Strange but True: When Half a Brain Is Better than a Whole OneYou might not want to do it, but removing half of your brain will not significantly impact who you areMay 24, 2007 |By Charles Choi

COURTESY OF JOHNS HOPKINS CHILDREN'S CENTER The operation known as hemispherectomy—where half the brain is removed—sounds too radical to ever consider, much less perform. In the last century, however, surgeons have performed it hundreds of times for disorders uncontrollable in any other way. Unbelievably, the surgery has no apparent effect on personality or memory.The first known hemispherectomy was performed on a dog in 1888 by German physiologist Friedrich Goltz. In humans, neurosurgeon Walter Dandy pioneered the operation at Johns Hopkins University in 1923 on a brain tumor patient. (That man lived for more than three years before ultimately succumbing to cancer.) The procedure is among the most drastic kinds of brain surgery—"You can't take more than half. If you take the whole thing, you've got a problem," Johns Hopkins neurologist John Freeman quips.

One side effect Canadian neurosurgeon Kenneth McKenzie reported in 1938 after a hemispherectomy on a 16-year-old girl who suffered a stroke was that her seizures stopped. Nowadays, the surgery is performed on patients who suffer dozens of seizures every day that resist all medication, and which are due to conditions that mostly afflict one hemisphere. "These disorders are often progressive and damage the rest of the brain if not treated," University of California, Los Angeles, neurosurgeon Gary Mathern says. Freeman concurs: "Hemispherectomy is something that one only does when the alternatives are worse."

Anatomical hemispherectomies involve the removal of the entire hemisphere, whereas functional hemispherectomies only take out parts of a hemisphere, as well as severing the corpus callosum, the fiber bundle that connects the two halves of the brain. The evacuated cavity is left empty, filling with cerebrospinal fluid in a day or so.

The strength of anatomical hemispherectomies, a specialty of Hopkins, lies in the fact that "leaving even a little bit of brain behind can lead seizures to return," Freeman says. On the other hand, functional hemispherectomies, which U.C.L.A. surgeons usually perform, lead to less blood loss. "Our patients are usually under two years of age, so they have less blood to lose," Mathern says. Most Hopkins hemispherectomy patients are five to 10 years old.

Neurosurgeons have performed the operation on children as young as three months old. Astonishingly, memory and personality develop normally. A recent study found that 86 percent of the 111 children who underwent hemispherectomy at Hopkins between 1975 and 2001 are either seizure-free or have nondisabling seizures that do not require medication. The patients who still suffer seizures usually have congenital defects or developmental abnormalities, where brain damage is often not confined to just one hemisphere, Freeman explains.

Another study found that children that underwent hemispherectomies often improved academically once their seizures stopped. "One was champion bowler of her class, one was chess champion of his state, and others are in college doing very nicely," Freeman says.

Of course, the operation has its downside: "You can walk, run—some dance or skip—but you lose use of the hand opposite of the hemisphere that was removed. You have little function in that arm and vision on that side is lost," Freeman says.

Remarkably, few other impacts are seen. If the left side of the brain is taken out, "most people have problems with their speech, but it used to be thought that if you took that side out after age two, you'd never talk again, and we've proven that untrue," Freeman says. "The younger a person is when they undergo hemispherectomy, the less disability you have in talking. Where on the right side of the brain speech is transferred to and what it displaces is something nobody has really worked out."

Mathern and his colleagues have recently conducted the first functional magnetic resonance imaging study into hemispherectomy patients, investigating how their brain changes with physical rehabilitation. Probing how the remaining cerebral hemispheres of these patients acquire language, sensory, motor and other functions "could shed a great deal of light on the brain's plasticity, or ability to change," Freeman notes. Still, having half a brain—and therefore only the use of one hand and half a field of vision in each eye—is a condition most would prefer to avoid.

'My Lobotomy': Howard Dully's Journey November 16, 200512:00 AM ET NPR.ORG

On Jan. 17, 1946, a psychiatrist named Walter Freeman launched a radical new era in the treatment of mental illness in this country. On that day, he performed the first-ever transorbital or "ice-pick" lobotomy in his Washington, D.C., office. Freeman believed that mental illness was related to overactive emotions, and that by cutting the brain he cut away these feelings.

