[Diagnosis, treatment and progress after frontal lobe injury]

The comprehensive assessment of a frontal lobe injury is one of the most complex problems in diagnosis and treatment due to the variability of nature, extent and effect of various disorders of higher cerebral functions, i. e. impairment of the ability to act systematically, attention, motivation and emotionality. This brings about considerable differences in assessing and judging the effects of frontal lobe syndromes. Impairments of initiation, planning and carrying out of actions, of impulse control, attention, memory and self-perception often manifest in disorganised and dissocial behaviour which brings about serious effects in many fields of social adaptability. Deeper neurological insights in nature and effects of these deficiencies and improved diagnostical methods and concepts of intensive-care treatment as well as the improved understanding in the necessity of a longterm rehabilitation program have led to the development of specific strategies concerning the dealing with the patient, the counseling of the social environment, especially of the relatives, and the treatment of the patient's symptoms. In the course of acute and rehabilitative treatment the patient normally has to develop strategies of habituation and adaptation to his social environment, furthermore techniques of compensation as well as an improvement of personal resources including attention, memory and planning of actions. The ability of self-control ought to be improved by training of behavioural strategies leading to an increased independence. The success of treatment varies distinctly from individual to individual. As a rule, basic capabilities in the scope of higher brain functions as well as executive and behavioural abilities can be improved. However, a restitutio ad integrum of all dysfunctions is very rare.