978-0-306-45530-8. 
  8. ↑ 8.0 8.1 Bourtchouladze, Rusiko (2004). Memories Are Made of This: How Memory Works in Humans and Animals. Columbia University Press. p. 82. ISBN 978-0-231-12021-0. https://books.google.com/books?id=L2jO1AYeevoC&q=%22Kl%C3%BCver-Bucy+syndrome%22+%22Heinrich&pg=PA82. 
  9. ↑ Glick, Robert A.; Steven P. Roose (1993). Rage, Power, and Aggression. Yale University Press. p. 214. ISBN 978-0-300-05271-8. https://archive.org/details/ragepoweraggress00yale. "Klüver-Bucy syndrome." 
  10. ↑ Terzian, H.; Ore, G.D. (1955). "Syndrome of Klüver and Bucy; reproduced in man by bilateral removal of the temporal lobes". Neurology 5 (6): 373–80. doi:10.1212/wnl.5.6.373. PMID 14383941. https://pubmed.ncbi.nlm.nih.gov/14383941/. 
  11. ↑ Tancredi, Laurence R. (2005). Hardwired Behavior: What Neuroscience Reveals about Morality. Cambridge University Press. pp. 98–99. ISBN 978-0-521-86001-7. https://archive.org/details/hardwiredbehavio00tanc_0. "Klüver-Bucy syndrome." 
  12. ↑ "Complete Klüver-Bucy syndrome in man". Cortex 11 (1): 53–9. 1975. doi:10.1016/s0010-9452(75)80020-7. PMID 168031. 
  13. ↑ 13.0 13.1 13.2 13.3 13.4 13.5 13.6 Lippe, S.; Gonin-Flambois, C.; Jambaqué, I. (2013-01-01) (in en). The neuropsychology of the Klüver–Bucy syndrome in children. Handbook of Clinical Neurology. 112. pp. 1285–1288. doi:10.1016/B978-0-444-52910-7.00051-9. ISBN 9780444529107. https://www.sciencedirect.com/science/article/abs/pii/B9780444529107000519. 
  14. ↑ 14.0 14.1 14.2 14.3 M Das, Joe; Siddiqui, Waquar (2021), "Kluver Bucy Syndrome", StatPearls (Treasure Island (FL): StatPearls Publishing), PMID 31334941, http://www.ncbi.nlm.nih.gov/books/NBK544221/, retrieved 2021-09-18 
  15. ↑ NPR, Radiolab, season 15, "Revisiting the Fault Line," 50:06 minutes. First aired June 27, 2017. Produced by Jad Abumrad. http://www.radiolab.org/story/revisiting-fault-line/
  16. ↑ NPR, Radiolab, season 16, episode, "Blame," segment "Fault Lines," 24:12 minutes. First aired September 12, 2013. Produced by Pat Walters. http://www.radiolab.org/story/317421-blame/



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