The effect of prefrontal leucotomy on symptomatology : a study of fifty-two cases
1. A series of fifty -two chronic cases on whom prefrontal leucotomy was performed has been surveyed. over a period from nine months to two and a half years using the Sands and Malamud Rating Scale. A precise evaluation of the effect of leucotomy in each case has been obtained by comparing the post - leucotomy state with the premorbid profile. Scatter graphs for each item studied.- appearance, motor activity, responSivityy aggressiveness, socializ- ation, attention, speech, appetite, sexuality, sleep, work, mood, emotional tone, tension, awareness, ideation, thought content and memory - show the general effect of prefrontal leucotomy on symptomatology.2. In the schizophrenic group of twenty -eight cases (ten hebephrenics and eighteen katatonics) there was one death, twc female patients are considered recovered, twenty patients show _ improvement ranging from moderate to good, one hebephrenic was discharged but relapsed, and four showy little or no change. Ail the patients in this group were of the destructive, aggressive and impulsive type and a general finding was that behaviour improved, they were less resistive and more amenable to nursing -management.In the affective group of thirteen cases here uere ten discharge , two of whom relapsed. Personality c an.ges in two cases have been noted. The patients who have not been discharged from hospital have shown some degree of improvement. There were two deaths in this group, one directly due to operation and another two years after operation.In the paranoid group of five cases four are considered to have made social recoveriesThe psychopathic group of three cases has shown a poor response to operation. One case of hysteria improved but, over a period of about six months, gradually developed a personality change.One epileptic was operated on but died,soon afterwards.3. It is concluded that the effect of prefrontal leucotomy is to remove mental tension and that even in chronic deteriorated patients, improvement may occur. The association of mental tension with hallucinations and delusions and the effect of leucotomy on these features is discussed, but it has been noted that while the disturbed patients improve in some respects, there is little or riö change in the basic features of schizophrenia.The view is expressed that prefrontal _leucotomy should be reserved for cases with a duration of illness of at least five years and where other methods of treatment have failed to produce improvement. Where good remissions of reasonable duration occur, prefrontal leucotomy is inadvisable.