1. In this prospective study, forty patients who had undergone stereotactic limbic leucotomies, were assessed clinically, psychologically and physiologically, before and six weeks following operation. All of the patients were suffering from severe and long-standing illness and had failed to respond to a great deal of previous therapy, including, in nine patients, previous leucotomy operations of a more extensive type.
The patients' mean duration of symptoms was 11 years and their mean number of hospital admissions was 4.5. All but four had received at least one course of ECT, twenty-four had undergone one or more courses of modified narcosis, combined with ECT and anti-depressants, and twenty-seven had received formal psychotherapy or psychoanalysis.
2. The overall improvement was 67 per cent, with 76 per cent improvement in obsessional neurosis, 80 per cent in depression, 55 per cent in chronic anxiety and 66 per cent in schizophrenia.
3. There was significant improvement on the psychometric scales measuring Neuroticism (Maudsley Personality Inventory), Anxiety (Taylor and Hamilton Scales, and Middlesex Hospital Questionnaire), Depression (Beck and Hamilton Scales, and M.H.Q.), Phobias Obsessions, and Somatic Complaints (M.H.Q.) Self and observer ratings of depression were significantly reduced, as were observer ratings of anxiety.
4. Physiologically, the patients were less aroused following limbic leucotomy, as evidenced by significant reductions in mean `basal' forearm blood flow, heart rate, systolic and diastolic blood pressures. The mean values of heart rate, systolic and diastolic blood pressures in response to stress were also significantly reduced, and the `stress' forearm blood flow just failed to reach significance at the p < 0.05 level.
5. There was no fall-off in intelligence following limbic leucotomy, as shown by a mean increase (probably due to practice effects) on the verbal, performance and full-scale scores on the Wechsler Adult Intelligence Scale, and no significant reductions in any of the sub-scales. No other adverse effects of limbic leucotomy were seen at six weeks.
6. The results of the present series compare favourably with those of a previous study, in which similar methods were used to assess the results of more extensive leucotomy operations.
7. Surgically, limbic leucotomy has the advantage of causing a minimum of tissue damage, far less than that in modified pre-frontal and rostral operations. If, therefore, it produces comparable results, it is a considerable advance. It will, however, require long-term assessment.
8. An on-going study is being carried out, in which the patients described in this paper, and those on whom operations are being subsequently carried out, are assessed clinically, psychologically and physiologically at one year. They are also being seen before and one year following operation, by an extremely experienced independent assessor.