A new approach to unilateral and bilateral lobotomies for psychomotor epilepsy

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Abstract
The new approach in the treatment of focal epilepsy is that of cutting tracts without removing tissue. The operative procedures that have been used in the present study are as follows: (1) section of the tracts leading through the isthmus of the temporal lobe; (2) section between the uncus and the main body of the hippocampus; and (3) section of fibres in the basal frontal lobe region sweeping backwards and upwards from the orbital surface of the frontal lobe. Of primary concern is the first operation which was aimed at benefiting not only the fits but the mental state of the patient. This operation alone was performed in 20 cases and improvement in the frequency of fits was most gratifying. Short attacks of confusion, depression and hypo-chondriacal concern, however, were not benefited. The depression and hypochondria were improved with operation No. 3 and the results of operation No. 2 on the minor attacks of confusion are encouraging but the follow-up has been too short for good evaluation. In general, unilateral operations are less successful than bilateral; neither produce any demonstrable or subjective intellectual deficit; and none of the procedures improved paranoid features. The findings presented in this study indicate that selective section of the deepest pathways reduced or abolished the spread of epileptic processes. In addition, these operative procedures produce no intellectual, memory, or character changes. This suggests that the connections that have not been cut still allow the cortical structures to perform some useful function.

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