Bilateral anterior capsulotomy and amygdalotomy for mental retardation with psychiatric symptoms and aggression

Zhang, Shizhen; Zhou, Peizhi; Jiang, Shu

doi:10.1097/md.0000000000005840

Cited by 9 publications

(6 citation statements)

References 20 publications

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“…Quite often, however, patients with severe self-aggressive behavior towards the face and head are precluded from DBS consideration for fear of complications such as infection, skin erosion, and lead fracture 19 . For this small population of non-responsive individuals, stereotactic ablative surgery targeting the amygdala has been performed with beneficial result 11,20 . As this patient population is small and the number of recent publications are limited, in depth clinical follow up and the study of neuroanatomical and/or functional aspects of this surgery remain sparse.…”

Section: Introductionmentioning

confidence: 99%

Longitudinal Changes After Amygdala Surgery for Intractable Aggressive Behavior: Clinical, Imaging Genetics, and Deformation-Based Morphometry Study—A Case Series

Gouveia

Germann²,

Morais³

et al. 2020

Neurosurg.

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BACKGROUND Intractable aggressive behavior (iAB) is a devastating behavioral disorder that may affect psychiatric patients. These patients have reduced quality of life, are more challenging to treat as they impose a high caregiver burden and require specialized care. Neuromodulatory interventions targeting the amygdala, a key hub in the circuitry of aggressive behavior (AB), may provide symptom alleviation. OBJECTIVE To Report clinical and imaging findings from a case series of iAB patients treated with bilateral amygdala ablation. METHODS This series included 4 cases (3 males, 19-32 years old) who underwent bilateral amygdala radiofrequency ablation for iAB hallmarked by life-threatening self-injury and social aggression. Pre- and postassessments involved full clinical, psychiatric, and neurosurgical evaluations, including scales quantifying AB, general agitation, quality of life, and magnetic resonance imaging (MRI). RESULTS Postsurgery assessments revealed decreased aggression and agitation and improved quality of life. AB was correlated with testosterone levels and testosterone/cortisol ratio in males. No clinically significant side effects were observed. Imaging analyses showed preoperative amygdala volumes within normal populational range and confirmed lesion locations. The reductions in aggressive symptoms were accompanied by significant postsurgical volumetric reductions in brain areas classically associated with AB and increases in regions related to somatosensation. The local volumetric reductions are found in areas that in a normal brain show high expression levels of genes related to AB (eg, aminergic transmission) using gene expression data provided by the Allen brain atlas. CONCLUSION These findings provide new insight into the whole brain neurocircuitry of aggression and suggest a role of altered somatosensation and possible novel neuromodulation targets.

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Section: Introductionmentioning

confidence: 99%

Longitudinal Changes After Amygdala Surgery for Intractable Aggressive Behavior: Clinical, Imaging Genetics, and Deformation-Based Morphometry Study—A Case Series

Gouveia

Germann²,

Morais³

et al. 2020

Neurosurg.

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“…This should be a cause for potential concern, particularly given the differences in understanding of personal freedom and autonomy between our cultures. The performance of ablative surgeries for mental illness in China without clear consent further highlights the potential danger that BCI technology could be abused by an authoritarian state ( Zamiska, 2007 ; Wu et al, 2010 ; Zhang et al, 2017 ).…”

Section: Considerations For Individual Categoriesmentioning

confidence: 99%

Neuroethics of Non-primary Brain Computer Interface: Focus on Potential Military Applications

Munyon

2018

Front. Neurosci.

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The field of neuroethics has had to adapt rapidly in the face of accelerating technological advancement; a particularly striking example is the realm of Brain-Computer Interface (BCI). A significant source of funding for the development of new BCI technologies has been the United States Department of Defense, and while the predominant focus has been restoration of lost function for those wounded in battle, there is also significant interest in augmentation of function to increase survivability, coordination, and lethality of US combat forces. While restoration of primary motor and sensory function (primary BCI) has been the main focus of research, there has been marked progress in interface with areas of the brain subserving memory and association. Non-Primary BCI has a different subset of potential applications, each of which also carries its own ethical considerations. Given the amount of BCI research funding coming from the Department of Defense, it is particularly important that potential military applications be examined from a neuroethical standpoint.

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“…After that, Sturm et al ( 2013 ) published the first case describing the efficacy of DBS of the amygdala for the treatment of pathological aggressiveness. Direct comparison of the reported cases is challenging due to the different clinical outcome measurements used, nonetheless most studies report satisfying results in most of the patients (Jiménez et al, 2012 ; Zhang et al, 2017 ; Torres et al, 2021 ; Yan et al, 2022 ). In summary, there are several possible target structures along the limbic system described in scientific literature for the treatment of pathological aggressiveness.…”

Section: Introductionmentioning

confidence: 99%

Connectivity in deep brain stimulation for self-injurious behavior: multiple targets for a common network?

Heiden

Weigel

Loução

et al. 2022

Front. Hum. Neurosci.

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Self-injurious behavior (SIB) is associated with diverse psychiatric conditions. Sometimes (e.g., in patients with autism spectrum disorder or acquired brain injuries), SIB is the most dominant symptom, severely restricting the psychosocial functioning and quality of life of the patients and inhibiting appropriate patient care. In severe cases, it can lead to permanent physical injuries or even death. Primary therapy consists of medical treatment and if implementable, behavioral therapy. For patients with severe SIB refractory to conventional therapy, neuromodulation can be considered as a last recourse. In scientific literature, several successful lesioning and deep brain stimulation targets have been described that can indicate a common underlying neuronal pathway. The objectives of this study were to evaluate the short- and long-term clinical outcome of patients with severe, therapy refractory SIB who underwent DBS with diverse underlying psychiatric disorders and to correlate these outcomes with the activated connectivity networks. We retrospectively analyzed 10 patients with SIB who underwent DBS surgery with diverse psychiatric conditions including autism spectrum disorder, organic personality disorder after hypoxic or traumatic brain injury or Tourette syndrome. DBS targets were chosen according to the underlying disorder, patients were either stimulated in the nucleus accumbens, amygdala, posterior hypothalamus, medial thalamus or ventrolateral thalamus. Clinical outcome was measured 6 months after surgery and at long-term follow-up after 10 or more years using the Early Rehabilitation Barthel index (ERBI) and time of restraint. Connectivity patterns were analyzed using normative connectome. Based on previous literature the orbitofrontal cortex, superior frontal gyrus, the anterior cingulate cortex, the amygdala and the hippocampus were chosen as regions of interest. This analysis showed a significant improvement in the functionality of the patients with DBS in the short- and long-term follow-up. Good clinical outcome correlated with higher connectivity to the amygdala and hippocampus. These findings may suggest a common pathway, which can be relevant when planning a surgical procedure in patients with SIB.

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Bilateral anterior capsulotomy and amygdalotomy for mental retardation with psychiatric symptoms and aggression

Abstract: Supplemental Digital Content is available in the text

Cited by 9 publications

References 20 publications

Longitudinal Changes After Amygdala Surgery for Intractable Aggressive Behavior: Clinical, Imaging Genetics, and Deformation-Based Morphometry Study—A Case Series

Longitudinal Changes After Amygdala Surgery for Intractable Aggressive Behavior: Clinical, Imaging Genetics, and Deformation-Based Morphometry Study—A Case Series

Neuroethics of Non-primary Brain Computer Interface: Focus on Potential Military Applications

Connectivity in deep brain stimulation for self-injurious behavior: multiple targets for a common network?

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