Treatment of schizophrenia: III. A survey of the literature on prefrontal leucotomy

May, Philip R. A.

doi:10.1016/0010-440x(74)90037-6

Cited by 8 publications

(2 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Lesioning of these structures probably explains the known side effects of lobotomy, such as emotional flattening, postoperative seizures, and changes to cognitive function and personality. 25,28,29,43,54,88 In fact, the original development of stereotactic psychiatric lesioning procedures in part aimed to avoid thalamofrontal connections to minimize the adverse effect of emotional flattening. 43 …”

Section: Discussionmentioning

confidence: 99%

Lesion analysis for cingulotomy and limbic leucotomy: comparison and correlation with clinical outcomes

Yang

Ginat

Dougherty

et al. 2014

JNS

View full text Add to dashboard Cite

Object Cingulotomy and limbic leucotomy are lesioning surgeries with demonstrated benefit for medically intractable psychiatric illnesses. They represent significant refinements of the prefrontal lobotomy used from the 1930s through the 1950s. However, the associations between anatomical characterization of these lesions and outcome data are not well understood. To elucidate these procedures and associations, the authors sought to define and compare the neuroanatomy of cingulotomy and limbic leucotomy and to test a method that uses neuroanatomical data and voxel-based lesion–symptom mapping (VLSM) to reveal potential refinements to modern psychiatric neurosurgical procedures. Methods T1-weighted MR images of patients who had undergone cingulotomy and limbic leucotomy were segmented and registered onto the Montreal Neurological Institute T1-weighted template brain MNI152. Using an atlas-based approach, the authors calculated, by case, the percentage of each anatomical structure affected by the lesion. Because of the infrequency of modern lesion procedures and the requirement for higher-resolution clinical imaging, the sample size was small. The pilot study correlated cingulotomy and limbic leucotomy lesion characteristics with clinical outcomes for patients with obsessive-compulsive disorder. For this study, preoperative and postoperative Yale-Brown Obsessive Compulsive Scale scores for 11 cingulotomy patients and 8 limbic leucotomy patients were obtained, and lesion masks were defined and compared anatomically by using an atlas-based method. Statistically significant voxels were additionally calculated by using VLSM techniques that correlated lesion characteristics with postoperative scores. Results Mean lesion volumes were 13.3 ml for cingulotomy and 11.8 ml for limbic leucotomy. As expected, cingulotomy was isolated to the anterior cingulum. The subcaudate tractotomy portion of limbic leucotomy additionally affected Brodmann area 25, the medial orbitofrontal cortex, and the nucleus accumbens. Initial results indicated that the dorsolateral regions of the cingulotomy lesion and the posteroventral regions of the subcaudate tractotomy lesion were associated with improved postoperative Yale-Brown Obsessive Compulsive Scale scores. Conclusions Cingulotomy and limbic leucotomy are lesioning surgeries that target pathological circuits implicated in psychiatric disease. Lesion analysis and VLSM contextualize outcome data and have the potential to be useful for improving lesioning neurosurgical procedures.

show abstract

Section: Discussionmentioning

confidence: 99%

Lesion analysis for cingulotomy and limbic leucotomy: comparison and correlation with clinical outcomes

Yang

Ginat

Dougherty

et al. 2014

JNS

View full text Add to dashboard Cite

show abstract

“…The most commonly used procedure has been the prefrontal lobotomy and other discrete ablations of frontal lobe and other mesocortical areas. As reviewed by Sweet (1973) and May (1974), there was some evidence for a nonspecific effect in schizophrenia, especially for affective symptoms, but the results were not impressive and such operations have virtually disappeared. Cingulotomy is also thought to have value for affective symptoms in some schizophrenic patients (Ballantine et al 1987).…”

Section: Other Approaches To Treatment-resistant Schizophreniamentioning

confidence: 99%

Treatment of the Neuroleptic-Nonresponsive Schizophrenic Patient

Meltzer

1992

Schizophrenia Bulletin

296

129

View full text Add to dashboard Cite

The treatment and management of neuroleptic-resistant schizophrenic patients, who comprise 5 to 25 percent of all patients with that diagnosis, are major problems for psychiatry. In addition, another large group of schizophrenic patients, perhaps 5 to 20 percent, are intolerant of therapeutic dosages of neuroleptic drugs because of extrapyramidal symptoms, including akathisia, parkinsonism, and tardive dyskinesia. Because about 60 percent of neuroleptic-resistant schizophrenic patients respond to clozapine and a large percentage of neuroleptic-intolerant patients are able to tolerate clozapine, it should be considered the treatment of choice for such patients until other therapies are proven to be superior. A trial of clozapine alone should usually be continued for up to 6 months before it is terminated or supplemental agents are tried. Plasma levels of clozapine may be useful to guide dosage. The major side effects of clozapine are granulocytopenia or agranulocytosis (1%-2%) and a dose-related increase in the incidence of generalized seizures. Psychosocial treatments such as education of the patient and the family about the nature of the illness, rehabilitation programs, social skills training, and assistance in housing are generally needed to obtain optimal benefit from clozapine, as with other somatic therapies. If clozapine is unavailable, unacceptable, or not tolerated, a variety of approaches may be employed to supplement typical antipsychotic drugs for patients who do not respond adequately to these agents alone. These include lithium; electroconvulsive therapy; carbamazepine or valproic acid; benzodiazepines; antidepressant drugs; reserpine; L-dopa and amphetamine; opioid drugs; calcium channel blockers; and miscellaneous other pharmacologic approaches. The evidence for the efficacy of these ancillary somatic therapies in treatment-resistant patients is relatively weak. Polypharmacy should be tried only for discrete periods and with clear goals. If these are not achieved, supplemental medications should be discontinued. Psychosurgery is not a recommended alternative at this time.

show abstract

Psychosurgery and the Porteus Maze Tests

Riddle¹

1978

Arch Gen Psychiatry

View full text Add to dashboard Cite

Treatment of schizophrenia: III. A survey of the literature on prefrontal leucotomy

Cited by 8 publications

References 24 publications

Lesion analysis for cingulotomy and limbic leucotomy: comparison and correlation with clinical outcomes

Lesion analysis for cingulotomy and limbic leucotomy: comparison and correlation with clinical outcomes

Treatment of the Neuroleptic-Nonresponsive Schizophrenic Patient

Psychosurgery and the Porteus Maze Tests

Contact Info

Product

Resources

About