Paradoxical functional facilitation in brain-behavior research: a critical review

Kapur’s (1996) review of paradoxical functional facilitation prominent before treatment, ceased when treatment was begun (Adamset al., 1984). The investigators considered (PFF) highlighted counter-intuitive examples of restoration or enhancement of brain functioning after lesions of the the ‘improvement’ to be due to apathy. Improvement in recognition of previously learned material was observed after brain. As he noted, examples of such a phenomenon ar scattered through the literature, are hard to locate, and have infection with common cold viruses, in the context of impaired performance of other memory tasks; this was not previously been collated. He indicated that he would not discuss personality change or movement disorders, but tentatively explained as a nonspecific improvement of recall due to reduced alertness (Tyrell t al., 1990). he neglected a number of other observations concerning PFF. Some of these are historically important, clinically Reports that the development of a schizophrenic disorder in epileptics had a curative effect on the epilepsy led to interesting and theoretically provocative. Extending the discussion beyond his generally neuropsychological focus may Laszlo von Meduna’s effort to treat schizophrenics by means of convulsions (Meduna, 1956; Fink, 1984). ‘The epileptic be productive. Julius Wagner von Jauregg’s introduction of malarial process, I assumed, might have, probably through its stimulating effect upon the torpid glia system in schizophrenia, a therapy was considered worthy of a Nobel Prize in 1927 (Whitrow, 1990). The root of his idea of inducing fever in beneficial effect upon the process of schizophrenia itself’, wrote von Meduna (1956, p. 78). Observations of amelioration patients with general paresis of the insane was the ‘centuriesold observation that mental patients following an incidental of schizophrenic symptoms by epileptic attacks and of recovery from catatonia after spontaneous seizures confirmed febrile disease occasionally show great improvement’ (Wagner-Jauregg, 1946, p. 577). He wrote that fever therapy von Meduna’s thinking and led directly to camphor-induced therapeutic convulsions (Fink, 1984). The observed antagon‘attempted to imitate the method by which nature itself produces cures’ (Whitrow, 1990, p. 301). Slater and Roth ism between seizures and psychosis would today be called forced, or paradoxical, normalization (Trimble, 1991). (1969) in a standard text stated that among schizophrenics during acute febrile illness ‘all the more prominent symptoms, Improvement of psychosis, depression and catatonia after spontaneous seizures does occur (Diethelm, 1939; Blanchet such as stupor, mannerisms, hallucinations, delusional idea , may disappear and the patient who was hitherto regarded as and Frommer, 1986), and we need to do better in its explanation than the mythical pathology of schizophrenia severely deteriorated and withdrawn may become accessibl , show adequate emotions naturally expressed and take an upon which von Meduna based his treatment. Kapur mentioned amelioration of cognition by callosotomy, interest in his surroundings’ (pp. 259–60). Spontaneously occurring delirium may also alleviate depressive illness but at least one additional example of PFF in epilepsy deserves attention. In four patients with unilateral limbic (Borchardt and Popkin, 1987). Dretler (1935) reported several cases in which epidemic encephalitis lethargica led to epilepsy studied with depth electrodes during tachistoscopically presented cognitive tasks, Regard et al. (1994) improvement in a schizophrenic illness. If intercurrent infection ameliorates noninfective mental illness, mechanisms showed that during seizures the contralateral hemisphere performed better at tasks ordinarily subserved by the ipsilatother than a treponemicidal effect of fever must be at work. One possibility is the effect of circulating mediators of eral hemisphere. Thus, for example, a language task was better perfomed by the right hemisphere during a leftinflammation on mental function (Xu et al., 1994). The cerebral action of cytokines may be the mechanism hemisphere ictus than when the left hemisphere was functioning normally. If this means that each hemisphere ordinarof delirium in some cases of systemic infection as well as when they are therapeutically administered (Ovsiew, 1995). ily inhibits the capacities of the opposite hemisphere, the finding strengthens Kapur’s emphasis on release from inhibiIn one study of the neuropsychiatric effects of interferonα, asthenia and cognitive impairment commonly developed, but tion as a mechanism of PFF. Relief of pain by spontaneously occurring brain lesions depressive features (including anxiety and suicidal ideation),