Early life and family Meduna was born to a well-to-do family in
Budapest,
Hungary, in 1896. His grandfather
Giuseppe Carlo (József), a descendant of the
Meduna family, came from
Castelcucco,
Italy, to Hungary, where he became a successful and awarded
salami maker. Multiple members of the family branch, including Ladislas Meduna during his military service in
World War I, oftentimes used the name
Meduna di Montecucco or alternatively the noble title "
von" in their name. Meduna studied medicine in Budapest from 1914 to 1921, his studies being interrupted by military service in the Italian front from 1915 to 1918.
Early career He was appointed to the Hungarian Interacademic Institute for Brain Research, also in Budapest, where he worked under the direction of
Károly 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.
Induction of seizures 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,
coramine,
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 only about one-third of his subjects. Nevertheless, three of the first eleven patients had a positive response, encouraging his work (see Gazdag et al., 2009). In his autobiography, he recalls the case of a 33-year-old patient with severe
catatonia who began his treatment on January 23, 1934. After just five sessions, catatonia and
psychotic symptoms were abolished. Increasing his sample size to twenty-six patients, Meduna achieved recovery in ten and improvement in three more. A major factor in Meduna's achievement was his selection of patients: nine of the first eleven were catatonic.
Catatonia is a syndrome that is remarkably responsive to induced seizures. The serendipity that catatonia was considered schizophrenia at the time made his discovery possible. Early on, Meduna replaced camphor with
pentylenetetrazol (brand name Metrazol), an intravenous agent that typically induced seizures within a few minutes, compared with the long delay of 15 to 45 minutes after intramuscular administration of camphor. In addition to being a powerful
analeptic drug, pentylenetetrazol is a potent cardiac and respiratory stimulant; consequently, patients experienced sensations most considered unpleasant. They were completely alert until unconsciousness from the convulsion set in, and unlike with electroconvulsive therapy, which caused
retrograde amnesia that ameliorated any unpleasant memory of that treatment, patients remembered any sensations that preceded the Metrazol-induced convulsion. Meduna and some other physicians felt that the fear reaction may have been part of the reason the treatment was successful in some patients.
Published research 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. After his results were quickly reproduced in many other centers around the world, 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 April 1938 and by the mid-1940s, electricity had replaced Metrazol as the induction agent.
Carbon dioxide therapy Meduna also developed
carbon dioxide therapy in which the patient breathed a gaseous mixture of 30%
carbon dioxide and 70%
oxygen called
carboxygen or
carbogen (and sometimes "''Meduna's Mixture''") that was designed to provoke a powerful feeling of suffocation, quickly triggering an unresponsive yet intense altered mental state. The treatment, while usually unpleasant or even terrifying, proved very useful for revealing previously unconscious fears. Challenging experiences on carbogen prepared patients for later
psychedelic therapy in a profound way. It was not as effective as convulsive therapy in relieving the symptoms of
obsessive-compulsive disorder and was therefore abandoned.
Migration to the United States With the increase of
antisemitism and the rise to power of
Nazism, Meduna emigrated to the United States 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. ==References==