Phineas Gage Syndrome A systematic review of literature

Context: <br> Phineas Gage syndrome refers to the set of alterations of various kinds and severity, product of lesions in the cortex of the frontal lobe and its connections with the limbic system where rationality and emotions respectively occur, with which no optimal decisions can be made, along with this they will suffer from uninhibited, impulsive and in certain cases antisocial behavior. The damage of said areas or their underlying circuits lead to the development of greater problems in the behavior and personality of the affected person, without presenting serious problems in communication or the memory of the subject, the subjects who present this syndrome show little initiative and abandon the tasks that are being carried out without meeting the objectives. Gage's case is considered the first to have scientific evidence that frontal lobe damage alters personality and can be affected through focal physical changes in the brain, altering mood and social interactions. Prior to this event, the frontal lobe was considered a silent, nonfunctional structure unrelated to human behavior. <br> Materials and methods: We follow the PRISMA methodology, a systematic search was performed on PubMed, Biblioteca Virtual de Salud, Science Direct, World Wide Science, SCIELO, taking into consideration biomedical literature about Phineas Gage Syndrome in English, Spanish and Portuguese published up to February 23, th 2023. The inclusion and exclusion criteria were created using a PICOS framework. The search contained the following terms: Phineas Gage Syndrome, Síndrome de Phineas Gage, Phineas Gage. In each database, an input contained terms as Phineas Gage. Titles and abstracts of all studies were independently reviewed by five investigators using the Rayyan web tool and discrepancies were resolved through reviewer discussion and consensus. A total of 900 unique citations were initially retrieved. The review process in this review is detailed by the PRISMA flow diagram in Figure 1. We identified and include 258 citations as potentially relevant. 235 publications were excluded. We included 23 publications. A list of publications are included in Additional material. Biomedical literature from the United States of America were most common, followed by Australia, Canada and France.