Freeman, equal parts physician and showman, became a barnstorming crusader for the procedure. Before his death in 1972, he performed transorbital lobotomies on some 2,500 patients in 23 states.

One of Freeman's youngest patients is today a 56-year-old bus driver living in California. Over the past two years, Howard Dully has embarked on a quest to discover the story behind the procedure he received as a 12-year-old boy.

Last Resort: Psychosurgery and the Limits of Medicine by Jack Pressman (Cambridge University Press, 1998)

In researching his story, Dully visited Freeman's son; relatives of patients who underwent the procedure; the archive where Freeman's papers are stored; and Dully's own father, to whom he had never spoken about the lobotomy.

"If you saw me you'd never know I'd had a lobotomy," Dully says. "The only thing you'd notice is that I'm very tall and weigh about 350 pounds. But I've always felt different — wondered if something's missing from my soul. I have no memory of the operation, and never had the courage to ask my family about it. So two years ago I set out on a journey to learn everything I could about my lobotomy."Neurologist Egas Moniz performed the first brain surgery to treat mental illness in Portugal in 1935. The procedure, which Moniz called a "leucotomy," involved drilling holes in the patient's skull to get to the brain. Freeman brought the operation to America and gave it a new name: the lobotomy. Freeman and his surgeon partner James Watts performed the first American lobotomy in 1936. Freeman and his lobotomy became famous. But soon he grew impatient.

"My father decided that there must be a better way," says Freeman's son, Frank. Walter Freeman set out to create a new procedure, one that didn't require drilling holes in the head: the transorbital lobotomy. Freeman was convinced that his 10-minute lobotomy was destined to revolutionize medicine. He spent the rest of his life trying to prove his point.

As those who watched the procedure described it, a patient would be rendered unconscious by electroshock. Freeman would then take a sharp ice pick-like instrument, insert it above the patient's eyeball through the orbit of the eye, into the frontal lobes of the brain, moving the instrument back and forth. Then he would do the same thing on the other side of the face.

Freeman performed the procedure for the first time in his Washington, D.C., office on Jan. 17, 1946. His patient was a housewife named Ellen Ionesco. Her daughter, Angelene Forester, was there that day.

"She was absolutely violently suicidal beforehand," Forester says of her mother. "After the transorbital lobotomy there was nothing. It stopped immediately. It was just peace. I don't know how to explain it to you, it was like turning a coin over. That quick. So whatever he did, he did something right."

Ellen Ionesco, now 88 years old, lives in a nursing home in Virginia. "He was just a great man. That's all I can say," she says. But Ionesco says she remembers little about Freeman, including what he looked like.

By 1949, the transorbital lobotomy had caught on. Freeman lobotomized patients in mental institutions across the country.

"There were some very unpleasant results, very tragic results and some excellent results and a lot in between," says Dr. Elliot Valenstein, who wrote Great and Desperate Cures, a book about the history of lobotomies.Valenstein says the procedure "spread like wildfire" because alternative treatments were scarce. "There was no other way of treating people who were seriously mentally ill," he says. "The drugs weren't introduced until the mid-1950s in the United States, and psychiatric institutions were overcrowded... [Patients and their families] were willing to try almost anything."

By 1950, Freeman's lobotomy revolution was in full swing. Newspapers described it as easier than curing a toothache. Freeman was a showman and liked to shock his audience of doctors and nurses by performing two-handed lobotomies: hammering ice picks into both eyes at once. In 1952, he performed 228 lobotomies in a two-week period in West Virginia alone. (He lobotomized 25 women in a single day.) He decided that his 10-minute lobotomy could be used on others besides the incurably mentally ill.

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Anna Ruth Channels suffered from severe headaches and was referred to Freeman in 1950. He prescribed a transorbital lobotomy. The procedure cured Channels of her headaches, but it left her with the mind of a child, according to her daughter, Carol Noelle. "Just as Freeman promised, she didn't worry," Noelle says. "She had no concept of social graces. If someone was having a gathering at their home, she had no problem with going in to their house and taking a seat, too."

Howard Dully's mother died of cancer when he was 5. His father remarried and, Dully says, "My stepmother hated me. I never understood why, but it was clear she'd do anything to get rid of me."

A search of Dully's records among Freeman's files archived at George Washington University turned up clues about why Freeman lobotomized him.

