H.T. Wycis

Stimulation of Forel's field during stereotaxic operations in the human brain

Abstract 1. 1. Increase or depression of Parkinson tremor may appear on stimulation of the prerubral area; this may be due partly to stimulation of pallidofugal fibers and partly of cerebello-rubro-thalamo-pallidal and of corticofugal fibers that pass through, or synapse in, the field H. 2. 2. Close to the prerubral field there are, in the human brain, cell groups or fibers of the cranial part of the oculomotor nucleus innervating the internal rectus muscle. 3. 3. Various vegetative effects were observed on stimulation of the field H: changes of the pupil, of the vasomotor system, of the heart rate and EKG, and appearance of a galvanic skin reaction. Apparently, hypothalamofugal fibers are stimulated; the participation of indirect stimulation of the hypothalamus cannot be excluded. 4. 4. Cortical recruitment responses could also be elicited; they are apparently chiefly due to stimulation of reticulo-thalamic fibers. A surface positive deflection may precede in records from the frontal lobe and is explained by stimulation of cerebello-rubro-thalamic fibers. 5. 5. This study shows the complexity of Forels field H that contains various systems of different physiologic significance.

Convulsions in tuberous sclerosis controlled byelimination of impulses originating in the basal ganglia

Summary Control of major and minor seizuresin a 10-year-old boy with tuberous sclerosis is reported. In conjunction with roentgenographic studies a striatal focus was located by depth electroencephalography, and circumscribed lesions were produced in this area and the corresponding ansa lenticularis. The recording as well as the coagulating electrodes were inserted by means of the steroencephalotome. The practical and theoretical implications of these observations are discussed.

Stimulation and elimination of the anterior thalamic nuclei in man and cat

Summary1. Stimulation of the anterior nucleus in anesthetized cats and man induces slowing or arrest of respiration. The effect upon the blood pressure in cats is variable, though a depressor effect is frequently observed.2. Stimulation of the anterior nucleus in unanesthetized cats produces a “reaction of alertness” (the head is raised, the eyes are opened, the animal looks around and starts to walk), probably by activating hypothalamic mechanisms.3. These reactions persist in cats after ablation of the cingular gyrus and of the fornix.4. The inhibition of respiration observed on stimulation of the cingular gyrus is not prevented by elimination of the anterior nucleus. Efferent impulses from the cingular gyrus seem to reach the lower centers partly by a pathway coursing outside the anterior nucleus and partly by fibers synapsing in this nucleus.5. Bilateral lesions of the anterior nuclei in cats produce a brief state of catalepsy followed by a transient period of reduced reactivity to threatening or painful stimuli.

Survey of the value of neurosurgical treatment for the relief of intractable pain

The common causes for intractable pain are presented. Minor and major neurosurgical procedures for its relief are listed. Table VIII Table VIII. Death within fourteenth days after various neurosergical procedures for the relief of intractable pain Operations No. No. of Deaths Cause of Deaths Chordotomy Unilateral 14 0 Bilateral 20 0 Rhizotomy Unilateral 7 0 Bilateral 9 0 Chordotomy and Rhizotomy 2 1 Bronchopneumonia (12 days) Rhizotomy, 5th and 9th cranial, C1, C2, C3 3 1 Postoperative shock (18 hr.) Medullary spinothalmic tractotomy 2 2 Medullary softening (24 hr.) cardiac metastasis with hemopericardium (6 days) Mesencephalic spinothalamic tractotomy 1 0 Sympathectomy 4 0 Total 62 4 (6.4%) The advantages and disadvantages of subarachnoid and paravertebral alcohol injections are compared with those of chordotomy, rhizotomy and sympathectomy. Fifty-seven cases of intractable pain in which operation was performed by the authors are then presented in the following groups: (1) malignancies, nasopharynx and neck, paraveretbral, gastrointestinal, pelvic and skeletal; (2) vascular: neurosyphilis with and without tabetic crises, causalgia with and without phantom pain, cardiac (angina); (3) miscellaneous: tuberculosis of the bladder, arachnoiditis, herpes zoster and fracture of the thoracic vertebra; (4) unknown etiology with neurosis. The relief of pain, mortality from operations and complications, are listed in tables. Each group is then analyzed and the results compared with those published by others. Conclusions were then made as to the relative merits of the various procedures and contraindications to their use. The possibilities of recent procedures such as resection of the sensory cortex and prefrontal lobotomy are discussed.

