The Greatest Neuroscientific Blunders: The Rise and Fall of Lobotomy

December 13 marks the 61st day of death of António Egas Moniz. Having developed the surgical procedure "lobotomy" he received the Nobel Prize in 1949.
In remembrance of Moniz, todays post features an article that originally appeared August 2010 in Volume 3, Issue 2 "Special Focus on Technology Transfer".


Lobotomies were performed at a time when an effective treatment for chronically institutionalized

António Caetano de Abreu Freire Egas Moniz
29 November 1874 - 13 December 1955
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patients with different kinds of severe psychiatric disorders - such as schizophrenia, affective disorders and obsessive-compulsive syndromes (Swayze, 1995) did not exist. In this psycho-surgical procedure, connections from-and-to the prefrontal cortex were cut or frontal tissue was destroyed. The procedure was based on the theory that malformed or damaged nerves connecting the frontal lobe with the rest of the brain were the reason for psychiatric disorders.
Egas Moniz pioneered the lobotomy in 1935 after attending a frontal lobe symposium. In this symposium, it was reported that frontal and prefrontal cortical damage in chimpanzees led to a massive reduction in aggression. With the help of a neurosurgeon he performed his first so-called prefrontal leucotomy (white matter destruction) on a female manic depressive patient. A series of holes were drilled on either side of the woman's skull and ethanol was injected to destroy the fibers connecting the frontal lobe with the rest of the brain. Moniz reported that the patient was less anxious and paranoid and pronounced the operation a success. Subsequently, they used a special wire knife, called leucotome, to cut out small cores of brain tissue.

LOBOTOMY WAS QUICKLY ACCEPTED 

AS A LEGITIMATE THERAPY

Being intrigued by Moniz's work, Walter Freeman introduced the lobotomy to the United States in 1936. Together with neurosurgeon James Watts he first refined the technique developed by Moniz and called it lobotomy (white and grey matter destruction). However, Freeman considered the procedure too time-consuming and not easily available to those that need it the most: Patients in state mental hospitals having no operating rooms, surgeons, or anesthesia. He developed the transorbital lobotomy, the worst form of psychosurgery, which was also known as the ice-pick lobotomy. With the patient rendered unconscious by electroshock, an ice-pick like instrument was hammered through the eye socket. Once inside the brain, the instrument was moved back and forth; this was then repeated on the other side. This new technique could be performed in 10 minutes without a neurosurgeon — and became subject to widespread use. Even children were treated by Freeman. Despite the award of the Nobel prize to Moniz in 1949, the lobotomy procedure was largely discredited and finally replaced by the antipsychotic drug chlorpromazine in the 1950s.

THE PROCEDURE WAS DISCREDITED IN THE 1950s

The lobotomy technique was performed without any immediate means to verify the success of the resulting operation - the neurosurgeons could not know for certain if they had severed the nerves or not. Thus a lobotomy usually led to mixed results with many patients being permanently disabled. Convulsive seizures were reported subsequent to a prefrontal lobotomy in 5 to 10 percent of all cases. Post-operative blunting of the personality, apathy, and irresponsibility were a common occurrence rather than a rare exception. Other side effects included destructivness, childishness, lack of tact or discipline, and post-operative incontinence. The most famous case was the lobotomy of Rosemary Kennedy, the sister of President John F. Kennedy. Her father, Joseph Kennedy, had complained to doctors about the 23-year-old's moodiness which eventually led to her being subjected to a lobotomy. However, instead of improving her mental state the procedure resulted in Rosemary being reduced to an infantile state which included incontinence. Her father hid the nature of Rosemary's affliction for years and described it as the result of mental retardation.
As there were no alternative therapies for severe mental disorders in the 1930s, it is not surprising that the lobotomy was quickly accepted as a legitimate therapy and was considered a therapeutic advance. However, from today's point of view, the lobotomy is seen as a brutal intervention into the brain, a region unique to human beings and the seat of all higher cognitive functions. When considering the lobotomy one can not help but agree with Swayze (1995) who wrote: "If we learn nothing else from that era, it should be recognized that more rigorous, prospective long-term studies of psychiatric outcome are essential to assess the long-term outcomes of our treatment methods."

 by Nicole Hentschel