Treatment of Psychoses with Bilateral Ablation of a Focal Area of the Frontal Cortex

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Abstract
The results of excising discrete areas of frontal cortex bilaterally (topectomy) are reported for 2 series of patients. One series (part of the Greystone Project) consisted of 24 chronic psychotic patients who had proved resistant to conventional therapy. In these patients there was bilateral extirpation of different areas and combination of areas of frontal cortex. A control group of 24 additional patients were anesthetized and led to believe they had received a brain operation in order to determine the effect of total push. 7.5 months after operation, 11 of the 24 topectomized patients had left the hospital and 10 of these had regained their pre-illness level of function. After the same interval only 2 of the control group were able to function adequately outside the hospital environment. In all patients showing definite post-operative improvement, Brodmann''s areas 9 and/or 10 were included in the removal. Patients with the extirpation of other brain areas showed little change in behavior. The symptoms of tactlessness, irresponsibility and lack of remorse which so often follow conventional lobotomy did not occur when excision was restricted to areas 9 and/or 10, or when the total area excised was of smaller surface area than 9 and 10 combined. Best results to date have been obtained with the removal of the posterior part of area 10 and the anterior part of area 9. Consistent changes in affective response resulted from the removal of these areas. Although emotions were still felt, they no longer dominated the patient, did not cause the accumulation of tensions, and were more readily and appropriately discharged. Psychologic tests showed a post-operative improvement in over-all intellectual function, and little or no loss in the ability for abstract thinking. Even more striking results have been obtained on a series of 15 private patients in which areas 9 and/or 10 were removed. 13 of these 15 patients are now out of institutions and 10 are functioning at pre-illness capacity.

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