Studies in stereoencephalotomy II a new procedure for exploration and elimination of subcortical structures

Abstract A method is described for inserting stereotactically directed electrodes into the human brain under local anesthesia. This method is being used for the insertion into the subcortex of recording or stimulating electrodes and for production of subcortical lesions.

Somatic procedures for the relief of anxiety; a review.

Summary and Conclusions1.There is a unanimity of opinion that psychotherapy is the treatment of first choice for anxiety associated with the psychoneuroses. It is only when this approach has failed or cannot be utilized that any of the somatic procedures may be indicated.2.Insulin subshock therapy would seem to be definitely of benefit in allaying anxiety both in the neuroses and the psychoses.3.The work of D. E. Cameron on autonomous anxiety and its treatment by adrenalin-desensitization is valuable from a theoretical aspect and promising from the therapeutic angle.4.The use of the barbiturates to lessen tension and diminish anxiety has been amply reviewed and confirmed by many observers.5.In contradistinction: Electric shock therapy seems to have limited value in anxiety states, and, indeed, in some cases it is claimed that anxiety has been enhanced because of a residual fear of treatment.6.The now classical procedure of prefrontal lobotomy has unquestioned value in relieving anxiety-tension states but produces undesirable by-effects such as convulsions, diminution of intelligence, and “blunting of the personality” characterized by childishness, lack of foresight, impaired judgment and shallowness of feeling.7.The latest procedure is thalamotomy which is aimed to obtain the beneficial results of lobotomy, i. e, relief of tension and anxiety without the aforementioned undesirable complications.1. There is a unanimity of opinion that psychotherapy is the treatment of first choice for anxiety associated with the psychoneuroses. It is only when this approach has failed or cannot be utilized that any of the somatic procedures may be indicated. 2. Insulin subshock therapy would seem to be definitely of benefit in allaying anxiety both in the neuroses and the psychoses. 3. The work of D. E. Cameron on autonomous anxiety and its treatment by adrenalin-desensitization is valuable from a theoretical aspect and promising from the therapeutic angle. 4. The use of the barbiturates to lessen tension and diminish anxiety has been amply reviewed and confirmed by many observers. 5. In contradistinction: Electric shock therapy seems to have limited value in anxiety states, and, indeed, in some cases it is claimed that anxiety has been enhanced because of a residual fear of treatment. 6. The now classical procedure of prefrontal lobotomy has unquestioned value in relieving anxiety-tension states but produces undesirable by-effects such as convulsions, diminution of intelligence, and “blunting of the personality” characterized by childishness, lack of foresight, impaired judgment and shallowness of feeling. 7. The latest procedure is thalamotomy which is aimed to obtain the beneficial results of lobotomy, i. e, relief of tension and anxiety without the aforementioned undesirable complications. There is a unanimity of opinion that psychotherapy is the treatment of first choice for anxiety associated with the psychoneuroses. It is only when this approach has failed or cannot be utilized that any of the somatic procedures may be indicated. Insulin subshock therapy would seem to be definitely of benefit in allaying anxiety both in the neuroses and the psychoses. The work of D. E. Cameron on autonomous anxiety and its treatment by adrenalin-desensitization is valuable from a theoretical aspect and promising from the therapeutic angle. The use of the barbiturates to lessen tension and diminish anxiety has been amply reviewed and confirmed by many observers. In contradistinction: Electric shock therapy seems to have limited value in anxiety states, and, indeed, in some cases it is claimed that anxiety has been enhanced because of a residual fear of treatment. The now classical procedure of prefrontal lobotomy has unquestioned value in relieving anxiety-tension states but produces undesirable by-effects such as convulsions, diminution of intelligence, and “blunting of the personality” characterized by childishness, lack of foresight, impaired judgment and shallowness of feeling. The latest procedure is thalamotomy which is aimed to obtain the beneficial results of lobotomy, i. e, relief of tension and anxiety without the aforementioned undesirable complications.