Personality changes after rostral leucotomy: a comparison with standard prefrontal leucotomy.
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Humans↗
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[Painful stump of the left arm; failure of controlateral leucotomy; recovery by unilateral topectomy following primary leucotomy].
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Amputation Stumps↗
Improvement in severe self-mutilation following limbic leucotomy: a series of 5 consecutive cases.
BACKGROUND: The efficacy of neurosurgical intervention for self-mutilation behavior associated with severe, intractable psychiatric disorders remains undetermined. We report the effects of limbic leucotomy in 5 consecutive patients with severe self-mutilation behaviors. METHOD: After unsolicited referrals from their psychiatrists and careful consideration by the Massachusetts General Hospital Cingulotomy Assessment Committee (MGH-CAC), 5 patients were treated with limbic leucotomy. Their primary DSM-IV psychiatric diagnoses were either obsessive-compulsive disorder or schizoaffective disorder. Comorbid severe, treatment-refractory self-mutilation was an additional target symptom. Outcome was measured by an independent observer using the Clinical Global Improvement. Current Global Psychiatric-Social Status Rating, and DSM-IV Global Assessment of Functioning scales in addition to telephone interviews with patients, families, their psychiatrists, and treatment teams. The mean postoperative follow-up period was 31.5 months. RESULTS: All measures indicated sustained improvement in 4 of 5 patients. In particular, there was a substantial decrease in self-mutilation behaviors. Postoperative complications were transient in nature. and postoperative compared with preoperative neuropsychological assessments revealed no clinically significant deficits. CONCLUSION: In carefully selected patients as described in this report, limbic leucotomy may be an appropriate therapeutic consideration for self-mutilation associated with severe, intractable psychiatric disorders.
Adult↗
Longitudinal evolution of prefrontal leucotomy in Tourette's syndrome.
We report the case of a 69-year-old man with severe Tourette's syndrome (TS) who underwent a bilateral prefrontal leucotomy at the age of 29 years to alleviate coprolalia, copropraxia, and obsessive-compulsive disorder. No improvement was observed during the 5 years after the leucotomy. Tics and associated behavioral abnormalities disappeared thereafter, to recur at age 67. Long-term follow-up of single cases can help to estimate the role of neurosurgery in the treatment of TS.
Aged↗
Stereotactic limbic leucotomy--a follow-up at 16 months.
Sixty-six patients were assessed clinically, psychologically and physiologically before operation, at six weeks and at a mean of 16 months following stereotactic limbic leucotomy. Seventy-three per cent were clinically improved at six weeks and 76 per cent at 16 months. In obsessional neurosis, 89 per cent of patients showed definite clinical improvement at 16 months; in chronic anxiety, 66 per cent were improved; in depression, 78 per cent; and in the small number of schizophrenics treated the improvement rate was over 80 per cent. Self-assessment and observer-assessment questionaires and scales measuring Depression, Anxiety, Neuroticism, Hysterical symptoms and Obsessional symptoms and traits all showed highly significant reductions of mean scores at 16 months. There was no fall-off in intelligence, and adverse effects were minimal. Limbic leucotomy, with its enhanced accuracy and safety, compares very favourably with similarly assessed, more extensive 'free-hand' procedures, and in obsessional neurosis and chronic anxiety the results are superior.
Adult↗
The effects on personality of open prefrontal leucotomy.
The Sixteen Personality Factor Test was administered to 28 patients both before and six months after they received open prefrontal leucotomies. The preoperative and postoperative test results are compared. Preoperatively the group was excessively apprehensive, tense, affected by feelings, sober, shy, and humble. After leucotomy these aspects of personality all showed significant change in the direction of normality. With the exception of the humble versus assertive aspect, however, the mean scores in each case remained outside the normal range.
Adult↗
[Dynamic syndrome formation in patients with schizophrenia in the late period after a prefrontal leucotomy].
The authors analyze the course of the underlying process after prefrontal leucotomy in 15 patients with schizophrenia. Types of syndrome transformation are analyzed on the basis of a long-term follow-up (30 years). Three variants of the course of the underlying disease and the initial status of patients are described. Destructive postoperative morphological changes in the brain are examined by unidimensional echoencephalography. The relationship between classical leucotomy and modern methods of psychosurgery is considered.
Aged↗
A prospective evaluation of open prefrontal leucotomy.
Forty-three patients received an open prefrontal leucotomy for severe and intractable psychiatric illnesses. As a result of the operation three patients died, three developed personality changes and one had repeated grand-mal seizures. Of the 40 patients followed up for six months, 57-5% showed marked improvement in their clinical state and 30-0% mild to moderate degrees of improvement whilst no patient's condition was considered to be worse. Significant improvement was obtained after operation in the mean scores on the Hamilton Anxiety Scale, the Hamilton Depression Scale, the Beck Depression Scale and the Neuroticism Scale of the Eysenck Personality Inventory. Extroversion, as measured by the Eysenck Personality Inventory, was significantly increased after operation. It is recommended that open prefrontal leucotomy procedures be replaced by the safer stereotactic or electrode implantation techniques and that all psychosurgery be confined to specialist units.
Adult↗
D-aspartate binding to the glutamate uptake site in human brain tissue--effects of leucotomy.
