Alteration of intention and self-initiated action associated with bilateral anterior cingulotomy

Neuropsychological manifestations of bilateral anterior cingulate cortex le sions were studied in patients treated with cingulotomy for chronic intract able pain. Cingulotomy patients more than 1 year postsurgery were contraste d with nonsurgical chronic pain patients. Patients were assessed an a neuro psychological battery, including measures of response intention, initiation , generation, and persistence. Cingulotomy patients were intact across most cognitive domains, but they showed deficits of focused and sustained atten tion as well as mild executive dysfunction. Self-initiated responding-inclu ding spontaneous verbal utterances and unstructured design fluency-was most impaired. Results indicate that the greatest impact of cingulotomy lesions is on response intention and self-initiated behavior, with reduced behavio ral spontaneity.