Q J Med 2001; 94: 449
© 2001 Association of Physicians
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Bilateral frontal lobe lesions
For the accompanying Historical note please see page 451.
Department of Geriatrics, Peterborough District Hospital
An 87-year-old lady with depression was admitted with suspected head injury following a fall from her wheelchair. CT head scan showed marked bilateral low attenuation with cystic changes within the white matter of both frontal lobes, compatible with the patient's known history of leucotomy in 1964.
The Portuguese neurologist Egas Moniz received the Nobel Prize for Medicine in 1949 for his discovery and popularization of the prefrontal lobotomy. This radical surgery was the product of the prevailing attitudes of the times and the professional rivalry between psychiatrists and neurologists. Fuelled by a large number of uncontrolled studies reporting considerable therapeutic benefit, this surgery was performed until the late 1960s. Relatives were usually asked for their consent, but the information they received was often questionable.1 Evidence-based medicine offers little support for leucotomy.2
The history of leucotomy is an interesting example of medicine regarding as useful a treatment method which present day consensus evaluates in a contrary fashion. In the context of an era when no efficacious treatments were available for psychosis, was its use justified?
References
1. Ersland S, Kringlen E, Waal H, Thaulow JF. Lobotomy at the Gaustad Hospital. Tidsskr Nor Laegeforen 1993; 113:2092–5.[Medline]
2. White RT, Stedman T. Evidence-based medicine offers little support for psychosurgery. Aust N Z J Psychiatry 1998; 324:60–3.
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