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On Being a Patient |

Brain Anatomy: Thoughts From the InsideBrain Anatomy

William T. Pordy, MD
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From New York, New York.

Requests for Single Reprints: William T. Pordy, MD, 484 West 43rd Street, Apartment 5Q, New York, NY 10036; e-mail, wtpfacp@yahoo.com.


Ann Intern Med. 2016;165(1):66. doi:10.7326/M15-2351
© 2016 American College of Physicians
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After an extensive neurologic work-up when I began having symptoms of verbal disability, I was diagnosed with variant asymmetrical frontotemporal degeneration. I was told that the disease has an unknown natural history, treatment, and prognosis. Prompted by my own curiosity and by new funding for the NIH to study brain anatomy, I began paying attention to how my symptoms of neurologic atrophy affect me. I've come up with my own theory about a specific brain anatomy.

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Posted on July 28, 2016
Lawrence N. Cosner Jr, MD
Ridgecrest Regional Hospital Rural Health Clinics
Conflict of Interest: None Declared
I read with interest the “On Being A Patient” essay (1) discussing a patient’s view of word-choice difficulties in disorders like Frontotemporal Degeneration [FTD]. I could not help but think of a common pastime for those of us with a computing background, often called a ‘Travesty Generator’. This is an algorithm, generally implemented as a computer program, which generates text based on a table of “next word” (or “next letter”) frequency as related to the previous words (or letters); though I’ve not see this implemented at the syllable level, it is easy to envision that possibility. There are, of course, many variations on this theme, and their output in numerous circumstances can be fascinating, humorous and even potentially insightful.
It struck me that there is, to Dr. Pordy’s hypothesis, at least one alternate explanation; or perhaps more accurately, a potential refinement. There may indeed be, implemented via inter-neuronal connections, some similar device to the above-noted text (speech) generator. Likely this is not the entire mechanism for generating final speech output, but perhaps one subsystem feeding that function.
If this be the case, then both the errors noted and the fact that such errors are immediately recognized – probably by some different sub-system – could be explained by a disruption of the connection between a frequency-coefficient-generated word-choice mechanism and some sort of ‘supervisor’ mechanism, approving that choice. Indeed, it seems probable that this sort of disruption, between major subsystems, might be more likely, else the word-choice errors would be spotty (ie – some neuronal connections for specific words might remain intact longer than others).
All this, of course, remains somewhat beyond definitive testing; that is, our understanding of many aspects of neurophysiology is still too incomplete to use rigorous scientific method to differentiate various pathology explanations (in this disorder and many others). But it is still worth while, it seems, to generate hypotheses. Perhaps our children, or their children, will understand enough to shed more light on exactly what goes on at this level of brain function.

(1) Pordy, W. Brain Anatomy: Thoughts From the Inside. Ann Intern Med. 2016;165:66.
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