Directional Deep Brain Stimulation of the Posteromedial Hypothalamus for Refractory Intermittent Explosive Disorder: A Case Series Using a Novel Neurostimulation Device and Intraoperative Microdialysis

Networks and genes modulated by posterior hypothalamic stimulation in patients with aggressive behaviours: Analysis of probabilistic mapping, normative connectomics, and atlas-derived transcriptomics of the largest international multi-centre dataset

“…33 patients from five international centers were included in this study: Hospital Universitario San Vicente Fundación, Colombia; University Hospital La Princesa, Spain; International Misericordia Clinic, Colombia; Universidad Autónoma de Bucaramanga and FOSCAL Clinic, Colombia; Sírio-Libanês Hospital, Brazil. Detailed demographics, medical history, surgical procedure, and relevant information regarding institutional ethical review board and informed consent can be found in previous publications (7)(8)(9)(10)(11). All patients had pre-operative T1w MRI images as well as postoperative imaging (CT or MRI) that allowed for the precise determination of individual electrode placement (imaging parameters may be found in the original publications of the individual centers) (7)(8)(9)(10)(11).…”

“…Overall, 21 patients diagnosed with autism spectrum disorder, intellectual disability, obsessive-compulsive disorder, epilepsy and schizophrenia with ages ranging from 10-51y have been reported. Using validated scales, improvement in aggressive behaviours at long-term (up to several years of follow-up) was in the order of 38-100% compared to baseline (7)(8)(9)(10)(11).…”

“…(2)). Several international centers have reported on their experience with pHyp-DBS for the treatment of aggressive behaviour with variable outcomes (7)(8)(9)(10)(11). Overall, 21 patients diagnosed with autism spectrum disorder, intellectual disability, obsessive-compulsive disorder, epilepsy and schizophrenia with ages ranging from 10-51y have been reported.…”

“…Despite their efficacy, a substantial proportion (30%) of patients fail to respond and are considered to be treatment refractory (4)(5)(6). For these patients, neuromodulation therapies, such as deep brain stimulation (DBS), have been investigated as a possible avenue of treatment (2,(7)(8)(9)(10)(11). DBS is a neurosurgical therapy in which implanted electrodes are used to adjustably deliver electrical current to specific brain targets (12).…”

Editorial: Deep brain stimulation for neuropsychiatric disorders: Current status and perspectives

“…The authors report substantial reduction in self-destructive and aggressive behavior (by 30–100% and by an average of 74.5%, more pronounced in patients with Tourette syndrome. Although other targets have been used in the last years, such as the posteromedial hypothalamus ( 1 ) and amygdala ( 2 ), the nucleus accumbens has both anatomical and neurophysiological foundations to be elected as a target for the control of aggression, and this case series is one of the first reports for this indication. These results introduce the ventral striatum as an alternative target for such patients, who are often very challenging to manage.…”