tag:blogger.com,1999:blog-2186593343917545414.post4113413589992717439..comments2024-03-10T12:29:30.004-07:00Comments on pediatric neurology: Frontal lobotomyGalen Breningstall, MDhttp://www.blogger.com/profile/07170864203251456228noreply@blogger.comBlogger3125tag:blogger.com,1999:blog-2186593343917545414.post-30702706073010230302016-05-09T14:50:48.528-07:002016-05-09T14:50:48.528-07:00By the early 1930s, Egas Moniz had already left hi...By the early 1930s, Egas Moniz had already left his mark on the treatment of the human brain. His method of cerebral angiography allowed physicians to observe cranial blood flow for the first time. But on November 12, 1935, the Portuguese neurologist would attempt something more audacious: a surgery to relieve the suffering caused by severe mental disorders.<br /><br />His patient was a 63-year-old woman suffering from hallucinations, severe anxiety and crying spells, insomnia and paranoia (she believed her pharmacist and physician were trying to poison her). Few effective treatments were available for psychiatric patients at the time. Moniz believed that mental disorders were caused by “fixed thoughts” brought on by problems in nerve pathways in the brain’s frontal lobes. Because his hands were distorted by gout, he enlisted his colleague Almeida Lima to assist him with the experimental operation. Lima drilled holes on each side of the woman’s head, inserted a syringe and injected the prefrontal lobe of her brain with pure alcohol, rendering it permanently useless.<br /><br />A few months after the procedure, a psychiatrist who examined the patient noted that she still seemed somewhat sad, but that her anxiety and paranoia had decreased significantly. The operation, deemed a success, came to be called a lobotomy...<br /><br />Valenstein questions Moniz’s evidence that he cured many of the patients. But overcrowding in U.S. mental institutions made psychiatrists desperate for new treatments, and the lobotomy quickly became part of mainstream medicine. By one estimate, 60,000 lobotomies were performed in the United States between 1936 and 1956 on patients with a variety of diagnoses, such as depression and schizophrenia. Walter J. Freeman, a neurologist at George Washington University, became the procedure’s most enthusiastic practitioner. Freeman eventually developed his own version, the transorbital lobotomy, in which he inserted an ice pick into the brain by way of the patient’s eye socket, then pounded the tool with a mallet, rocking it back and forth to sever nerve fibers...<br /><br />Some patients did benefit from the procedure, recovering from previously untreatable depression, anxiety and other conditions. Yet complications included profound apathy, childish or uninhibited behavior and epilepsy. Freeman’s own records suggest that lobotomies killed or worsened the conditions of 14 percent of patients.<br /><br />http://protomag.com/articles/a-hole-in-the-headGalen Breningstall, MDhttps://www.blogger.com/profile/07170864203251456228noreply@blogger.comtag:blogger.com,1999:blog-2186593343917545414.post-10504095234105656792016-03-02T09:22:38.745-08:002016-03-02T09:22:38.745-08:00She was a young woman of beauty and grace, but dis...She was a young woman of beauty and grace, but displayed behavioural problems, as she fell behind her success-oriented siblings in academic and sporting life, through a mental disability that was long kept secret. Her father arranged one of the first prefrontal lobotomies for her at age 23, but it failed and left her permanently incapacitated. She spent the rest of her life in an institution in Jefferson, Wisconsin, with minimal contact from her family...<br /><br />Placid and easygoing as a child and teenager, the maturing Rosemary Kennedy became increasingly assertive and rebellious. She was also reportedly subject to violent mood swings. Some observers have since attributed this behavior to her difficulties in keeping up with siblings who were expected to perform to high standards, as well as the hormonal surges associated with puberty. In any case, the family had difficulty dealing with her stormy moods and reckless behavior. Rosemary had begun to sneak out at night from the convent school in Washington, D.C. where she was cared for and educated. Her normally placid personality and occasional erratic behavior frustrated her parents who expected all of their children to behave appropriately, be highly goal-oriented, and act competitively. Joseph P. Kennedy, Sr. was especially worried that his daughter's behavior would bring shame and embarrassment upon the family and possibly damage his political career.<br /> <br />In November 1941, when Rosemary Kennedy was 23, doctors told Joseph P. Kennedy, Sr. that a new neurosurgical procedure, lobotomy, would help calm her mood swings and stop her occasional violent outbursts. (About 80 lobotomies, 80% on women, had been performed in the United States at the time.) He decided that his daughter should have the lobotomy performed; however, he did not inform his wife Rose of this until after the procedure was completed. Rosemary was strapped to the operating table. James W. Watts, who carried out the procedure with Walter Freeman, of Wingdale Psychological and Correctional Facility, described what happened next (as narrated by Ronald Kessler): <br /><br />"We went through the top of the head, I think she was awake. She had a mild tranquilizer. I made a surgical incision in the brain through the skull. It was near the front. It was on both sides. We just made a small incision, no more than an inch." The instrument Dr. Watts used looked like a butter knife. He swung it up and down to cut brain tissue. "We put an instrument inside", he said. As Dr. Watts cut, Dr. Freeman put questions to Rosemary. For example, he asked her to recite the Lord's Prayer or sing "God Bless America" or count backwards..... "We made an estimate on how far to cut based on how she responded." ..... When she began to become incoherent, they stopped.<br /> <br />After the lobotomy, it quickly became apparent that the procedure was not successful. Kennedy's mental capacity diminished to that of a two-year-old child. She could not walk or speak intelligibly and was considered incontinent.<br /> <br />After the procedure, Rosemary was immediately institutionalized where she remained for the rest of her life. She initially lived for several years at Craig House, a private psychiatric hospital an hour north of New York City.[19] In 1949, she moved to a house in Jefferson, Wisconsin, where she lived for the rest of her life on the grounds of the St. Coletta School for Exceptional Children (formerly known as "St. Coletta Institute for Backward Youth").<br /><br />https://en.wikipedia.org/wiki/Rosemary_KennedyGalen Breningstall, MDhttps://www.blogger.com/profile/07170864203251456228noreply@blogger.comtag:blogger.com,1999:blog-2186593343917545414.post-28018712237125483692016-03-02T08:45:17.385-08:002016-03-02T08:45:17.385-08:00Gross D, Schäfer G. Egas Moniz (1874-1955) and the...Gross D, Schäfer G. Egas Moniz (1874-1955) and the "invention" of modern psychosurgery: a historical and ethical reanalysis under special consideration of Portuguese original sources. Neurosurg Focus. 2011 Feb;30(2):E8.<br /><br />Abstract<br /><br /><br />The Portuguese neurologist Egas Moniz (1874-1955) is often regarded as the founder of psychosurgery. He performed the first prefrontal leukotomy in 1935—about 75 years ago—with the help of neurosurgeon Almeida Lima (1903–1985) [corrected]. In contrast to the psychosurgical interventions performed by the Swiss psychiatrist Gottlieb Burckhardt (1836-1907), Moniz's interventions on the white brain substance caught great attention worldwide. As a matter of fact, it was this repercussion that led to the award of the Nobel Prize for Medicine in 1949, an award that is still highly controversial today. The goal of the present article is to reconstruct the historical background of the first leukotomies, the tangible expert debate since 1935 on the indication and legitimacy of these interventions, and their contemporary and recent (ethical) evaluation. Special focus will be set on the original Portuguese literature, which has been given too little attention thus far in the English-language literature.Galen Breningstall, MDhttps://www.blogger.com/profile/07170864203251456228noreply@blogger.com