Changes in painting patterns in an illiterate individual with artistic behavior: Comparisons of brain network blood flow by SPECT studies

Background and importance: It is proposed that the prefrontal cortex instigates the process of creativity. Convincing clinical examples of increased creativity with decreased frontal lobe functioning are provided by patients with fronto-temporal dementia. Clinical presentation: In this case report, a 74 year-old illiterate man with semantic dementia developed compulsion for painting and singing was described. His initial artwork was abstract and he produced slightly sexual but well-crafted paintings of cows. Treatment with quetiapine 25 mg and valproate 600mg per day, the patient gradually showed improvement in disinhibitions, distractibility and insomnia while the paintings style also changed, being more realistic but emotionally silent. Two single photon emission computer tomography (SPECT) studies were arranged before and after the antipsychotic medication. The major brain perfusion changes demonstrated with SPECT following treatment were in the mid-frontal and anterior temporal regions where previously decreased uptake had increased. Conclusion: The painting pattern in relation with SPECT findings suggested the modulation of the prefrontal and temporal-parietal network in the emergence of artistic behavior. Transient hypofrontality, especially in the medial frontal region, may participate in the production of novelty. Well-functioning of the frontal lobe is fundamental for producing paintings in accordance with internal representation of images.