According to Freeman's notes, Lou Dully said she feared her stepson, whom she described as defiant and savage looking. "He doesn't react either to love or to punishment," the notes say of Howard Dully. "He objects to going to bed but then sleeps well. He does a good deal of daydreaming and when asked about it he says 'I don't know.' He turns the room's lights on when there is broad sunlight outside."

On Nov. 30, 1960, Freeman wrote: "Mrs. Dully came in for a talk about Howard. Things have gotten much worse and she can barely endure it. I explained to Mrs. Dully that the family should consider the possibility of changing Howard's personality by means of transorbital lobotomy. Mrs. Dully said it was up to her husband, that I would have to talk with him and make it stick."

Then on Dec. 3, 1960: "Mr. and Mrs. Dully have apparently decided to have Howard operated on. I suggested [they] not tell Howard anything about it."

In an entry dated Jan. 4, 1961, two and a half weeks after the boy's lobotomy, Freeman wrote: "I told Howard what I'd done to him... and he took it without a quiver. He sits quietly, grinning most of the time and offering nothing."

Dully says that when Lou Dully realized the operation didn't turn him "into a vegetable, she got me out of the house. I was made a ward of the state.

"It took me years to get my life together. Through it all I've been haunted by questions: 'Did I do something to deserve this?, Can I ever be normal?', and most of all, 'Why did my dad let this happen?'"

For more than 40 years, Howard Dully had never discussed the lobotomy with his father. In late 2004, Rodney Dully agreed to talk with his son about the operation.

"So how did you find Dr. Freeman?" Howard Dully asks.

"I didn't," Rodney Dully replies, adding that Lou Dully was the one. "She took you... I think she tried some other doctors who said, '...there's nothing wrong here. He's a normal boy.' It was the stepmother problem."

Why would a father let this happen to his son?

"I got manipulated, pure and simple," Rodney Dully says. "I was sold a bill of goods. She sold me and Freeman sold me. And I didn't like it."

The meeting proves cathartic for Howard Dully. "Although he refuses to take any responsibility, just sitting here with my dad and getting to ask him about my lobotomy is the happiest moment of my life," Howard Dully says.

Rebecca Welch's mother Anita was lobotomized by Freeman for postpartum depression in 1953. After spending most of her life in mental institutions, Anita McGee now lives in a

nursing home in Birmingham, Ala. Rebecca visits her every week. She believes Walter Freeman's lobotomy destroyed her mother's life.

"I personally think that something in Dr. Freeman wanted to be able to conquer people and take away who they were," Welch says.

At a meeting in the nursing home, Welch and Howard Dully find common ground in their experiences with Freeman. "It does wonders to know that other people have the same pain," Dully says.

Howard Dully's two-year journey in search of the story behind his lobotomy is over. "I'll never know what I lost in those 10 minutes with Dr. Freeman and his ice pick," Dully says. "By some miracle it didn't turn me into a zombie, crush my spirit or kill me. But it did affect me. Deeply. Walter Freeman's operation was supposed to relieve suffering. In my case it did just the opposite. Ever since my lobotomy I've felt like a freak, ashamed."

But now, after meeting with Welch and her mother, Dully says his suffering is over. "I know my lobotomy didn't touch my soul. For the first time I feel no shame. I am, at last, at peace."

After 2,500 operations, Freeman performed his final ice-pick lobotomy on a housewife named Helen Mortenson in February 1967. She died of a brain hemorrhage, and Freeman's career was finally over. Freeman sold his home and spent the rest of his days traveling the country in a camper, visiting old patients, trying desperately to prove that his procedure had transformed thousands of lives for the better. Freeman died of cancer in 1972.

At 24, Woman Discovers She Was Born Without A Key Brain Structure, The Cerebellum

BY CHRISTIAN JARRETT   

 Image: “Sobo 1909 624” by Dr. Johannes Sobotta – Atlas and Text-book of Human Anatomy Volume III Vascular System, Lymphatic system, Nervous system and Sense Organs. Licensed under Public domain via Wikimedia Commons.

