PSYCHOSURGERY

the treatment of psychoses or other mental disorders by means of brain surgery. The first such technique was developed by a Portuguese neurologist, Antnio Egas Moniz, and the first operation was performed by his colleague, Almeida Lima, in 1935. The operation, called prefrontal lobotomy, or leucotomy, was based on experimental studies demonstrating that certain neurotic symptoms induced in chimpanzees could be modified by cutting brain fibres. Egas Moniz' original operation consisted of cutting two openings in the skull, one on each side above the temple, and then severing the nerve fibres connecting the thalamus with the frontal lobes of the brain. (See lobotomy.) Prefrontal lobotomy has come to be generally regarded as a radical procedure to be followed only after all other forms of treatment have proved ineffective and the patient remains severely distressed or tormented by his illness; since the introduction of antipsychotic drugs and tranquilizing agents, the condition of only a very few patients has warranted such a drastic measure. In the 1930s, '40s, and '50s psychosurgery was performed on patients who showed chronic agitation and severe distress, persistent depression, emotional aggressiveness, and excited and impulsive behaviour. Such patients frequently did show a reduction of such symptoms after the surgery, but they also exhibited reduced drive and initiative, increased apathy, and, in general, reduction in the depth and intensity of their emotional response to life. Radical psychosurgery of this type is almost never used now owing to the undesirable effects of the operation. In addition to antipsychotic drugs, psychosurgery that involves the placement of tiny lesions in specific areas of the brain and that has virtually no effect on intellectual function or on the so-called quality of life has also been developed. These techniques are used in cases of obsessive-compulsive behaviour and occasionally in cases of severe anxiety. This form of neurosurgery is also used in the management of chronic pain, such as that caused by damage to the nervous system or that associated with terminal cancer.