Psychosomatic Medicine 14:383-405 (1952)
© 1952 American Psychosomatic Society

Frontal Lobe Surgery in the Treatment of Pain

With Consideration of Postoperative Psychological Changes

¹ Psychiatric and Neurosurgical Services of the Massachusetts General Hospital Boston, Massachusetts

The results in terms of the relief of pain following bilateral leukotomy, bilateral lower quadrant leukotomy, unilateral leukotomy, and orbital gyrectomy are described.

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 twenty-three and eighteen months, 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 one patient followed for thirty-six months, 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 amount of spontaneous speech, decrease in the rate of speech in words per minute, and increase in the time interval prior to responding to the interviewer's questions. Three cases, followed for two years, twenty-two months, and nineteen months 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 neurophysiological effect of leukotomy in reducing pain.