Clinical and Electroencephalographic Effects of Prefrontal Lobotomy and Topectomy in Chronic Psychoses

Abstract

Case Material and Procedures.\p=m-\Withthe exception of one patient with manic-depressive psychosis, all had chronic advanced schizophrenia of paranoid, hebephrenic, or catatonic type. A comparative study of the effects of prefrontal lobotomy and topectomy seemed to be particularly applicable in a rather homogeneous group of patients with advanced schizophrenia.A selection of the patients for one or the other procedure was deliberately avoided. All 105 patients\p=m-\84 from the Northport Veterans Administration Hospital, 17 from the Canandaigua Veterans Administration Hospital, and four from other hospitals\p=m-\wereselected for psychosurgical procedures by the lobotomy boards of the various hospitals, according to several criteria. The duration of illness was at least two or three years, with an average duration of five years. All patients had had previous treatment, consisting of institutional care, electric shock, or insulin coma, resulting in little or no improvement. Most patients came from the wards for disturbed patients and constituted grave problems in management. Their symptoms ranged from violent, destructive, assaultive, homicidal, suicidal, or agitated behavior to apathy, complete withdrawal, and marked deterioration, with lack of control of bodily functions. Several patients had required prolonged tube feeding, and many had been under continuous medical sedation or pack therapy for a long period. The prognosis was considered extremely poor in all cases. The majority of the patients, mostly of similar social background, were young to middle-aged male veterans of World War II, with an average age of approximately 30. After transfer to the Bronx Veterans Administration Hospital, the patients were reevaluated for the advisability of psychosurgery after a preoperative observation period of two to four weeks, during which time various laboratory procedures and psychological tests were per-

An Unusual Neurological Side Effect of Psychotropic Drug Treatment

“…and inhibition of spindle activity in the sleep EEG., the site of action of butaperazine and other piperazine-phenothiazines was also postulated to be on the reticular formation at brainstem level (1, 13). Since studies in man and animals have shown that the frontal lobotomy operation may result in thalamocortical dysfunction and thalamic degeneration (8,10,18,19,21,24,25), in our case, the functional interaction between thalamus, basal ganglia, and reticular formation was already disturbed by possible degenerative changes in the thalamus. It would seem reasonable to suggest, therefore, that the episodes of akinetic mutism were associated with drug-induced functional alterations in the reticular formation at brainstem or thalamic level as a result of thalamic dysfunction.…”

Sleep Spindles – As a Biomarker of Brain Function and Plasticity

“…The ipsilateral spindle depression following unilateral frontal leucotomy was first observed [125][126]. Cress and Gibbs (1948) observed spindle asymmetries (ipsilateral depression) in 98 % of patients with hemispheric cerebrovascular accidents, whereas only 48% had focal abnormalities in the waking EEG [127].…”

Advances in Clinical Neurophysiology

“…Spindle distribution may be locally depressed by various types of cortical, subcritical pathology, including the generation of ascending reticular formation and thalamo-cortical pathways. The ipsilateral spindle depression following unilateral frontal leucotomy was first observed [125][126]. Cress and Gibbs (1948) observed spindle asymmetries (ipsilateral depression) in 98 % of patients with hemispheric cerebrovascular accidents, whereas only 48% had focal abnormalities in the waking EEG [127].…”