Ovariotomy for Mental Illness and Epilepsy in the Late 1800s: A Possible Treatment for Autoimmune Encephalitis
Objective:
To review published cases of ovariotomy for mental illness in the late 1800s and determine whether physicians were performing this procedure as appropriate treatment of cases of NMDA receptor antibody positive autoimmune encephalitis (NMDARE).
Background:
Ovariotomies were performed in the late 1800s to treat mental illness and psychosis. NMDARE is an autoimmune disease featuring antibodies against NMDA receptors in the brain, resulting in symptoms including psychosis, cognitive disturbance, speech disorder, movement disorder, memory deficit, seizures, and autonomic dysfunction. Most cases are in children and young adults, but anyone of any age or sex may be affected. Females are affected more than males with a ratio of 4:1. Tumors, particularly ovarian tetratoma, can be associated with NMDARE.
Notably, the procedure of ovariotomy for mental illness was promoted by two well-known early women neurologists: Alice Bennett, MD, PhD, superintendent of a mental institution; and Laura Forster, a neuropathologist who worked with Nobel Prize winner Santiago Ramon y Cajal.
Design/Methods:
The authors performed a non-systematic review of ovariotomy cases from the 1800s and early 1900s.
Results:
As newer technologies, including MRI, EEG, and CSF antibody testing, contribute to the diagnosis of autoimmune encephalitis, it is challenging to retrospectively diagnose women with NMDARE. However, some cases with seizures and psychosis may have fit clinical criteria. No clinically appropriate cases with frank ovarian teratoma were identified.
Conclusions:
In almost all cases, ovariotomy was an inappropriate treatment for mental illness and psychosis. Some physicians, recognizing this, even argued that the procedure increased mental illness in women. However, two early female neurologists supported ovariotomy in absence of other, more appropriate treatments, in an attempt to provide women in mental institutions with some respite. In fact, some women appeared “cured” of mental illness after ovarian resection, which could be evidence of successful treatment of NMDARE.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.