Ladislas J. Meduna
Encyclopedia
Ladislas J. Meduna was a Hungarian neurologist
and neuropathologist noted for his development of shock treatment for persons suffering from schizophrenia
.
Meduna was born to a well-to-do family in Budapest
, Hungary
, in 1896. He studied medicine in Budapest from 1914 to 1921, his studies being interrupted by military service in the Italian front from 1915 to 1918.
He was appointed to the Hungarian Interacademic Institute for Brain Research, also in Budapest. He worked under the direction of Karl Schaffer. He studied the neuropathology of the structure and development of the pineal gland
and of microglia, lead poisoning
, and avitaminosis
. In 1927 he moved to the Psychiatric Institute with Dr. Schaffer and began clinical and research work in psychopathology
.
Meduna's interest in treating schizophrenia began with observations that the concentration of brain glia varied among patients who died with epilepsy (more glia than normal) and those with schizophrenia (less glia than normal). He thought that the inductions of seizures in patients with schizophrenia would increase the concentration of glia and relieve the illness. The concept was supported by reports that the incidence of epilepsy in hospitalized patients with schizophrenia was extremely low; and that a few schizophrenic patients who developed seizures after infection or head trauma, were relieved of their psychosis.
He sought ways to induce seizures in animals with chemicals; after trials with the alkaloids strychnine
, thebaine
, coramin, caffeine
, and brucin, he settled on camphor
dissolved in oil as effective and reliable. For a population with severe schizophrenia, he moved from Budapest to the psychiatric hospital at Lipotmező, outside Budapest. He began his dose-finding experiments on January 2, 1934. He was able to induce seizures in about 1/3 the first subjects. Nevertheless, three of the first 11 patients had a positive response, encouraging his work.[See Gazdag et al., 2009.] In his autobiography, he recalls the patient who began his treatment on January 23, 1934 in a severe 33-year-old catatonic
patient. After just 5 treatments, catatonia and psychotic
symptoms were abolished. Increasing his cases to 26 patients, Meduna achieved recovery in 10 and improvement in 3 more.
A major factor in Meduna's achievement was his selection of patients—9 of the first 11 patients were catatonic. Catatonia
is a syndrome that is remarkably responsive to induced seizures. The serendipity that catatonia was considered schizophrenia made his discovery possible.
Early in his work Meduna replaced camphor with pentylenetetrazol (Metrazol), an intravenous agent that induced seizures immediately compared with the long delay of 15 to 45 minutes after intramuscular camphor.
He first published his results in 1935 and then his major text in 1937. Die Konvulsionstherapie der Schizophrenie describes the results in 110 patients. Of these patients about half recovered. The results were much better for patients who were ill less than a year compared to those who had been ill for many years.
His results were quickly reproduced in many other centers around the world and this form of therapy became widely used and recognized as the first effective treatment for schizophrenia. (A parallel development was insulin coma therapy.) A more facile form of induction of seizures, using electricity instead of chemicals, was developed by the Italian psychiatrists Ugo Cerletti
and Lucio Bini
. They treated their first patient with ECT in May 1938 and by the mid-1940s, electricity had replaced Metrazole as the induction agent.
Meduna also developed carbon dioxide therapy. The patient had to breathe a mixture of 30% carbon dioxide
and 70% oxygen
until becoming unconscious, the treatment being repeated several times weekly. Although it was effective in relieving obsessive-compulsive disorder
s, it was not as effective as convulsive therapy, and it was abandoned.
With the increase of anti-semitism
and the rise to power of National Socialism
, Meduna emigrated to the USA in the following year (1938), to become Professor of Neurology
at Loyola University
, in Chicago. One of his last contributions to psychiatry was the study of confusional and dream-like states in psychoses (oneirophrenia
). He was also a founder of the Journal of Neuropsychiatry and a President of the Society of Biological Psychiatry. After the war, he moved his research to the Illinois Psychiatric Institute, where he worked until his death in 1964.
Neurologist
A neurologist is a physician who specializes in neurology, and is trained to investigate, or diagnose and treat neurological disorders.Neurology is the medical specialty related to the human nervous system. The nervous system encompasses the brain, spinal cord, and peripheral nerves. A specialist...
and neuropathologist noted for his development of shock treatment for persons suffering from schizophrenia
Schizophrenia
Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...
.
