A "Conceptual Nervous System" for multiple sclerosis.

Abstract

Neuropsychological diagnosis requires a structure-function correlation model or a "Conceptual Nervous System." The unpredictably variable, widespread, and multifocal nature of pathological changes in multiple sclerosis (MS) challenges the neuropsychological localizationist assumption. To be adapted to MS pathological and clinical heterogeneity, a Conceptual Nervous System should explain impairments associated with multifocal, subcortical, and white matter lesions that cause information processing slowing and working memory/executive function impairment. Our main goal in this theoretical study was to develop a Conceptual Nervous System for MS by integrating current neuropsychological conceptions of structural-functional correlations in MS with a model of conscious mental activity developed by Ernst Pöppel , based on periodic reentrant activity between cortical and subcortical structures. Neuropsychological profiles in MS can be explained by both threshold and multiple disconnection mechanisms. The Conceptual Nervous System encompasses a functional and structural model of the human brain-mind. The functional model classifies mental function into material and formal. Material/semantic functions are modularly organized, and their impairment causes classical focal neuropsychological symptoms. Multiple sclerosis preferentially impairs formal/syntactic function related to widespread patterns of activation and temporal organization. The structural model specifies the system anatomically functions. The neuropsychological adequacy of the proposed Conceptual Nervous System to MS is analyzed by comparing its predictions to results of extant metaanalytic studies.

Current perspectives on the anatomo-clinical method in neuropsychology.

“…Anatomo-clinical analysis should not be based on cerebral localizational methods, seeking one-to-one correlations between the site of damage and cognitive functioning. In reality, not even at the beginning of neuropsychology as a science was this type of localization defended, such as in Wernicke's writings, who already had a connectionist and distributed conception of cerebral localization (Gage & Hickok, 2005), very similar to what is currently defended (Haase et al, 2008(Haase et al, , 2010(Haase et al, , 2012.…”