Limbic Encephalitis and Autoimmune Encephalitides: Pathophysiology, Classification, Clinical Presentation, and Treatment

Limbic encephalitis represents a cluster of autoimmune disorders, with inflammation in the medial temporal lobe characterised by the subacute onset of neuropsychiatric symptoms such as anxiety, affective symptoms, psychosis, short-term memory impairment, as well as faciobrachial and grand mal seizures. The limbic system is a complex anatomical structure which this paper seeks to explain in terms of its anatomy and physiology, before exploring what happens when it is impaired as is the case of autoimmune and limbic encephalitis. We will discuss the pathophysiology, clinical symptomatology and diagnosis of autoimmune encephalitis, a cluster of symptoms which can be easily overlooked or misdiagnosed within psychiatric settings. Characteristic indicators of autoimmune encephalitis include neurologic symptoms such as facial twitching, seizures, confusion, and cognitive decline;however, our experience realises that autoimmune encephalitis is not easy to identify as most patients initially present with psychiatric symptomatology rather than these neurological symptoms. Furthermore, immunological and laboratory testing take a long time to diagnose the condition. Importantly, few psychiatrists consider the autoimmune nature of the neuropsychiatric presentation. It is hence vital to consider autoimmune encephalitis in all patients with atypical presentations.

Stereotactic multi-target limbic leucotomy for treating intractable psychiatric disease in 30 patients Three-year follow-up of memory, intelligence, and psychiatric symptoms

BACKGROUND： The biochemical hypothesis of dopamine hyperfunction in the brain can explain the pathological mechanisms of schizophrenia. Surgery is performed based on limbic system circuit theory correspondence to above-mentioned hypothesis. Stereotactic surgery for the treatment of mental disorders is related to stereotactic surgery that influences the Papez circuit. OBJECTIVE： To observe the effects of stereotactic multi-target limbic leucotomy on the improvements in memory, intelligence and psychiatric symptoms in the treatment of intractable psychiatric disease. DESIGN： Self-control case analysis and follow-up of therapeutic effects. SETTING： Department of Neurosurgery, First Hospital, Hebei Medical University. PARTICIPANTS： Thirty patients with intractable psychiatric disease, who received stereotactic surgery in the Department of Neurosurgery, First Hospital, Hebei Medical University between July 2002 and August 2005, were included in this study. The patients, 21 males and 9 females, all met the diagnostic criteria of intractable psychiatric disease, determined by the national psychosurgery cooperation team in 1998. Informed consents for surgery and clinical follow-up exams were obtained from patients and/or patients＇ relatives （guardians）. METHODS： In 30 patients with intractable psychiatric disease, limbic leucotomy was performed by stereotactic technique. Multi-target radiofrequency hyperthermia was performed in the intracranial amygdaloid nucleus, anterior limb of internal capsule, callosal gyrus, among other regions. The therapeutic effects of patients were evaluated by Brief Psychiatric Rating Scale （BPRS） before surgery, and 6 months, 1, and 3 years after surgery. The Wechsler Adult Intelligence Scale （WAIS） and Clinical Memory Scale （CMS） were used to assess memory and intelligence before and after surgery. MAIN OUTCOME MEASURES： Memory, intelligence, and psychiatric symptoms of patients before and after operation. RESULTS： Thirty patients were included in the final analysis. （1） Memory and intelligence changes of patients： CMS and WAIS showed there were no significant differences in the changes of brain functions before and after operation （P 〉 0.05）. （2） Improved degree of symptoms： 5 patients were cured, 8 patients significantly improved, 8 patients improved, 3 patients had no changes, and 6 patients had recurrent symptoms. CONCLUSION： Stereotactic multi-target limbic leucotomy can improve the symptoms of patients with intractable psychiatric disease. Follow-up results showed that memory and intelligence were not noticeably improved after surgery.

