Effect of unilateral amygdalotomy and hypothalamotomy in patients with refractory aggressiveness

Abstract

Background"Normal" aggressive behavior has very specific objectives: to maintain the individual's physical integrity, predation for subsistence purposes, vital space or territory preservation and perpetuation of the species. These functions are perfectly summarized in the term expressed by Walter Canon 1 , "fight or flight". Human aggressiveness shows a common pattern of behaviors similar to other animal species and is only activated in the presence of a threatening stimulus. This innate behavior is associated with the limbic system. The first description of the existence of an "emotional brain" was made by Christfried Jakob 2 in 1907-1908, laying the groundwork for subsequent contributions by James W. Papez in 1932 and Paul D. MacLean 1 . These concepts culminated in the integration of the limbic system and gave a better insight, between physiology and anatomy, in the generation and control of behavioral and emotional patterns. On the other hand, "unnatural or pathological" aggressiveness is an exaggerated behavior that occurs disproportionately in the presence of a stimulus that normally would not imply danger. This symptom is present with certain frequency in some neurological and/or psychiatric conditions.

Posterior Hypothalamic Region Deep Brain Stimulation for the Treatment of Aggression Disorders in Patients with Intellectual Disability: A Systematic Review

“…This procedure has been applied in European and South American countries, with a concentration of centers in Colombia, where another group is active in gamma knife posterior hypothalamotomy for aggression disorders [23]. Radiofrequency lesioning of the hypothalamus [24,25], but also cingulum and anterior capsule [26], is another valuable reported option for aggressive patients. Other groups proposed the globus pallidus internus as the target for DBS for the treatment of dystonia and self-injury behavior related to Lesch-Nyhan syndrome [27,28], with success.…”

Innovative perspectives in limbic surgery using deep brain stimulation

“…Symptoms by themselves are not a disorder. Brain lesioning surgery has been performed in patients with good results in diverse clinical studies ( García-Muñoz et al, 2019 ; Marquez-Franco et al, 2022 ). The most frequent target used in surgery is the hypothalamus ( Rizzi et al, 2017 ; Marquez-Franco et al, 2022 ), then the cingulum and amygdala ( Langevin, 2012 ).…”

“…The criteria to perform psychosurgery includes: (1) The presence of brain nuclei lesions or stimulation in different animal models of mental illness ( Oterdoom et al, 2020 ). (2) The surgical experiences of limbic surgery in patients with psychiatric diseases ( Langevin, 2012 ; García-Muñoz et al, 2019 ). (3) DBS use in neurological illness to treat mental symptoms and modify them with neuromodulation; based on the experience learned from STN, Thalamus, or GPi in patients with Parkinson’s disease, pain, and epilepsy ( Hosobuchi et al, 1973 ; Benabid et al, 1991 ; Lee et al, 2019 ).…”

Ablation Surgeries for Treatment-Resistant Depression: A Meta-Analysis and Systematic Review of Reported Case Series

“…Ablative neurosurgical procedures for mental illness are now mostly done for TRD and TROCD, where there is, worldwide, the most cumulative experience and consensus for these destructive interventions. Uncommonly, ablative surgery has also been used to treat refractory anorexia nervosa using BAC [79] and refractory aggression using combination surgical targets that include BAC, amygdalotomy, and hypothalamotomy [80, 81].…”