Meduna was born to a well-to-do family in Budapest
Budapest
Budapest is the capital of Hungary. As the largest city of Hungary, it is the country's principal political, cultural, commercial, industrial, and transportation centre. In 2011, Budapest had 1,733,685 inhabitants, down from its 1989 peak of 2,113,645 due to suburbanization. The Budapest Commuter...
, Hungary
Hungary
Hungary , officially the Republic of Hungary , is a landlocked country in Central Europe. It is situated in the Carpathian Basin and is bordered by Slovakia to the north, Ukraine and Romania to the east, Serbia and Croatia to the south, Slovenia to the southwest and Austria to the west. The...
, in 1896. He studied medicine in Budapest from 1914 to 1921, his studies being interrupted by military service in the Italian front from 1915 to 1918.
He was appointed to the Hungarian Interacademic Institute for Brain Research, also in Budapest. He worked under the direction of Karl Schaffer. He studied the neuropathology of the structure and development of the pineal gland
Pineal gland
The pineal gland is a small endocrine gland in the vertebrate brain. It produces the serotonin derivative melatonin, a hormone that affects the modulation of wake/sleep patterns and seasonal functions...
and of microglia, lead poisoning
Lead poisoning
Lead poisoning is a medical condition caused by increased levels of the heavy metal lead in the body. Lead interferes with a variety of body processes and is toxic to many organs and tissues including the heart, bones, intestines, kidneys, and reproductive and nervous systems...
, and avitaminosis
Avitaminosis
Avitaminosis is any disease caused by chronic or long-term vitamin deficiency or caused by a defect in metabolic conversion, such as tryptophan to niacin...
. In 1927 he moved to the Psychiatric Institute with Dr. Schaffer and began clinical and research work in psychopathology
Psychopathology
Psychopathology is the study of mental illness, mental distress, and abnormal/maladaptive behavior. The term is most commonly used within psychiatry where pathology refers to disease processes...
.
Meduna's interest in treating schizophrenia began with observations that the concentration of brain glia varied among patients who died with epilepsy (more glia than normal) and those with schizophrenia (less glia than normal). He thought that the inductions of seizures in patients with schizophrenia would increase the concentration of glia and relieve the illness. The concept was supported by reports that the incidence of epilepsy in hospitalized patients with schizophrenia was extremely low; and that a few schizophrenic patients who developed seizures after infection or head trauma, were relieved of their psychosis.
He sought ways to induce seizures in animals with chemicals; after trials with the alkaloids strychnine
Strychnine
Strychnine is a highly toxic , colorless crystalline alkaloid used as a pesticide, particularly for killing small vertebrates such as birds and rodents. Strychnine causes muscular convulsions and eventually death through asphyxia or sheer exhaustion...
, thebaine
Thebaine
Thebaine , its name coming from the Greek Θῆβαι, Thēbai, an ancient city in Upper Egypt, is an opiate alkaloid. A minor constituent of opium, thebaine is chemically similar to both morphine and codeine, but has stimulatory rather than depressant effects, causing convulsions similar to strychnine...
, coramin, caffeine
Caffeine
Caffeine is a bitter, white crystalline xanthine alkaloid that acts as a stimulant drug. Caffeine is found in varying quantities in the seeds, leaves, and fruit of some plants, where it acts as a natural pesticide that paralyzes and kills certain insects feeding on the plants...
, and brucin, he settled on camphor
Camphor
Camphor is a waxy, white or transparent solid with a strong, aromatic odor. It is a terpenoid with the chemical formula C10H16O. It is found in wood of the camphor laurel , a large evergreen tree found in Asia and also of Dryobalanops aromatica, a giant of the Bornean forests...
dissolved in oil as effective and reliable. For a population with severe schizophrenia, he moved from Budapest to the psychiatric hospital at Lipotmező, outside Budapest. He began his dose-finding experiments on January 2, 1934. He was able to induce seizures in about 1/3 the first subjects. Nevertheless, three of the first 11 patients had a positive response, encouraging his work.[See Gazdag et al., 2009.] In his autobiography, he recalls the patient who began his treatment on January 23, 1934 in a severe 33-year-old catatonic
Catatonia
Catatonia is a state of neurogenic motor immobility, and behavioral abnormality manifested by stupor. It was first described in 1874: Die Katatonie oder das Spannungsirresein ....
patient. After just 5 treatments, catatonia and psychotic
Psychosis
Psychosis means abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality"...
symptoms were abolished. Increasing his cases to 26 patients, Meduna achieved recovery in 10 and improvement in 3 more.
