Is Your Brain Really Necessary? Roger Lewin Science, New Seties, Vol. 210, No, 4475 (Dec. 12, 1980), 1232-1234. Stable URL: butp//links jstor.org/sici2sici=0036-8075%28 198012124 203%3A210%3A4475%3C 1232% 3AIY BRNG3E2.0,CO%3B2-L, Science is currently published by American Association for the Advancement of Science, ‘Your use of the ISTOR archive indicates your acceptance of JSTOR’s Terms and Conditions of Use, available at hhup:/www.jstororg/about/terms.hml. JSTOR’s Terms and Conditions of Use provides, in part, that unless you have obtained prior permission, you may not download an entire issue of a journal or multiple copies of articles, and you may use content in the JSTOR archive only for your personal, non-commercial use. Please contact the publisher regarding any further use of this work. Publisher contact information may be obtained at hup:/www jstor.org/journalsaaas.huml Each copy of any part of a JSTOR transmission must contain the same copyright notice that appears on the sereen or printed page of such transmission, STOR is an independent not-for-profit organization dedicated to creating and preserving a digital archive of scholarly journals, For more information regarding JSTOR, please contact jstor-info@ umich edu, hupslwww jstor.org/ Tue Mar 9 10:01:45 2004‘Research News- Is Your Brain Really Necessary? “Professor John Lorber has a facility for making doctors sit up and think about hallowed concepts." writes Adrian Bow: cr, a neuroanatomist at Sheffield Univer- sity, England, where Lorber holds a research chair in pediatrics. “The hu- man brain is the curtent object of his challenging speculation,” continues Bower, refering to his colleague's re- cent propositions concerning hydroceph- alus, or water on the brain. For instance, Lorber was not jestng totally when he addressed a conference of pediatricians with paper entitled “Is your brain real- ly necessary?” Lorber believes that his observations on a series of hydro: cephalies who have severely reduced brain tissue throws into question many traditional notions about the brain, both in linical and scientific terms. “There's a young student at this uni versity," says Lorber, “who has an IQ of 126, has gained a first-class honors de- sree in mathematis, andis socially com- pletely normal. And yet the boy has vir- tually no brain.” The student's physician at the university noticed that the youth had a slighty larger than normal head, and so referred him to Lorber, simply fot of interest. “When we did’ a brain scan on him,” Lorber recalls, “we saw that instead ofthe normal 4S-centimeter thickness of brain tissue between the Yentscles and the cortical surface, there ‘vas usta thin layer of mantle measuring millimeter or so. His cranium is filled mainly with cerebrospinal uid.” This is dramatic by any standards, and Lorber clearly enjoys retailing the story. But, stating as it may seem, this case is nothing new t© the medical world “Scores of similar accounts litter the ‘medical literature, and they go back a Jong way," observes Patrick Wall, pro fessor of anatomy at University Collese, London, “but the important thing about Lorber is that he's done a long series of systematic. scanning, rather than just dealing with ancedotes. He has gathered ‘a remarkable set of data and he challeng 8, “How do we explain it” " How can someone with a grossly re- duced cerebral mantle not only move lamong his fellows with no apparent so- cial deficit, but also reach high academic achievement? How is it that in some hy- John Lorber, a British neurologist, claims that some patients are more normal than would be inferred from their brain scans Grocephalics whose brains are severely distorted asymmetrically, the expected one-sided paralysis is typically absent? ‘And how is one to interpret the apparent restoration to normality of a hydro- cephalic brain following a shunt opera tion? These are the challenges that Lor ber is proffering his neurology col- leagues. Lorber came to make his observations fon hydrocephalus through his volvement with assessment and treat ‘ment of spina bifida, a congenital condi tion in which the spinal column fails 10 fuse completely, leaving nerve tissue perilously exposed. The great majority ‘of patients with spina bifida also suffer from hydrocephalus, Although the origins of hydrocephalus are to some degree shrouded in mystery, itis clearly associated with a disturbance of the circulation of cerebrospinal fluid ‘through a system of channels and reser- voirs, or ventricles, in the brain, Back pressure apparently develops, and this may balloon the ventricles to many times their normal size, so pressing the over- lying brain tissue against the cranium. In young children, whose skulls are still ‘malleable, one obvious consequence can be a grossly enlarged head. Additionally, this physical assault from within leads to areal loss of brain matter. It is therefore not surprising that many hydrocephalics suffer intellectual and physical dis- abilities. What is surprising, however, is Cerebral ventricles Two horalike lateral ventricles drain into a Common third ventricle which i its turn leads 10.4 common fourth ventricle. Cerebrospinal ‘Mui flows