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Une histoire controversée

  • Marc Lévêque
Chapter

En résumé

La psychochirurgie est née de la nécessité de prendre en charge des patients souffrant de pathologies mentales en impasse thérapeutique. Le neurologue portugais Moniz fut l’un des fondateurs de cette spécialité, avec la mise au point, en 1935, de la leucotomie frontale, couronnée par le prix Nobel une quinzaine d’années plus tard. Au début des années 1950, la psychochirurgie connaîtra son apogée avec plus de soixante mille interventions réalisées dans le monde. Cette chirurgie des lobes frontaux connaîtra, à partir de cette époque, deux évolutions parallèles: d’une part la simplification, avec la leucotomie transorbitaire popularisée par l’Américain Freeman,qui rendra ce geste réalisable en ambulatoire et donc à grande échelle; d’autre part la recherche d’une plus grande sélectivité des lésions, les interventions précédentes, réalisées à l’aveugle, étant responsables d’une lourde morbidité associant altération cognitive et mutilation de la personnalité. Parmi ces interventions plus ciblées, certaines, comme la capsulotomie ou la cingulotomie, restent d’actualité. L’avènement de la psychopharmacologie et ses premiers succès viendront, dès 1955, ralentir considérablement le rythme de ces interventions. À la fin des années 1960, l’échec de la médication chez certains patients et les progrès de la chirurgie, notamment de la stéréotaxie, entraîneront un regain d’intérêt pour la psychochirurgie. Celui- ci sera de courte durée: la survenue d’abus, une opinion déjà échaudée et la crainte d’une société «psychocontrôlée» aboutiront à un encadrement très strict voire à son interdiction dans plusieurs pays. À partir de 1999, le succès de la stimulation cérébrale profonde, une nouvelle technique réversible et adaptable, dans le traitement de la maladie de Parkinson, est venu offrir de nouveaux espoirs thérapeutiques chez les patients souffrant de pathologie psychiatrique sévère comme les troubles obsessionnels compulsifs. Aujourd’hui, ces nouveaux traitements par neuromodulation viennent écrire une nouvelle page de l’histoire de la psychochirurgie.

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Copyright information

© Springer-Verlag Paris 2013

Authors and Affiliations

  • Marc Lévêque
    • 1
  1. 1.Service de neurochirurgie Hôpital universitaire de la Pitié-Salpêtrière Assistance publiqueHôpitaux de ParisParisFrance

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