One of the potential treatment methods of obesity is deep brain stimulation (DBS) of nucleus accumbens. We describe the case of 19 years old woman with hypothalamic obesity. She weighted 151.4 kg before DBS and the non-surgical methods proved to be inefficient. She was treated with implantation of DBS electrode to nucleus accumbens bilaterally. Results were measured with body mass index and neuropsychological tests. Follow-up was 14 months. Fourteen months after surgery weight was 138 kg, BMI was 48.3. Neuropsychological test results were intact. The presented case supports the thesis of treatment of obesity with nucleus accumbens stimulation.

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Self-destructive and aggressive behaviors can have a significant impact on the quality of life of affected individuals and their carrers. While deep brain stimulation (DBS) has been applied to the treatment of self-destructive and aggressive behaviors in isolated cases, clinical data on this treatment modality are still lacking. We therefore assessed responses to treatment with bilateral DBS of the nucleus accumbens in six patients with severe self-destructive and aggressive behaviors. Three patients had Tourette syndrome and three had other underlying predispositions including obsessive compulsive disorder, cerebral palsy, encephalitis, and epilepsy. Patients were followed up for between 2 and 7 years, and patients were assessed using the Modified Overt Aggression Scale (six patients) and the Buss-Perry Aggression Questionnaire (three patients able to complete the questionnaire on their own). DBS reduced self-destructive and aggressive behaviors by 30–100% and by an average of 74.5%. Patients with Tourette syndrome responded better to DBS and improved by 27.3% according to the Buss-Perry Aggression Questionnaire. These results suggest that nuclei accumbens stimulation may be an effective treatment for aggressive and self-destructive behaviors regardless of etiology.

Background: We describe a case of deep brain stimulation in a patient with severe aggression refractory to conservative treatment. The targets of the stimulation were set bilaterally in the posteromedial hypothalamus and - in a second procedure due to its ineffectiveness - in the nucleus accumbens (NAcc) bilaterally. Methods: In the first stage, we implanted electrodes into the posteromedial hypothalamus, after obtaining consent of the Bioethics Committee. In the early postoperative period, we observed significant improvement in the range of 50-90% in terms of quantity and quality of the attacks of aggression. After about 3 weeks, attacks of aggression started to return. Despite changes in the stimulation parameters there was no improvement. For this reason, based on the experience of surgery in patients with obsessive-compulsive disorder, Tourette syndrome and with morbid obesity, we decided to implant electrodes into the NAcc. Results: After 15 months of follow-up, the patient has no aggressive behavior, with no side effects. Conclusions: Although the stimulation of the posterior-medial hypothalamus did not bring long-term benefits, its combination with bilateral stimulation of the NAcc practically freed the patient from aggressive disorders. It significantly improved the patient's quality of life.

(1) Background: The uncinate fasciculus (UF) is a white matter bundle connecting the prefrontal cortex and temporal lobe. The functional role of the uncinate fasciculus is still uncertain. The role of the UF is attributed to the emotional empathy network. The present study aimed to more accurately the describe anatomical variability of the UF by focusing on the volume of fibers and testing for correlations with sex and age. (2) Material and Methods: Magnetic resonance imaging of adult patients with diffusion tensor imaging (DTI) was performed on 34 patients. The total number of fibers, volume of UF, and number of tracts were processed using DSI studio software. The DSI studio allows for mapping of different nerve pathways and visualizing of the obtained results using spatial graphics. (3) Results: The total number of UF tracts was significantly higher in the right hemisphere compared to the left hemisphere (right M ± SD = 52 ± 24; left: 39 ± 25, p < 0.05). A hook-shaped UF was the most common variant (91.7%). The UF volumes were larger in men (1410 ± 150.7 mm3) as compared to women (1325 ± 133.2 mm3) (p < 0.05). The mean fractional anisotropy (FA) values of the UF were significantly larger on the left side 0.597, while the right UF had an average of 0.346 (p < 0.05). Patients older than 50 years old had a significantly higher value of mean diffusivity (MD) (p = 0.034). In 73.5% of patients, a greater number of fibers terminated in the inferior part of the inferior frontal gyrus. (4) Conclusions: The morphological characteristics of the UF, unlike the shape, are associated with sex and are characterized by hemispheric dominance. These findings confirm the results of the previous studies. Future research should examine the potential correlation among the UF volume, number of fibers, and total brain volume in both sexes and patient psychological state.