from the lateral venircles,throueh the third and fourth venwieles. leading to a ‘ink along the midline at the top of the head and to a channel that rans dovn the spinal columa: [21232500500 Copyright © 1980 AAAS that a substantial proportion of patients appear to escape functional impairment in spite of grossly abnormal brain struc- ture. “The spina bifida unit at the Chil. dren's Hospital here in Sheffield is one of the largest in the world,” explains Lor- ber, “and this gives us an opportunity to make many observations. Since the in- troduction of the safe, noninvasive brain scanning technique just a few years ago ‘we have done more than 600 scans on pa tients with hydrocephalus.” Lorber di- vides the subjects into four categories: those with minimally enlarged vent cles; those whose ventricles fill $0 t0 70 percent of the cranium; those in which the ventricles fill between 70 and 90 per- ccent of the intracranial space; and the most severe group, in which ventricle ex- pansion fills 95 percent of the cranium. Many of the individuals in this last group, which forms just less than 10 per cent of the total sample, are severely dis- abled, but half of them have 1Q's greater than 100, This group provides some of the most dramatic examples of apparent- ly normal function against all odds. ‘Commenting on Lorber's work, Ken neth Till, a former neurosurgeon at the Great Ormond Street Hospital for Sick Children, London, has this to say: “In terpreting brain scans can be very tricky ‘There can be a great deal more brain tis sue in the cranium than is immediately apparent.” Till echoes the cautions of ‘many practitioners when he says, “Lor ber may be being rather overdramatic ‘when he says that someone has ‘virtually no brain.’ " Lorber acknowledges the problem of interpretation of brain scans, and he counters Till’s remarks by insist. ing, “OF course these results are dramat- jc, but they're not overdramatic. One ‘would not make the claim if one did not have the evidence.” ‘A major obstacle in this work is the difficulty of obtaining the kind of quan: titative data that would be expected in a scientific investigation of, say, rat brains. “I can’t say whether the mathe- ‘matics student has a brain weighing 50 grams or 150 grams, but it’s clear that it is nowhere near the normal 1.5 kilo: grams," asserts Lorber, “and much of the brain he does have is in the more SCIENCE, VOL. 210, 12 DECEMBER 1980primitive deep structures that are rela tively spared in hydrocephalus.” Lorber concludes from these observa- tions that “there must be a tremendous amount of redundancy or spare capacity in the brain, just as there is with kidney and liver.” He also contends that “the cortex probably is responsible fora great deal less than most people imagine.” ‘These are two areas of considerable dis- pute in neurobiology. Wall lends support for this second point. “One reason why results such as Lorber's have been ne- lected for so long is because of the im- plied attack on the predominance of the cerebral cortex,” suggests Wall. “For hhundreds of years neurologists have as ‘sumed that all that is dear to them is per- formed by the cortex, but it may well be that the deep structures in the brain ear- ry out many of the functions assumed 10 be the sole province of the cortex.” H likens the cortex to a “reference library that may be consulted from time to time, Norman Geschwind, a neurologist at the Beth Israel Hospital, Boston, strikes a different note. “Deep structures in the brain are undoubtedly important for ‘many functions,” he agrees, “but I don’t believe the explanation that the cortex does far less than we think is very sound." And neither does David Bow- sher, professor of neurophysiology at Liverpool University, England: “I don't think we attribute more to the cortex than it deserves." Bower, however, takes the middle ground, with the sug- gestion that “the deep structures are al- ‘most certainly more important than is currently thought.” ‘On the question of the brain’s spare capacity there is equal contention. “To talk of redundancy in the brain is an in- tellectual cop-out to try to get round something you don’t understand,” states ‘Wall. Geschwind agrees: “Certainly the brain has a remarkable capacity for reas- signing functions following trauma, but you can usually pick up some kind of deficit withthe right tests, even after ap- parently full recovery.” However, Colin, Blakemore, professor of physiology at Oxford University, England, sees spare capacity as an important quality of the fhuman brain. “The brain frequently has to cope with minor lesions and it’s cru cial that it can overcome these readily,” he says; “there may be some reorganiza tion of brain tissue, but mostly there's a reallocation of function,” Itis perhaps significant that many of the instances in which gross enlargement of cerebral ventricles is compatible with ‘normal life are cases where the condition develops slowly. Gross surgical lesions in rat brains are known to inflict severe 12 DECEMBER 1980 Scans of normal and hydrocephalic brains __ 1 horizontal scan across the brain shows the ventricles ax narrow sits in @ normal individual ‘and large