White matter connectivity damage secondary to hippocampal and amygdala target injuries in acute limbic encephalitis Diffusion tensor image and voxel-based morphometry paired study

BACKGROUND： Limbic encephalitis is a rare syndrome that specifically affects the limbic system. Magnetic resonance imaging （MRI） has been typically used to detect brain changes in this disease. However, the mechanisms of limbic encephalitis-related white matter damage remain poorly understood. OBJECTIVE： To characterize white matter connectivity changes secondary to injuries of the limbic system in limbic encephalitis through combined application of diffusion tensor imaging （DTI） and voxel-based morphometry. DESIGN, TIME AND SETTING： A non-randomized, controlled, clinical, neuroimaging, DTI study was performed at the Department of Radiology, West China Hospital in December 2008. PARTICIPANTS： A male, 46-year-old, limbic encephalitis patient, as well as 11 age- and gender-matched healthy volunteers, were enrolled in the present study. METHODS： MRI was performed on the limbic encephalitis patient using a 3.0T MR scanner. Three-dimensional SPGR Tl-weighted images and DTI were acquired in the patient and controls. Data were analyzed using Matlab 7.0 and SPM2 software. MAIN OUTCOME MEASURES： Results from routine MRI scan with contrast enhancement of patient, as well as fractional anisotropy and mean diffusivity value map differences between patient and controls. RESULTS： Significant symmetric MRI signal intensity abnormalities were observed with routine MRI Affected bilateral hippocampi and amygdala exhibited hypointense signals in TIWI and hyperintense signals in T2 images. The DTI study revealed decreased fractional anisotropy values in the bilateral alveus and fimbria of the hippocampus, bilateral internal and external capsules, white matter of the right prefrontal area, and left corona radiate in the patient compared with normal controls （P 〈 0.001） Significantly increased fractional anisotropy, mean diffusivity, or decreased mean diffusivity were not observed in the patient, compared with controls. CONCLUSION： Secondary white matter damage to the hippocampal afveus and fimbria was apparent in the limbic encephalitis patient. In addition, other white matter fiber injuries surrounded the limbic structures, which were not attributed to secondary limbic system injuries.

Case Study on Focal Retrograde Amnesia due to Limbic Encephalitis

This case study addresses episodic memory impairment or focal retrograde amnesia related to limbic encephalitis. The patient in question was a right-handed man in his 60s who developed focal retrograde amnesia due to limbic encephalitis. An abnormal MRI signal was observed in the right medial temporal lobe. Immediately after the encephalitis onset, mental symptoms—including impaired consciousness, disorientation, hallucinations, and delusions—appeared;however, his condition improved with medical treatment. After transfer to a convalescent and rehabilitation hospital, various neuropsychological tests were conducted but no apparent functional decline was observed in intellectual function, attention, memorization, or retention. However, the patient exhibited impairments related to autobiographical memory and memory of events 4?-?5 years before the onset of limbic encephalitis. Based on these observations, the patient was considered to exhibit focal retrograde amnesia due to limbic encephalitis. Despite exhibiting retrograde amnesia, he had no difficulty in his daily life in the ward. Moreover, after discharge from hospital, smooth work reinstatement was possible. This case demonstrates that, even after exhibiting retrograde amnesia, if its duration is relatively short and physical function and other higher-order brain functions are sustained, social rehabilitation—including work reinstatement—is feasible.

Four kinds of antibody positive paraneoplastic limbic encephalitis: A rare case report

BACKGROUND It is not uncommon to develop autoimmune encephalitis and paraneoplastic neurological syndromes(PNS).4 kinds of antibody-positive autoimmune paraneoplastic limbic encephalitis(PLE)have not been reported.CASE SUMMARY PNS are distant effects of cancer on the nervous system,rather than syndromes in which cancer directly invades and metastasizes to the nerves and/or muscle tissues.If the limbic lobe system of the brain is involved,this will result in PLE.The detection of patients with PNS is challenging since tumors that cause paraneoplastic neurologic disorders are often asymptomatic,obscure,and thus easily misdiagnosed or missed.Currently,single-or double-antibody-positive paraneoplastic marginal encephalitis has been reported.However,no cases of three or more-antibody-positive cases have been reported.Here,we report a case of PLE that is anti-collapsing response-mediator protein-5,anti-neuronal nuclear antibody-type 1,anti-aminobutyric acid B receptor,and anti-glutamate deglutase positive,and address relevant literature to improve our understanding of the disease.CONCLUSION This article reports on the management of a case of PLE with four positive antibodies,a review of the literature,in order to raise awareness among clinicians.

