Deep brain stimulation for aggressiveness: long-term follow-up and tractography study of the stimulated brain areas

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Initial studies applying deep brain stimulation (DBS) of the posteromedial hypothalamus (PMH) to patients with pathological aggressiveness have yielded encouraging results. However, the anatomical structures involved in its therapeutic effect have not been precisely identified. The authors’ objective was to describe the long-term outcome in their 7-patient series, and the tractography analysis of the volumes of tissue activated in 2 of the responders.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>This was a retrospective study of 7 subjects with pathological aggressiveness. The findings on MRI with diffusion tensor imaging (DTI) in 2 of the responders were analyzed. The authors generated volumes of tissue activated according to the parameters used, and selected those volumes as regions of interest to delineate the tracts affected by stimulation.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>The series consisted of 5 men and 2 women. Of the 7 patients, 5 significantly improved with stimulation. The PMH, ventral tegmental area, dorsal longitudinal fasciculus, and medial forebrain bundle seem to be involved in the stimulation field.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>In this series, 5 of 7 medication-resistant patients with severe aggressiveness who were treated with bilateral PMH DBS showed a significant long-lasting improvement. The PMH, ventral tegmental area, dorsal longitudinal fasciculus, and medial forebrain bundle seem to be in the stimulation field and might be responsible for the therapeutic effect of DBS.</jats:p></jats:sec>

A high-resolution in vivo magnetic resonance imaging atlas of the human hypothalamic region

“…In the field of neuroimaging, this effort is primarily directed towards volumetric and topological analyses in healthy and diseased states [9][10][11] . Conversely, probing of the hypothalamus by means of electrical stimulation and lesioning provides insights into the functional role of individual nuclei [12][13][14][15] . The accurate delineation and targeting of the hypothalamus, however, has conventionally been associated with technological and methodological challenges, namely the lack of structural detail and contrast on routinely acquired magnetic resonance imaging (MRI) scans.…”

Neurophysiological Characterization of Posteromedial Hypothalamus in Anaesthetized Patients

“…Microelectrode recording (MER) is a useful tool used during DBS surgery to identify deep brain nuclei [ 5 , 6 , 7 , 8 ]. When surgery is performed in the thalamus, subthalamus or globus pallidus, other physiological tests in addition to MER can be performed to identify nuclei, such as cellular responses to voluntary or passive movements, tactile stimuli or paraesthesia induced by electrical stimulation [ 9 , 10 , 11 ].…”

Treating Aggression and Self-destructive Behaviors by Stimulating the Nucleus Accumbens: A Case Series

“…Although another recent case series described successful outcome by DBS of the posteromedial hypothalamus ( 26 ), this is the largest group of patients reported in the literature treated neurosurgically for aggression and self-destruction by DBS of the nucleus accumbens. A common characteristic of the posteromedial hypothalamus and nucleus accumbens is the multiple connections with the limbic system (amygdala and hippocampus) and the independent connections of both structures with the thalamus, motor cortex, and the brainstem.…”