cavities ina hydrocephalle patient. functional disruption, but if the same ‘damage is done bit by bit over a long pe riod of time, the dysfunction can be mini mal. Just as the rat brains appear to cope with a stepwise reduction of available hardware, s0 too do the human brains in some cases of hydrocephalus. Another subgroup of some curiosity in Lorber’s subjects are those people in whom expansion of the ventricles is re stricted to just one side of the brain. "I've now seen more than 50 cases of asym- metric hydrocephalus,” says. Lorber, “and the interesting thing is that only a minority of these individuals show the expected and long-cherished neurologi- cal finding of paralysis with spasticity on the opposite side of the body.”" To make matters even more puzzling, one individ- ual in the group has enormously enlarged ventricles on the same side as his spastic paralysis, “This is exactly the opposite to all that we learnt in medical school,” reports Lorber with obvious glee. These ‘observations are cogent support for Bower's comment that “the concept of contralateral control is the least secure ‘of all our concepts about brain organiza- tion and function.” Lorber's extensive series of brain scans stands in marked contrast with the dearth of information on the fine stru. ture of hydrocephalic human brains. “It is erucial to know about the histological state of the brains of these functionally normal hydrocephalic patients,”* re marks Lorber, “but how am Ito have ac cess to such material, given the ethical barriers. to scientific’ research on pa- tients?” Inadequate though itis, the next, best thing is experimental work on ani- mals. ‘A group of researchers based at the New York University Medical Center has assembled a picture of the histologi- sal changes associated with hydrocepha- lus through experimental induction of the condition in cats. The group also ob- served the changes in tissue structure following the implantation of a shunt, the experimental equivalent to the normal treatment of hydrocephalus in humans. Speaking for the group, Fred Epstein says the following: “Hydrocephalus is principally a disease of the white matter. AAs the ventricles enlarge the layers of f- bers above them begin to be stretched and very quickly they are disrupted, with the axons and the myelin sheaths sur- rounding them breaking down. Even in severe and extended hydrocephalus, however, the nerve cels in the gray mat- ter were remarkably spared, though eventually there began to be a loss here too.” The sparing of the gray matter even in severe hydrocephalus could zo some way to explaining the remarkable retention of many normal functions in se- verely alfected individuals. Crucial to the approach to treatment of, hydrocephalus is the brain's ability tore cuperate following the release of fluid pressure when a shunt is implanted. One of the canons of neurobiology is that, once damaged, cells in the central ner- vous system are unable to repair them selves. Does Lorber’s work dent this hallowed concept too? “When you im- plant a shunt in a young hydrocephalic child you often see complete restoration of overall brain structure, even in cases where initially there is no detectable mantle,” claims Lorber. “There must be true regeneration of brain substance in some sense, but I'm not necessarily saying that nerve cells regenerate,” he says cautiously; "I don’t think anyone knows fully about that.” What, then, is happening when a hy- drocephalic brain rebounds from being a thin layer lining a uid-filled cranium to become an apparently normal structure when released from hydrostatic pres- sure? According to Epstein and on thebasis of his colleagues’ observations on experimental cats, the term rebound apt- ly describes the reconstitution process, ‘with stretched fibers shortening, thus di- minishing the previously expanded ven- tricular space. Within a short time sear tissue forms, constructed from the glial cells that pack between the nerve cells. “The reconstitution of the mantle,” re- port Epstein and his colleagues, “does not result in the reformation of lost ele- ‘ments, but rather in the formation of a lial sear and possibly a return to func tion of the remaining elements.” Lorber claims that his observations on the dramatic recovery of severely af- fected young children imply that “clini- cians shouldn't give up in the face of an apparently hopeless case; a shunt opera tion at an early stage has a good chance of producing @ normal individual.” In mild cases, or ones that develop slowly and late, Lorber takes a different ap: proach. Citing the example of the mathe ‘matics student and others like him, he proposes that perhaps the surgical knife should be stayed, “because a shunt op- eration makes an individual forever de- pendent on surgical care, and in any case ‘many of these subjects can lead perfectly normal lives.” The difference is between the acute and chronic conditions. ‘These statements are certain not to go unchallenged, partly because there is a ‘multiplicity of opinions about appropri- ate treatment of hydrocephalus and part- ly because it is Lorber who is making them. Lorber is no stranger to controver- sy. Just