IBA融合架构下基于应用场景的Limbic system研究

IBA(Internet of things,Big data,Artificial intelligence,IBA)融合架构下,基于应用场景的Limbic system系统将平台层设备管理的部分功能解耦至边缘侧,在边缘侧对异构设备实现协议发现、解析、转换、适配、管理全过程的自动化和智能化。通过对各类异构数据的统一治理和管理,实现在不同应用系统之间的智能扩展、即插即用及服务共享,并根据需要对数据进行认证加密、存储分发、分析控制、多模融合与边缘计算、策略管理与指令映射以及服务发布与链接管理,最终在减少时延、降低投资、提高链接可靠性的同时,实现多系统边缘侧智能控制自治、多节点智能控制协同以及端边云协同下的联控联动。

Limbic Encephalitis as the First Manifestation of Neurosyphilis: A Diagnostic Challenge

Limbic encephalitis (LE) is a clinical entity related to a mesial temporal lesion resulting in a combination of anterograde memory dysfunction, behavioral changes, and seizures. The most common causes of limbic encephalitis are Herpes Simplex Virus (HSV) encephalitis, autoimmune encephalitis. Neurosyphilis is an exceptional aetiology. The early diagnosis and management of the disease determine the prognosis. This clinical course highlights the diagnostic challenge limbic encephalitis can cause and the importance of considering neurosyphilis in patients with specific or unspecific neurological symptoms. We report a case of a mesiotemporal form of neurosyphilis revealed by a LE.

The expression of MMPs and TIMPs in gliomas of the limbic system

To investigate the function of matrix metalloproteinase-2(MMP-2),matrix metalloproteinase-9(MMP-9) and tissue inhibitors of metalloproteinase-2(TIMP-2) in the invasion of gliomas of the limbic system.Methods The expression of MMP-2,MMP-9 and TIMP-2 in low and high-grade gliomas and meningiomas was detected by using immunohistochemical technique.Results (1) The expression levels of MMP-2 and MMP-9 were significantly higher in high grade gliomas than those in low grade gliomas (P<0.05 and P<0.01 respectively).They were also significantly higher in low grade gliomas than those in meninginomas (P<0.05 and P<0.01 respectively).(2) The TIMP-2 expression level was obviously lower in gliomas of grade Ⅲ and grade Ⅳthan that in gliomas of grade Ⅰ and grade Ⅱ.Also,the expression of TIMP-2 in gliomas of grade Ⅰ and grade Ⅱ was significantly lower than that in meningiomas. Conclusion (1) The expression of MMP-2 and MMP-9 in human brain gliomas is related to malignant progression of gliomas.They might be used as the indicators to evaluate the malignancy and prognosis of gliomas.(2) Imbalance between MMP-s and TIMP-s may be one of the improtant factors promoting glioma invasion.5 refs,3 figs.

Limbic Encephalitis Associated with Anti-y-aminobutyric Acid B Receptor Antibodies： A Case Series from China

Background： Autoimmune encephalitis associated with antibodies against γ-aminobutyric acid B receptor （GABABR） in patients with limbic encephalitis （LE） was first described in 2010. We present a series of klan Chinese patients tbr further clinical refinement. Methods： Serum and cerebrospinal fluid （CSF） samples from patients referred to the program of encephalitis and paraneoplastic syndrome of Peking Union Medical College Hospital were tested with indirect immunofluorescence. Clinical information of patients with anti-GABABR antibody positivity was retrospectively reviewed, and descriptive statistical analysis was performed. Results： All eighteen anti-GABABR antibody-positive cases had limbic syndromes, and electroencephalogram （EEG） or neuroimaging evidence fulfilled the diagnostic criteria of LE. Four patients had additional antibodies against Hu in serum and one had anti-N-methyl-d-aspartate receptor antibody in both sera and CSF. Seventeen （17/18） patients presented with new-onset refractory seizure or status epileptics. Twelve （12/18） patients had memory deficits, 11 （11/18） patients had personality change, 7 （7/18） patients had disturbance of consciousness, and 3 （3/18） patients showed cerebellar dysfunction. One patient with LE had progressive motor and sensory polyneuropathy. Lung cancer was detected in 6 （6/18） patients. Ten （10/18） patients showed abnormality in bilateral or unilateral mediotemporal region on magnetic resonance imaging. Ten （10/18） patients had temporal lobe epileptic activity with or without general slowing on EEG. Seventeen patients received immunotherapy and 15 of them showed neurological improvement. Four patients with lung cancer died within 1-12 months due to neoplastic complications. Conclusions： Our study demonstrates that most Han Chinese patients with anti-GABABR antibody-associated LE have prominent refractory epilepsy and show neurological improvement on immunotherapy. Patients with underlying lung tumor have a relatively poor prognosis. Testing for anti-GABABR antibodies is necessary for patients with possible LE or new-onset epilepsy with unknown etiology.

