Stereotactic hypothalamotomy for behaviour disorders

Schvarcz, J. R.; Driollet, R.; Ríos, Elizabeth Rodríguez; Betti, Osvaldo

doi:10.1136/jnnp.35.3.356

Cited by 46 publications

(25 citation statements)

References 19 publications

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“…The results in this study could not be compared to information previously reported by Sano et al [13], Narabayashi and Uno [10], Kiloh et al [11] or Schvarcz et al [14], since the aforementioned researchers did not include sufficiently detailed information on their measuring instruments, side effects or appropriate methodology in their reports. In the past, the decision to modify patient behavior by neurosurgery has led to excesses and treatment errors.…”

Section: Discussioncontrasting

confidence: 54%

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Bilateral Cingulotomy and Anterior Capsulotomy Applied to Patients with Aggressiveness

Jiménez

Soto

Velasco

et al. 2012

Stereotact Funct Neurosurg

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Objective: To perform a preliminary study on the effects and safety of bilateral cingulotomy and anterior capsulotomy in patients with aggressive behavior. Patients and Methods: Twenty-three psychiatric patients showing aggressive behavior refractory to conventional treatment were initially evaluated. The subjects were clinically selected using the Overt Aggression Scale (OAS) and the Global Assessment of Functioning Scale (GAF). Each case was carefully reviewed by the Ethics Committee of Mexico’s General Hospital. Once selection criteria were met, stereotactic lesions were made using radiofrequency on the anterior limb of the internal capsule and supragenual cingulum. Statistical differences were evaluated with a Wilcoxon test at 6 months and at 4 years. Results: Ten patients underwent surgery. Their OAS and GAF scores decreased after the procedure at the 6-month (p < 0.05) and at the 4-year (p = 0.068) follow-up. Four patients showed mild and transitory postsurgical complications (hyperphagia and somnolence). Conclusions: Bilateral anterior capsulotomy in combination with cingulotomy may reduce aggressive behavior and improve clinical evaluations. Very strict clinical and ethical evaluations were applied prior to considering patients for this treatment.

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Section: Discussioncontrasting

confidence: 54%

“…In 1966, Sano et al [13] described the use of hypothalamotomy in 22 patients, with favorable outcome; mild complications were reported at a follow-up of 2 months to 3 years. In 1972, Schvarcz et al [14] reported hypothalamotomy in 11 patients without specifying the results or complications, with a follow-up of 6 months to 4 years.…”

Section: Introductionmentioning

confidence: 99%

Bilateral Cingulotomy and Anterior Capsulotomy Applied to Patients with Aggressiveness

Jiménez

Soto

Velasco

et al. 2012

Stereotact Funct Neurosurg

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“…245 As in the amygdala, lesions in the pHr have been used for the combination of epilepsy and aggressive behavior. 244,255 Modern application of DBS to the pHr has mostly been for cases of mental retardation combined with severe aggression, and thus few results have been reported. In the first of 2 cases in the literature, a 22-year-old patient with mental retardation and aggression received bilateral low-frequency stimulation (15 Hz) to the pHr, and at 18-month follow-up the patient's behavior was significantly improved.…”

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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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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“…After surgery, 1 patient became seizure free, and reductions in seizure intensity and frequency were experienced by another 9 patients (41%) who were receiving the same or a smaller dosage of medications at more than 2 years of follow-up. 54 In the 1970s and 1980s, other groups repeated Sano's procedures for the treatment of aggressive behavior 7,44,57,60 or for indications such as "extreme" sexual behavior 20 and alcohol and drug addiction 20 and for the treatment of "erethic children. "…”

Section: Human Surgery: the Lesional Era And Neurophysiological Testingmentioning

confidence: 99%

Exploring the brain through posterior hypothalamus surgery for aggressive behavior

Rizzi

Trezza

Messina

et al. 2017

Neurosurgical Focus

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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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Stereotactic hypothalamotomy for behaviour disorders

Cited by 46 publications

References 19 publications

Bilateral Cingulotomy and Anterior Capsulotomy Applied to Patients with Aggressiveness

Bilateral Cingulotomy and Anterior Capsulotomy Applied to Patients with Aggressiveness

Deep brain stimulation for psychiatric disorders: where we are now

Exploring the brain through posterior hypothalamus surgery for aggressive behavior

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