The rises and falls of disconnection syndromes
Abstract
In a brain composed of localized but connected specialized areas, disconnection leads to dysfunction. This simple formulation underlay a range of 19th century neurological disorders, referred to collectively as disconnection syndromes. Although disconnectionism fell out of favour with the move against localized brain theories in the early 20th century, in 1965, an American neurologist brought disconnection to the fore once more in a paper entitled, 'Disconnexion syndromes in animals and man'. In what was to become the manifesto of behavioural neurology, Norman Geschwind outlined a pure disconnectionist framework which revolutionized both clinical neurology and the neurosciences in general. For him, disconnection syndromes were higher function deficits that resulted from white matter lesions or lesions of the association cortices, the latter acting as relay stations between primary motor, sensory and limbic areas. From a clinical perspective, the work reawakened interest in single case studies by providing a useful framework for correlating lesion locations with clinical deficits. In the neurosciences, it helped develop contemporary distributed network and connectionist theories of brain function. Geschwind's general disconnectionist paradigm ruled clinical neurology for 20 years but in the late 1980s, with the re-emergence of specialized functional roles for association cortex, the orbit of its remit began to diminish and it became incorporated into more general models of higher dysfunction. By the 1990s, textbooks of neurology were devoting only a few pages to classical disconnection theory. Today, new techniques to study connections in the living human brain allow us, for the first time, to test the classical formulation directly and broaden it beyond disconnections to include disorders of hyperconnectivity. In this review, on the 40th anniversary of Geschwind's publication, we describe the changing fortunes of disconnection theory and adapt the general framework that evolved from it to encompass the entire spectrum of higher function disorders in neurology and psychiatry.
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Aberrant connectivity of a structural or functional network is proposed to lead to the development of clinical symptoms.
“Aberrant connectivity of a structural or functional network (for example in terms of impaired network integration or segregation) is proposed to lead to the development of clinical symptoms.”
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- Authors
- Catani, M., & ffytche, D. H.
- Affiliations
- King's College London (GB)
- Corresponding author
- Catani, Marco
- Venue
- Brain
- Publisher
- Oxford University Press (OUP)
- Published
- 2005-09-01
- Volume
- 128
- Issue
- 10
- Pages
- 2224-2239
- ISSN
- 0006-8950 (ISSN-L)
- 1460-2156
- OpenAlex
- W2060449369
- Cited by
- 863
- References
- 4
- Citations by year
- 2026: 26 · 2025: 33 · 2024: 28 · 2023: 39 · 2022: 44 · 2021: 58 · 2020: 45 · 2019: 29 · 2018: 54 · 2017: 59 · 2016: 38 · 2015: 48 · 2014: 44 · 2013: 62 · 2012: 40
- FWCI
- 2.10
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Brain (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion)
- Funders
- Wellcome Trust
- Topics
- Life Sciences › Neuroscience › Neurology › Neurology and Historical Studies
- Life Sciences › Neuroscience › Cognitive Neuroscience › Functional Brain Connectivity Studies
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Advanced Neuroimaging Techniques and Applications
- Keywords
- disconnection syndrome, Norman Geschwind, white matter lesions, association cortex, hyperconnectivity, distributed brain networks, connectionism, history of neurology, lesion localization, behavioral neurology
- MeSH terms
- Agnosia, Apraxias, Brain Diseases, Brain Mapping, Cerebral Cortex, Humans, Limbic System, Nerve Fibers, Phylogeny, Syndrome, Temporal Lobe, Visual Cortex, Aphasia, Conduction, Alexia, Pure
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