Expression of neurotrophin-3 mRNA induced by limbic seizuresin adult rat hippocampus

Kainic acid(KA),a prospective neuroexcitable and neurotoxic analog of glumate,inducespersistent seizure activity in limbic structures which results in behavioral symptoms,electrographic and neuropathologic alternations closely resembling human temporal lobe epi-lepsy.The hippocampal pyramidal cells possess abundant KA high affinity binding sites intheir membranes and are extremely vulnerable to KA neurotoxicity.NT-3 is a memberof the neurotrophic family(NTF)including nerve growth factor(NGF),brain derivedneurotrophic factor(BDNF),neurotrophin-4/5(NF-4/5).NT-3 mRNA was expressed

A Rare Case of Ovarian Cancer Presenting with Paraneoplastic Cerebellar Degeneration and Limbic Encephalitis

Paraneoplastic neurologic syndromes （PNSs） occur with increased frequency in patients with cancer and almost always antedate its diagnosis.These syndromes comprise a heterogeneous group of cancer-related neurologic diseases,and they may affect any part of the nervous system.The simultaneous involvement of different areas of the nervous system by the paraneoplastic process is not unusual.Until date,this is the first report of concurrent development of paraneoplastic cerebellar degeneration （PCD） and paraneoplastic limbic encephalitis （PLE） associated with the advanced ovarian cancer and anti-Yo antibodies following hepatitis B （HB） vaccination.The cause of most PNS is believed to be an immune response against neuronal proteins expressed by the tumor.

Progress in the mechanism of acupuncture intervention on pain emotion and pain cognition mediated by limbic system

Pain is a complex physiological and psychological activity,involving at least three dimensions,including pain sensation,pain emotion,and pain cognition.Acupuncture can clearly relieve the pain sensation of patients and improve pain emotion and pain cognition induced by pain;acupuncture participates in the multi-dimensional regulation of pain through brain regions of the limbic system such as anterior cingulate cortex(ACC),amygdala(AMY),and hippocampus.By analyzing relevant literature,it has been found that the regulation of acupuncture on pain emotion is mainly related to the activation of pertinent opioid receptors in the ACC,the decrease of the expression of extracellular signal-regulated kinase(ERK),and the promotion of the expression of glutamic acid(Glu)A1,metabotropic glutamate receptor-1(mGluR1),andγ-aminobutyric acid aminobutyric acid(GABA)B2 protein in the AMY.The regulation of acupuncture on pain cognition is mainly related to the elevation of the expression of protein kinase A(PKA)and phospho-p38 mitogen-activated protein kinase(phospho-p38 MAPK)and the inhibition of cyclic adenosine monophosphate(cAMP)/PKA/cAMP response element-binding protein(CREB)signaling pathway in the ACC.

Paraneoplastic limbic encephalitis associated with testicular mixed germ cell tumor

Paraneoplastic limbic encephalitis (PLE) is a rare immunopathological syndrome, reported in association with certain types of malignancies. Patients present with cognitive and memory impairments, disordered perception, mood and behavioral changes, sleep disturbances, and seizures. Despite the growing number of cases being reported, it still poses a diagnostic challenge. We encountered a patient with a myriad of neuropsychiatric symptoms who exhibited a highly variable response to therapy. A 36-year-old male presented with memory impairment, excessive sleepiness, and slurred speech. Brain magnetic resonance imaging revealed hyperintensities in the temporal lobes and hypothalamus, all suggestive of limbic encephalitis. He was found to have a mixed germ cell testicular teratoma. Screening for commonly associated antibodies did not yield positive results, which emphasizes that sero-negative PLE can be missed in patients with malignancies. In reporting this case, we urge neurologists to consider PLE as part of the differential diagnosis in similar ambiguous clinical scenarios.

