Deep-Brain Stimulation for Aggressive and Disruptive Behavior

Franzini, Angelo; Broggi, Giovanni; Cordella, Roberto; Dones, Ivano; Messina, Giuseppe

doi:10.1016/j.wneu.2012.06.038

Cited by 54 publications

(68 citation statements)

References 13 publications

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“…151 The largest reported cohort for pHr stimulation was of 7 patients, ages 20-68 years, with IQs between 20 and 40 and uncontrollable aggressive and violent behavior. [73][74][75] After implantation of DBS electrodes in the pHr, 6 patients had cessation or significantly decreased outbursts of violent behavior. As is seen with other diseases, relapse of behavior occurred when the stimulation was interrupted or the battery became depleted (Table 6).…”

Section: Aggressive Behaviormentioning

confidence: 99%

Deep brain stimulation for psychiatric disorders: where we are now

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Ozpinar

Raslan

et al. 2015

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Fossil records showing trephination in the Stone Age provide evidence that humans have sought to influence the mind through physical means since before the historical record. Attempts to treat psychiatric disease via neurosurgical means in the 20th century provided some intriguing initial results. However, the indiscriminate application of these treatments, lack of rigorous evaluation of the results, and the side effects of ablative, irreversible procedures resulted in a backlash against brain surgery for psychiatric disorders that continues to this day. With the advent of psychotropic medications, interest in invasive procedures for organic brain disease waned. Diagnosis and classification of psychiatric diseases has improved, due to a better understanding of psychiatric patho-physiology and the development of disease and treatment biomarkers. Meanwhile, a significant percentage of patients remain refractory to multiple modes of treatment, and psychiatric disease remains the number one cause of disability in the world. These data, along with the safe and efficacious application of deep brain stimulation (DBS) for movement disorders, in principle a reversible process, is rekindling interest in the surgical treatment of psychiatric disorders with stimulation of deep brain sites involved in emotional and behavioral circuitry. This review presents a brief history of psychosurgery and summarizes the development of DBS for psychiatric disease, reviewing the available evidence for the current application of DBS for disorders of the mind.

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Section: Aggressive Behaviormentioning

confidence: 99%

Deep brain stimulation for psychiatric disorders: where we are now

Cleary

Ozpinar

Raslan

et al. 2015

FOC

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“…23 In our experience, the patients who underwent DBS became calmer, antipsychotic drugs were reduced, and, in some cases, the patients had an opportunity to be reintegrated partially or totally with their family as a result of their markedly reduced aggressive behavior. In our series, before surgery, all the patients presented with severe ID or a severe acquired cognitive problem.…”

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confidence: 81%

“…These results were stable at followup. 23,46 A recent review of outcomes revealed that the best results have been obtained in patients with a codiagnosis of ID (our unpublished data).…”

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confidence: 85%

“…For example, surgery of the posterior hypothalamic region has been reported to be an effective treatment in severe cases of aggressive behavior in patients with intellectual disability (ID), 15,23,35,38,66 which enables us to formulate a hypothesis on disease pathogenesis and brain functioning. 51 …”

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confidence: 99%

“…They reported on 7 patients who had been affected by pathological aggressive and disruptive behavior, and the follow-up period ranged from 3 to 11 years; the patients benefited from high-frequency stimulation, and they experienced a marked reduction of aggressive outbursts until complete resolution. 23,25,26 Stimulation parameters in the series reported by Franzini et al 23 were as follows: frequency 185 Hz; current amplitude 1-3 V; and pulse width 60-90 msec with a monopolar configuration (case positive). The results were promising, including a mean improvement of 65% on the Overt Aggression Scale (OAS).…”

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confidence: 99%

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Exploring the brain through posterior hypothalamus surgery for aggressive behavior

Rizzi

Trezza

Messina

et al. 2017

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Neurological surgery offers an opportunity to study brain functions, through either resection or implanted neuromodulation devices. Pathological aggressive behavior in patients with intellectual disability is a frequent condition that is difficult to treat using either supportive care or pharmacological therapy. The bulk of the laboratory studies performed throughout the 19th century enabled the formulation of hypotheses on brain circuits involved in the generation of emotions. Aggressive behavior was also studied extensively. Lesional radiofrequency surgery of the posterior hypothalamus, which peaked in the 1970s, was shown to be an effective therapy in many reported series. As with other surgical procedures for the treatment of psychiatric disorders, however, this therapy was abandoned for many reasons, including the risk of its misuse. Deep brain stimulation (DBS) offers the possibility of treating neurological and psychoaffective disorders through relatively reversible and adaptable therapy. Deep brain stimulation of the posterior hypothalamus was proposed and performed successfully in 2005 as a treatment for aggressive behavior. Other groups reported positive outcomes using target and parameter settings similar to those of the original study. Both the lesional and DBS approaches enabled researchers to explore the role of the posterior hypothalamus (or posterior hypothalamic area) in the autonomic and emotional systems.

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