In 1936, Egas Moniz published his first paper on frontal leucotomy for psychiatric illness. The initial enthusiasm for this innovative treatment of intractable psychiatric disorders and chronic pain was soon tempered by reports of undesirable side-effects, and neurosurgeons began a search for modifications of leucotomy which would increase safety without reducing efficacy. As a result of these clinical investigations, the original imprecise, radical frontal leucotomy has been superseded by precise, small stereotactically placed lesions in the limbic system and the descriptive phase "limbic system surgery" is replacing the out-moded word "psychosurgery". This presentation will document some of the more important contributions to a currently under-utilized, often criticized approach to the treatment of suffering individuals chronically disabled by psychiatric illness and pain.
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When Walter Freeman Came to Town: The Prefrontal Lobotomy at Rochester State Hospital.
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In the United States, frontal lobe lesioning procedures have been uniformly linked to the neurologist Walter Freeman, although the prefrontal lobotomy was investigated in other institutions in the United States, the United Kingdom, Europe, Russia, Japan, and China, mostly in patients with psychosis, obsessive-compulsive disorder, and/or intractable pain syndromes. These procedures were based on earlier reports of improvement of psychiatric symptoms after surgical resection of frontal lobe tumors and led many to infer a causal relationship between frontal lobe dysfunction and abnormal behavior. Freeman first visited Rochester, MN, as a medical student in a gastrointestinal laboratory at the Mayo Clinic.
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