a few years ago he caused a storm in the medical world by suggesting that it is not always medically right to ad- ‘minister extensive treatment to some in- fants with spina bifida. His experience hhad taught him that the consequences in some severe cases were simply not toler able, either to the patient orto the imme- diate family. This position continues to be hotly debated, but Lorber’s ideas are beginning to receive favorable consid- eration, particularly in the United King- dom (see 12 September 1980, p. 1216) ‘What of the Lorber approach to hy- Arocephalus? “His attitude is based on ‘many years of clinical experience,” says Gerald Hochwald of New York Univer- sity Medical Center, “and it contains a certain amount of value.” Thomas Mil. hhorat, a neurosurgeon at the Children’s Hospital in Washington, D.C., voices strong support for Lorber, in spite of ‘many differences of opinion. “I'm glad there’s a John Lorber,” says Milhorat; “he could be more moderate in the way he expresses things, but a moderate view would not emerge if someone were not speaking out strongly. As to the question “Is your brain real- ly necessary?"” Lorber admits that it is only half serious. "You have to be dra ‘matic in order to make people listen, concedes the tactician, Bower's answer to the tongue-in-cheek question is this: “Although Lorber’s work doesn’t dem- onstrate that we don’t need a brain, it does show that the brain can work in conditions we would have thought im- possible."" Bower occasionally com Plains that Lorber’s style is less scien- tiie than it might be. He concedes, how- ‘ever, that “there are still many questions to be answered about the human br: and it has to be admitted that Lorber's provocative approach does make you think about them." —RooeR Lewin Math and Sex: Are Girls Born with Less Ability? A Johns Hopkins group says “probably.” Others are not so sure Throughout history there have been very few women mathematicians, and this trend continues today. For example, when Edith Luchins, a mathematician at Rensselaer Polytechnic Institute, and Abraham Luchins, a psychologist at the State University of New York at Allan asked mathematicians to list five famous contemporary women mathematicians, ‘many could not. When Ravenna Helson, 1 psychologist at the University of Cal fornia at Berkeley, set out in the 1960's to study creative women mathemat: cians, she reported that there were so few that she did not have to sample them—she could study all of them. ‘Since creativity in mathematics seems to be a talent, like musical or artistic abil- ity, the question has been, why are there so few outstanding women mathemat cians? Some researchers have said the answer lies in nurture rather than nature. ‘Mathematics is viewed as a “masculin field of study, and girls are discouraged from developing their mathematical abi ities. But Camilla Benbow and Julian Stanley of Johns Hopkins University question this theory. They have evi dence that extraordinary mathematical talent may be less prevalent in girls than in boys. The differences between the abilities of girls and boy’ are so striking, they say, that itis hard to imagine that they are entirely due to socialization. By sticking their necks out in this way, Ben- bow and Stanley seem to be asking for an attack. But, says Stanley, “We want our data out in the public domain so they can't be ignored.” ‘The data are from Stanley's mathe- ‘matics talent searches, the Study of ‘Mathematically Precocious Youth. From 1972 to 1979, Stanley and his associates conducted six talent searches, looking for Tth and 8th graders who scored in at least the upper 2 to $ percent in standard ized_mathematics achievement tests, such as the Iowa Tests of Basic Skills ‘They found 10,000 children, 43 percent fof whom were girls, and invited them to take the mathematics and verbal por- tions of the Scholastic Aptitude Tests (SAT). Those who did extremely well on the math portion were encouraged to take accelerated mathematics courses at Johns Hopkins. (Benbow and Stanley dis- ‘axe s079601212-1254500.500 Copyright © 1980 AAAS. css ther data on page 1262 of this issue.) Stanley contends that the math SAT serves as an aptitude test when given to 7h and Sth graders because they have not been formally taught the principles that underlie the math problems. If they can do the problems, they must have un- usual abilities. In 1980, the Johns Hopkins group ex- panded its talent search and changed its eligibility criteria. Any 7th grader who scored in the 97th percentile or above in any standardized achievement test— whether the high score was in @ math section ora verbal section or was a com- bined score—was invited to take the ver- ‘bal and math SAT's. The researchers found 10,000 such students, making the total tested thus far 20,000 Every year, the Johns Hopkins group has found that the girls and boys do equally well on the verbal SAT's but the boys do significantly better on the math SAT's. For example, more than twice as many boys as girls had math scores greater than S00. The greatest dif ferences were between the top-scoring girls and boys. And in every talent SCIENCE, VOL. 210, 12 DECEMBER 1980