Saturday, June 17, 2006

Surgical interventions to the frontal lobes before Egas Moniz started leucotomy

It was known that it is possible to remove one of the frontal lobes, left or right, without severe consequences to psychic integrity. At most the perturbations are transitory, the remaining lobe performs the function of the excised lobe.

Penfield and Evans had performed the excision of the left frontal lobe in a man 22 years old with epileptic seizures. The patient became mentally confused and also space and time disoriented during the first week after the operation. Those symptoms regressed progressively and six months later the patient had return to normal behaviour.

Wilder Penfield also removed the two frontal lobes on a patient with a large brain tumor.

Richard Brickner removed large portions of the two frontal lobes for the excision of a meningioma. He noticed pronounced changes of the mental activity. The patient forgot previous experiences and became like a child who had to learn again how to behave socially. The patient recovered progressively, however, with the preservation of a large part of his psychic functions, keeping essentially his personality although more childish in some regards.

An estonian surgeon, Ludwig Puusepp, reported in 1937 that years earlier he had severed the neural links between the frontal and the parietal lobes in three patients with manic depression. The surgery, however, had done no good . Later he performed leucotomy-like operations on fourteen patients with generally good results (Jack el-Hai in “The Lobotomist”, John Wiley & Sons, Inc.).