A major factor in Meduna's achievement was his selection of patients—9 of the first 11 patients were catatonic. Catatonia
Catatonia
Catatonia is a state of neurogenic motor immobility, and behavioral abnormality manifested by stupor. It was first described in 1874: Die Katatonie oder das Spannungsirresein ....
is a syndrome that is remarkably responsive to induced seizures. The serendipity that catatonia was considered schizophrenia made his discovery possible.
Early in his work Meduna replaced camphor with pentylenetetrazol (Metrazol), an intravenous agent that induced seizures immediately compared with the long delay of 15 to 45 minutes after intramuscular camphor.
He first published his results in 1935 and then his major text in 1937. Die Konvulsionstherapie der Schizophrenie describes the results in 110 patients. Of these patients about half recovered. The results were much better for patients who were ill less than a year compared to those who had been ill for many years.
His results were quickly reproduced in many other centers around the world and this form of therapy became widely used and recognized as the first effective treatment for schizophrenia. (A parallel development was insulin coma therapy.) A more facile form of induction of seizures, using electricity instead of chemicals, was developed by the Italian psychiatrists Ugo Cerletti
Ugo Cerletti
Ugo Cerletti was an Italian neurologist who discovered the method of electroconvulsive therapy in psychiatry. Electroconvulsive therapy is a procedure in which electric currents are passed through the brain, deliberately triggering a brief seizure...
and Lucio Bini
Lucio Bini
Lucio Bini was an Italian psychiatrist and professor at the University of Rome La Sapienza, Italy. Together with Ugo Cerletti, a neurophysiologist, he researched and discovered the method of electroconvulsive therapy, a kind of shock therapy for mental diseases.-References:*Kalinowsky, LB: Lucio...
. They treated their first patient with ECT in May 1938 and by the mid-1940s, electricity had replaced Metrazole as the induction agent.
Meduna also developed carbon dioxide therapy. The patient had to breathe a mixture of 30% carbon dioxide
Carbon dioxide
Carbon dioxide is a naturally occurring chemical compound composed of two oxygen atoms covalently bonded to a single carbon atom...
and 70% oxygen
Oxygen
Oxygen is the element with atomic number 8 and represented by the symbol O. Its name derives from the Greek roots ὀξύς and -γενής , because at the time of naming, it was mistakenly thought that all acids required oxygen in their composition...
until becoming unconscious, the treatment being repeated several times weekly. Although it was effective in relieving obsessive-compulsive disorder
Obsessive-compulsive disorder
Obsessive–compulsive disorder is an anxiety disorder characterized by intrusive thoughts that produce uneasiness, apprehension, fear, or worry, by repetitive behaviors aimed at reducing the associated anxiety, or by a combination of such obsessions and compulsions...
s, it was not as effective as convulsive therapy, and it was abandoned.
With the increase of anti-semitism
Anti-Semitism
Antisemitism is suspicion of, hatred toward, or discrimination against Jews for reasons connected to their Jewish heritage. According to a 2005 U.S...
and the rise to power of National Socialism
Nazism
Nazism, the common short form name of National Socialism was the ideology and practice of the Nazi Party and of Nazi Germany...
, Meduna emigrated to the USA in the following year (1938), to become Professor of Neurology
Neurology
Neurology is a medical specialty dealing with disorders of the nervous system. Specifically, it deals with the diagnosis and treatment of all categories of disease involving the central, peripheral, and autonomic nervous systems, including their coverings, blood vessels, and all effector tissue,...
at Loyola University
Loyola University Chicago
Loyola University Chicago is a private Jesuit research university located in Chicago, Illinois, United States. Founded by the Society of Jesus in 1870 under the title St...
, in Chicago. One of his last contributions to psychiatry was the study of confusional and dream-like states in psychoses (oneirophrenia
Oneirophrenia
Oneirophrenia is a hallucinatory, dream-like state caused by several conditions such as prolonged sleep deprivation, sensory deprivation, or drugs . From the Greek words "ὄνειρο" and "φρενός"...
). He was also a founder of the Journal of Neuropsychiatry and a President of the Society of Biological Psychiatry. After the war, he moved his research to the Illinois Psychiatric Institute, where he worked until his death in 1964.