Deep brain stimulation in aggressive behavior

Abstract

Deep-brain stimulation (DBS) of the posterior hypothalamic region was originally introduced to treat trigeminal autonomic cephalalgias (TACs), which are thought to result from hyper-activation of the posterior hypothalamic region (pHr) occurring during bouts pain bouts in these pathologies. In fact, patients experiencing chronic luster headache attacks often exhibit aggressive bouts during such episodes. In the past, the posterior hypothalamic region (pHr) was used as a lesional target in patients with aggressive behavior Aggressive behavior, epilepsy and, mental retardation. Furthermore, disruptive behavior was found to be induced by acute electrical stimulation within the so-called “triangle of Sano” in a Parkinsonian patient. The known interconnections between the pHr, the amygdala, and the overall so-called “Papez circuit” in may explain the role of the pHr in the development of disruptive behavior. The choice of targeting the pHr for this pathology is determined by the crucial role of pHr within the limbic circuits, which appear to be dysregulated according to several clinic and experimental data. We chose to use DBS to severely impaired patients affected by refractory aggressive behavior and mental retardation. The first surgery was performed in 2002. We here describe our technique and long-term follow-up in seven patients.