A case report of anti-N-methyl-d-aspartate receptor autoimmune encephalitis with sensory attack. Is limbic encephalitis only'limbic'?

To emphasize the early diagnosis and treatment of anti-N-methyl-d-aspartate-receptor (NMDAR) autoimmune encephalitis, a rare clinical condition, teratoma-related, anti-NMDAR encephalitis should be suspected if young patients present with psychiatric, movement, and sensory symptoms. Early diagnosis and treatment can decrease the mortality and disability rate.

Multiple autoimmune antibody limbic encephalitis:a case in a pregnant woman

Autoimmune limbic encephalitis is most commonly associated with antibodies against the N‑methyl‑D‑aspartate receptor(NMDAR),among other neuronal cell surface receptors.Here,a case of a pregnant female with limbic encephalitis in the presence of multiple additional autoimmune antibodies is described.The patient was a 36‑year‑old female who presented with 4 days of confusion,hallucinations,hypersexuality,disinhibition,and pressured speech.The patient’s work‑up detected the presence of anti‑NMDAR antibodies,anti‑glutamic acid decarboxylase antibodies,and a yet uncharacterized neuronal autoantibody.The patient was also found to be pregnant.No evidence of ovarian or other pelvic malignancy was discovered.Symptomatic control was achieved with plasma exchange.

Gamma-aminobutyric-acid-B receptor antibodies in limbic encephalitis with small cell lung cancer

Encephalitis associated with antibodies to gamma-aminobutyric-acid B(GABA-B)is a subgroup of autoimmune synaptic encephalitis with typical features of limbic encephalitis and small cell lung cancer(SCLC).We report a case of anti-GABA-B receptor encephalitis in a 57-year-old man who presented with seizures,memory loss,and abnormal behavior.He developed partially neurological responses to immunotherapy,but refused comprehensive tumor screening.The symptoms were aggravated again 4 months later.Workup showed antibodies to GABA-B receptors and tumor screening revealed SCLC.It highlights the importance of early screening of underlying tumor and anti-tumor treatment in paraneoplastic cases.

丙泊酚对成年癫痫患者左侧大脑新皮质与边缘系统立体定向脑电图的影响

目的探究不同效应室浓度丙泊酚对成年癫痫患者左侧大脑新皮质与边缘系统立体定向脑电图(SEEG)的影响。方法选择2021年1月—2022年12月于我院癫痫外科行机器人立体定向辅助左侧颅内电极植入术后择期电极拔除的患者14例,根据植入电极位置将患者分为新皮质组和边缘系统组,记录并比较两组患者术中丙泊酚效应室浓度分别为0、2、3、4、5 mg/L(后简称D1~D5浓度)时SEEG的δ、θ、α、β、γ波各波段功率范围和功率百分比,以及δ-γ、θ-γ、α-γ、β-γ相位幅度耦合(PAC)的调制指数(MI)。结果D2~D5浓度时,边缘系统组和新皮质组患者立体定向脑电图γ波功率范围显著低于D1浓度时(F=15.13、20.33,t=4.33~8.72,P<0.05);D3浓度时,边缘系统组患者α波功率百分比显著高于D1、D2浓度时(F=23.38,t=5.52、9.38,P<0.05);D3~D5浓度时,边缘组患者θ-γ、α-γPAC MI均显著低于D1浓度时(F=13.64、18.77,t=7.62~17.68,P<0.05)。结论丙泊酚可以引发成年癫痫患者左侧大脑新皮质及边缘系统的SEEGγ波功率范围降低以及边缘系统SEEGθ-γ、α-γ的PAC降低。