Binding of [3H]D-aspartate, as an indicator of glutamate uptake sites, was investigated in post-mortem human brain tissue by use of a centrifugation assay to separate free and bound ligand. Binding was displaceable, apparently saturable and to a single site, with mean KD and Bmax values of 2.3 microM and 40.3 nmol/g tissue in the frontal cortex. The method was applied to the study of tissue from frontal and temporal cortices and the caudate nucleus of five psychiatric patients who had undergone a frontal leucotomy. The effects of this neurosurgical procedure were to diminish by almost 50% the density of D-aspartate binding sites in the frontal cortex and caudate nucleus, while the temporal cortex was less affected. It is concluded that the method provides a potentially useful correlate of glutamatergic innervation in human brain tissue.
Aged↗
Long-term effects of prefrontal leucotomy--an overview of neuropsychologic residuals.
A battery of neuropsychologic tests was administered to 16 schizophrenics who had undergone prefrontal leucotomy approximately 25 years earlier. The 16 were divided into three groups based on their recovery after surgery. Five non-leucotomized chronic schizophrenics and five normal subjects served as controls. This paper presents a description of the subject population, a listing of the neuropsychologic battery administered, as well as main results from each major psychologic function tested. This information serves as an introduction and an overview for later detailed results.
Adult↗
The treatment of Gilles de la Tourette syndrome by limbic leucotomy.
A patient with Gilles de la Tourette syndrome and severe self-injurious compulsions who had failed to respond to drug treatment and behavioural therapy obtained a complete and sustained resolution of his destructive behaviour and improvement in his tics following bilateral limbic leucotomy.
Adult↗
The metabolic effects of limbic leucotomy in Gilles de la Tourette syndrome.
Regional cerebral oxygen metabolism was measured before and after limbic leucotomy in a patient with Gilles de la Tourette syndrome, obsessive compulsive disorder, and obsessional slowness. The preoperative scan showed hypermetabolism in the caudate nuclei, which normalised after operation. It is proposed that the beneficial effects of this operation on both tics and obsessive compulsive behaviour are mediated by disruption of abnormal neural activity in basal ganglia-thalamocortical loops.
Brain↗
[Lobotomy and leucotomy in Brazilian mental hospitals].
Lobotomy and leucotomy were used in Brazilian mental institutions from 1936 to 1956. Also called psycho-surgeries, they were operations that separated the right and left frontal lobes and pre-frontal lobes from the rest of the brains, aiming at modifying behavior or curing mental diseases. The technique, created by the Portuguese neurologist Egas Moniz in 1935 and developed by Walter Freeman from the United States, arrived in Brazil through the hands of Aloysio Mattos Pimenta, neurologist from Hospital PsiquiátricoJuquely in São Paulo. Soon, many doctors followed suit. These procedures were used on more than a thousand in-patients aiming at not only healing results, but also the technical improvement of the surgical technique, since preliminary experiments with animals were quite rare at the time. In Brazil, the technique was used until 1956, when it was considered as going against the 1947 Nuremberg Code, whose objective was to detain and regulate the medical experiments with human beings made during the Second World War.
Brazil↗
The effects on intellectual functioning of open prefrontal leucotomy.
The Wechsler Adult Intelligence Scale and the Wechsler Memory Scale were administered to 32 patients both before and six months after they received open prefrontal leucotomies. The preoperative and postoperative test results are compared, consideration being given to individual patients as well as to the group. The mean results for the group provide no evidence of any post-operative intellectual deterioration. However, it seems probable that in individual cases such deterioration occurred. In most of these cases brain damage would appear to be responsible, and the ability "to comprehend and size up a total situation" is seen as the area of functioning primarily affected.
Adult↗
[A preliminary report on stereotactic multi-target limbic leucotomy].
Ten patients suffering from chronic psychiatric disorder with violence were admitted for stereotactic multitarget limbic leucotomy. Eight of them were schizophrenia, one was paranoid, and one was mania. In operation, thermococagulative lesions were made bilaterally in the amygdala, the anterior cingulate region and the innominate region. The criteria of the patients selected for the operation, the operative procedure and evaluation of the results are introduced. Five patients achieved significant improvement and three patients showed some improvement after operation. The complications included, temporary mild paraplegia (in four cases) and sphincter disturbances (in five cases) in the first two weeks postoperation. The choice of targets and possible causes of complications are discussed.
Adult↗
Brain-pituitary-adrenal interrelationship in closed loop intestinal obstruction in man. Effects of stepwise removal of brain, midbrain section and frontal leucotomy in dogs after the same type of stress.
Volvulus shows high plasma 17-OHCS level and after operation there is a progressive fall. Brain-pituitary-adrenal interrelationship has been studied in experimental dogs using a different type of stressor i.e. closed loop intestinal obstruction. Midbrain section blocks the adrenocortical response. Frontal leucotomy leads to increased response after acute distension of the closed loop. Acute hypothalamectomy does not lead to blocking of the adrenocortical response to stress.
Animals↗
The effects of prefrontal leucotomy on visuoperceptive and visuoconstructive tests.
Visuoperceptive and visuoconstructive tests were administered to three groups of schizophrenics who had undergone bilateral prefrontal leucotomy approximately 25 years earlier. A nonoperated schizophrenic patient group and a normal subject group served as controls for the effects of schizophrenic symptomatology and for age and education. The results demonstrated that orbital frontal white matter lesions do not disturb simple perceptions and constructions. The nonoperated schizophrenics had significant problems on many of the tests. Only one test, the WAIS Picture Arrangement, revealed deficits in all patient groups, including the good recovery leucotomized patients. This suggests impairment in the higher-order control and organization of perceptual material which may be secondary to orbital frontal white matter lesions or reflect aspects of the underlying schizophrenic disorder.
Frontal Lobe↗
Transorbital leucotomy in a state hospital program.
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Hospitals, State↗