Neurosurgeons in China have reported the case of a 24-year-old woman who, after a series of brain scans to investigate dizziness, has just discovered she was born without a cerebellum. This cauliflower-like structure looks like a mini brain (its name is Latin for “little brain”) and it hangs off the back of its bigger brother. The cerebellum, shown on the left in the image above, is estimated to contain half the neurons of the entire brain. Experts used to think its function was purely to do with coordination, balance and

controlling the body, but in the last decade or so they’ve realised that its role is far more varied and includes language, emotion, memory and attention.

This revolution in our understanding of the functions of the cerebellum makes it seem all the more remarkable that the woman in question has only just discovered her brain is completely absent this key structure. Certainly, adults who develop illnesses, or incur injuries, that affect the function of the cerebellum (such as cerebellar ataxia) usually suffer profound difficulties with movement, including being unable to stand or walk. Recently its also become apparent that they often have other mental impairments too, in line with the structure’s diverse functions.

Although this woman with no cerebellum apparently started walking late (at age 7), walks unsteadily as an adult and has slurred speech, it’s amazing that she is able to walk and talk at all. The authors of the case study say she has mild intellectual impairment, but they also note that she is married with a daughter, had normal word comprehension and was “fully orientated” by which they presumably mean she had a normal sense of time and place.

“…[T]he functional compensation with the remaining brain tissue is remarkable,” the authors of the case study note in their report. “In our case, complete absence of the cerebellum results in only mild to moderate motor deficiency.” They added: “dysarthria [difficulty speaking] and ataxia [coordination problems], although clearly present, were less than would be expected in completely [sic] absence of the cerebellum.”

This is apparently only the ninth documented living case of “primary cerebellar agenesis”, although the condition was first described in 1831. And while it is amazing that this woman appears to have adapted so well to the absence of such a major brain structure, this is not the first time such claims have been made.

In fact, there was a case reported in 1940, of a man whose lack of a cerebellum was only discovered at autopsy after he died aged 76. Moreover, it was claimed he’d led a relatively symptom-free life. However, this interpretation was challenged in the 1990s. Neuroscientist Mitchell Glickstein noted the lack of information about the man’s life and his neuropsychological profile, and he said it was a “myth” that one could lead a normal life without a cerebellum.The debate continued with the discovery of more information about the man, including that he’d worked as a manual labourer. Summarizing in 2010, the British experts Roger Lemon and Steve Edgley said there was “potential ammunition for both sides of the

debate”, depending in part on whether you take a glass half-full or half-empty interpretation of a patient’s life and symptoms.This new Chinese case study represents the latest chapter in this ongoing debate. And again, there’s plenty of room for interpretation. Based on the case report, her adaptation to her unusual neuroanatomy is impressive, and it’s yet another example of how well the brain can accommodate extreme challenges, especially when these are present from birth or early in life (other recent case reports involving profound neurological adaptation include an elderly man who just discovered his brain hemispheres are disconnected; and a boy capable of speech even after his entire left brain hemisphere was removed). On a more skeptical note, the lack of detailed information on the Chinese woman’s neuropsychological profile, and the lack of detail about her life (including her employment, schooling and relationships), leaves open the question of how well she has truly coped without a cerebellum.There are reasons to guard against hyping cases such as this. The overwhelming majority of people who suffer brain injuries and illnesses often face great challenges and difficulties coping with the impairments associated with their conditions. When I was writing my forthcoming book on brain myths, one of the world’s leading experts on brain injury, Karen Hux, told me that people who suffer serious brain injury will always have some ongoing deficits. By sensationalising rare cases like this Chinese woman, we risk belittling the seriousness of the vast majority of brain disorders and injuries and generating unrealistic hope about the brain’s plasticity.On a related but less sober note, cases such as this new Chinese report also reinforce immortal myths about the brain, such as the idea we only use ten per cent of our brains. If a woman can adjust to the absence of so many neurons, the logic goes, then surely most of us are failing to fully exploit our full complement of grey matter. I think balance is the order of the day here. Yes it is incredible that some people are able to adapt so well to unusual brain development or to brain injuries, and it’s exciting to think how little we still understand about the way the brain accommodates these challenges, and how we might better learn to exploit this potential. But we should remember that for now there are nearly always serious impairments associated with brain injury and illness (in the case of the Chinese woman, the true extent of her difficulties will likely become clear with further testing), and that there is a significant difference between the brain adjusting developmentally to congenital or early acquired abnormalities, and its ability to adapt to problems encountered later in life.