抗SOX1抗体相关神经系统副肿瘤综合征的临床异质性分析

目的总结抗Y染色体性别决定区相关高迁移率超家族1(SRY⁃like high⁃mobility group superfamily of developmental transcription factors 1,SOX1)抗体相关神经系统副肿瘤综合征(paraneoplastic neurological syndrome,PNS)的临床表现、影像学特征和预后。方法选取2019年1月至2023年1月首都医科大学附属北京友谊医院抗SOX1抗体相关PNS患者6例,回顾性分析患者的相关资料。结果6例患者中,男5例、女1例,年龄42~76岁。6例患者中,感觉运动周围神经病合并小细胞肺癌(small cell lung cancer,SCLC)2例、边缘叶脑炎2例、副肿瘤小脑变性1例和Lam⁃bert-Eaton肌无力综合征合并SCLC 1例。6例患者血清抗SOX1抗体均阳性,其中合并其他抗体阳性1例、合并脑脊液抗SOX1抗体阳性2例。6例患者神经系统症状均早于肿瘤发现前,均于发现抗SOX1抗体后行肿瘤筛查,其中3例SCLC患者进行治疗后病情较稳定;截至随访时间,余3例患者经检查未发现肿瘤(其中病例5随访>2年,病例2和病例4随访<2年),进行治疗后,症状未见明显进展。结论抗SOX1抗体相关PNS患者存在高度临床异质性,部分患者伴发肿瘤。可增加副肿瘤抗体的检测,以提高早期诊断潜在肿瘤的可能性。

Rational and Continuous Measurement of Emotional-Fingerprint, Emotional-Quotient and Categorical vs Proportional Recognition of Facial Emotions with M.A.R.I.E., Second Half

Context: The advent of Artificial Intelligence (AI) requires modeling prior to its implementation in algorithms for most human skills. This observation requires us to have a detailed and precise understanding of the interfaces of verbal and emotional communications. The progress of AI is significant on the verbal level but modest in terms of the recognition of facial emotions even if this functionality is one of the oldest in humans and is omnipresent in our daily lives. Dysfunction in the ability for facial emotional expressions is present in many brain pathologies encountered by psychiatrists, neurologists, psychotherapists, mental health professionals including social workers. It cannot be objectively verified and measured due to a lack of reliable tools that are valid and consistently sensitive. Indeed, the articles in the scientific literature dealing with Visual-Facial-Emotions-Recognition (ViFaEmRe), suffer from the absence of 1) consensual and rational tools for continuous quantified measurement, 2) operational concepts. We have invented a software that can use computer-morphing attempting to respond to these two obstacles. It is identified as the Method of Analysis and Research of the Integration of Emotions (M.A.R.I.E.). Our primary goal is to use M.A.R.I.E. to understand the physiology of ViFaEmRe in normal healthy subjects by standardizing the measurements. Then, it will allow us to focus on subjects manifesting abnormalities in this ability. Our second goal is to make our contribution to the progress of AI hoping to add the dimension of recognition of facial emotional expressions. Objective: To study: 1) categorical vs dimensional aspects of recognition of ViFaEmRe, 2) universality vs idiosyncrasy, 3) immediate vs ambivalent Emotional-Decision-Making, 4) the Emotional-Fingerprint of a face and 5) creation of population references data. Methods: M.A.R.I.E. enables the rational, quantified measurement of Emotional Visual Acuity (EVA) in an individual observer and a population aged 20 to 70 years. Meanwhile, it can measure the range and intensity of expressed emotions through three Face- Tests, quantify the performance of a sample of 204 observers with hypernormal measures of cognition, “thymia” (defined elsewhere), and low levels of anxiety, and perform analysis of the six primary emotions. Results: We have individualized the following continuous parameters: 1) “Emotional-Visual- Acuity”, 2) “Visual-Emotional-Feeling”, 3) “Emotional-Quotient”, 4) “Emotional-Decision-Making”, 5) “Emotional-Decision-Making Graph” or “Individual-Gun-Trigger”, 6) “Emotional-Fingerprint” or “Key-graph”, 7) “Emotional-Fingerprint-Graph”, 8) detecting “misunderstanding” and 9) detecting “error”. This allowed us a taxonomy with coding of the face-emotion pair. Each face has specific measurements and graphics. The EVA improves from ages of 20 to 55 years, then decreases. It does not depend on the sex of the observer, nor the face studied. In addition, 1% of people endowed with normal intelligence do not recognize emotions. The categorical dimension is a variable for everyone. The range and intensity of ViFaEmRe is idiosyncratic and not universally uniform. The recognition of emotions is purely categorical for a single individual. It is dimensional for a population sample. Conclusions: Firstly, M.A.R.I.E. has made possible to bring out new concepts and new continuous measurements variables. The comparison between healthy and abnormal individuals makes it possible to take into consideration the significance of this line of study. From now on, these new functional parameters will allow us to identify and name “emotional” disorders or illnesses which can give additional dimension to behavioral disorders in all pathologies that affect the brain. Secondly, the ViFaEmRe is idiosyncratic, categorical, and a function of the identity of the observer and of the observed face. These findings stack up against Artificial Intelligence, which cannot have a globalist or regionalist algorithm that can be programmed into a robot, nor can AI compete with human abilities and judgment in this domain. *Here “Emotional disorders” refers to disorders of emotional expressions and recognition.

