Modified Frontal Leucotomy: A Review of 106 Cases

¹ Senior Registrar, Maudsley Hospital, London, S.E.5

The 106 patients originally seen at St. Thomas's Hospital who subsequently had a modified prefrontal leucotomy between the years 1950 and 1957 were followed up for an average period of five years. Fifty-five patients were considerably improved. Twenty-six patients showed some improvement. Twenty-four patients were unchanged, and one was worse.

Ninety-two patients were classified into three groups—obsessive compulsive (sixteen patients), "recurrent affective" (forty patients) and "single affective" (thirty-six patients). The first two groups of patients fared better than the "single affective" group. There was no significant association between the outcome and length of the illness, age at operation, and symptomatology. Personality changes were noted in twenty-eight patients, and were severe in six patients. Personality change was not associated with outcome. None of the patients whose personalities made them "operative risks" did well after the operation.

The results are discussed in the light of other studies and what is known of the "natural history" of the patients' disorders. It is concluded that prefrontal leucotomy appears to be of considerable value in certain psychiatric illnesses, but that further evaluation of the operation can best be done—perhaps can only be done—by controlled clinical trials.