Connectome-guided initiation of dopamine agonists facilitates cognitive recovery after frontal lobe resection: A case report

Abulia is a common problem that manifests following various brain conditions, including brain surgeries. Abulia is felt to be related to dysfunction with the brain’s dopamine-dependent circuitry. The role of default mode network (DMN) in its pathogenesis is crucial. In this case report, we detail the presentation of abulia in an elderly woman following surgical resection of a right frontal glioblastoma involving the DMN. Connectomic imaging was used pre-operatively and post-operatively, demonstrating disruption of regions integral to the DMN and the central executive network. We observed a significant cognitive improvement following the administration of levodopa and carbidopa. Preoperative assessment of both anatomical and functional networks can help ensure surgical safety and predict postoperative deficits. This evaluation not only enhances preparedness and facilitates early case diagnosis but also expedites the initiation of prompt and potentially targeted treatments. This case highlights the potential efficacy of levodopa and carbidopa in addressing DMN dysfunction and broadly suggests the potential for connectomics-guided post-operative therapies. ●Abulia, is linked to dysfunction in dopamine-dependent brain circuitry, particularly involving the default mode network (DMN).●In this paper, an elderly woman developed abulia after resection of a right frontal lesion●Connectomic imaging revealed disruption in DMN and central executive networks.●Cognitive improvement was observed with levodopa and carbidopa treatment.●The case shows the importance of preoperative assessment of functional networks for surgical safety.