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Deep Brain Stimulation in Pathological Aggression.

Marek Harat1, Marcin Rudaś, Piotr Zieliński

  • 1Department of Public Health, Collegium Medicum, Nicolaus Copernicus University, Torun, Poland.

Stereotactic and Functional Neurosurgery
|August 1, 2015
PubMed
Summary
This summary is machine-generated.

Deep brain stimulation targeting the nucleus accumbens (NAcc) effectively treated severe aggression refractory to other methods. This approach significantly improved the patient

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Area of Science:

  • Neuroscience
  • Neurosurgery
  • Psychiatry

Background:

  • Severe aggression can be refractory to conservative treatments.
  • Deep brain stimulation (DBS) is an emerging therapeutic option for such cases.
  • This case explores DBS for treatment-refractory aggression.

Purpose of the Study:

  • To evaluate the efficacy of DBS in a patient with severe aggression.
  • To investigate the role of posteromedial hypothalamus and nucleus accumbens (NAcc) as targets.
  • To assess long-term outcomes and side effects.

Main Methods:

  • Bilateral DBS electrodes were implanted in the posteromedial hypothalamus.
  • Due to initial transient effects, a second procedure targeted the nucleus accumbens (NAcc) bilaterally.
  • Stimulation parameters were adjusted post-implantation.

Main Results:

  • Initial hypothalamic stimulation showed temporary improvement (50-90%) in aggression.
  • Aggressive behaviors returned after approximately 3 weeks.
  • Combined hypothalamic and NAcc stimulation resulted in sustained cessation of aggressive behavior.
  • No adverse side effects were reported during 15 months of follow-up.

Conclusions:

  • Posteromedial hypothalamus stimulation alone provided only short-term benefits for aggression.
  • Bilateral NAcc stimulation, in combination with hypothalamic stimulation, achieved long-term remission of aggressive disorders.
  • This combined DBS approach significantly enhanced the patient's quality of life.