Rational and Continuous Measurement of the Emotional Decision Making in Visual Recognition of Facial Emotional Expressions with M.A.R.I.E.: First Half

Context: The advent of Artificial Intelligence (AI) requires modeling prior to its implementation in algorithms for most human skills. This observation requires us to have a detailed and precise understanding of the interfaces of verbal and emotional communications. The progress of AI is significant on the verbal level but modest in terms of the recognition of facial emotions even if this functionality is one of the oldest in humans and is omnipresent in our daily lives. Dysfunction in the ability for facial emotional expressions is present in many brain pathologies encountered by psychiatrists, neurologists, psychotherapists, mental health professionals including social workers. It cannot be objectively verified and measured due to a lack of reliable tools that are valid and consistently sensitive. Indeed, the articles in the scientific literature dealing with Visual-Facial-Emotions-Recognition (ViFaEmRe), suffer from the absence of 1) consensual and rational tools for continuous quantified measurement, 2) operational concepts. We have invented a software that can use computer-morphing attempting to respond to these two obstacles. It is identified as the Method of Analysis and Research of the Integration of Emotions (M.A.R.I.E.). Our primary goal is to use M.A.R.I.E. to understand the physiology of ViFaEmRe in normal healthy subjects by standardizing the measurements. Then, it will allow us to focus on subjects manifesting abnormalities in this ability. Our second goal is to make our contribution to the progress of AI hoping to add the dimension of recognition of facial emotional expressions. Objective: To study: 1) categorical vs dimensional aspects of recognition of ViFaEmRe, 2) universality vs idiosyncrasy, 3) immediate vs ambivalent Emotional-Decision-Making, 4) the Emotional-Fingerprint of a face and 5) creation of population references data. Methods: With M.A.R.I.E. enable a rational quantified measurement of Emotional-Visual-Acuity (EVA) of 1) a) an individual observer, b) in a population aged 20 to 70 years old, 2) measure the range and intensity of expressed emotions by 3 Face-Tests, 3) quantify the performance of a sample of 204 observers with hyper normal measures of cognition, “thymia,” (ibid. defined elsewhere) and low levels of anxiety 4) analysis of the 6 primary emotions. Results: We have individualized the following continuous parameters: 1) “Emotional-Visual-Acuity”, 2) “Visual-Emotional-Feeling”, 3) “Emotional-Quotient”, 4) “Emotional-Deci-sion-Making”, 5) “Emotional-Decision-Making Graph” or “Individual-Gun-Trigger”6) “Emotional-Fingerprint” or “Key-graph”, 7) “Emotional-Finger-print-Graph”, 8) detecting “misunderstanding” and 9) detecting “error”. This allowed us a taxonomy with coding of the face-emotion pair. Each face has specific measurements and graphics. The EVA improves from ages of 20 to 55 years, then decreases. It does not depend on the sex of the observer, nor the face studied. In addition, 1% of people endowed with normal intelligence do not recognize emotions. The categorical dimension is a variable for everyone. The range and intensity of ViFaEmRe is idiosyncratic and not universally uniform. The recognition of emotions is purely categorical for a single individual. It is dimensional for a population sample. Conclusions: Firstly, M.A.R.I.E. has made possible to bring out new concepts and new continuous measurements variables. The comparison between healthy and abnormal individuals makes it possible to take into consideration the significance of this line of study. From now on, these new functional parameters will allow us to identify and name “emotional” disorders or illnesses which can give additional dimension to behavioral disorders in all pathologies that affect the brain. Secondly, the ViFaEmRe is idiosyncratic, categorical, and a function of the identity of the observer and of the observed face. These findings stack up against Artificial Intelligence, which cannot have a globalist or regionalist algorithm that can be programmed into a robot, nor can AI compete with human abilities and judgment in this domain. *Here “Emotional disorders” refers to disorders of emotional expressions and recognition.