Frontal Lobe Surgery in the Treatment of Pain

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Abstract
The results in terms of the relief of pain following bilateral leukotomy, bilateral lower quadrant leukotomy, unilateral leukotomy, and orbital gyrectomy are descr. Following bilateral leukotomy in 6 patients severe psychological changes were noted which consisted largely of deterioration of the patients'' behavior and impaired judgment. These were most severe immediately following operation, improving with the passage of time. Two patients, followed for 23 and 18 mos., are reported. Following bilateral lower quadrant leukotomy in 9 patients apathy was the predominant feature noted immediately postoperatively, and, although there was improvement with the passage of time, in the 1 patient followed for 36 mos. it was still a predominant feature. Following unilateral leukotomy in 19 patients the psychological changes noted were on the whole slight in degree and, as with the previous groups, improved with the passage of time. The changes most frequently noted were slight flattening of affect, inappropriate affect, decrease in the amt. of spontaneous speech, decrease in the rate of speech in words/min., and increase in the time interval prior to responding to the interviewer''s questions. Three cases are reported. A preliminary chart is included on 6 patients, showing the major changes following unilateral and bilateral excision of the orbital cortex. Patients leukotomized for pain seem to suffer more mental deficit than those leukotomized for psychosis. A theory is promulgated to explain the neurophysiolog-ical effect of leukotomy in reducing pain.

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