Deep Brain Stimulation in the Posteromedial Hypothalamic Nuclei in Refractory Aggressiveness: Post-Surgical Results of 19 Cases

Deep brain stimulation may be a viable option for resistant to treatment aggression in children with intellectual disability

“…In this context, before the Covid-19 pandemic, our working group, 33 performed the largest follow-up study reported in the literature; which would explain the results of this series of cases. 10,22 Therefore, in this opportunity, we present the results of a second follow-up study, conducted during the Covid-19 pandemic (2021), in a pediatric population with neurodevelopmental disorder and intractable aggression.…”

“…10,22 Therefore, in this opportunity, we present the results of a second follow-up study, conducted during the Covid-19 pandemic (2021), in a pediatric population with neurodevelopmental disorder and intractable aggression. Unlike the first study, 33 we incorporated more objective measures of intelligence, graded the level of ID and adaptive functioning, and more accurately estimated the degree of aggressiveness of the patients; this to have a clean sample of subjects in severe stages of ID. Likewise, details of the clinical procedure and surgical technique were refined.…”

Posterior Hypothalamic Region Deep Brain Stimulation for the Treatment of Aggression Disorders in Patients with Intellectual Disability: A Systematic Review

“…Therefore, 33 studies were eligible for full-text screening. After exclusion of 23 studies (4 included overlapping populations, 13 had insufficient data, 2 dealt with irrelevant topics, 4 resulted in conference abstract), a total of 10 studies met the inclusion criteria and were included in our study [12][13][14][15][16][17][18][19][20][21]. All 10 studies were retrospective case series or case reports and published between 2008 and 2022 (Table 1).…”

“…The majority of patients have been treated in Colombia (65%). One study reported only the mean age at surgery which resulted 18.4 (+/− 4 SD) [20]; the mean age at surgery for the other 9 studies (41 out of 60 patients) resulted 25.3 years (+/− 11.2 SD) with 8 pediatric patients (19.5%) and a minimum age at surgery of 10 years. The median follow-up is 21 months (IQR 40), with only 3 patients with a follow-up inferior to 12 months [12,14,18].…”

“…Targeting and Implantation Strategies DBS system implantation was performed with a stereotactic frame, following a software-based targeting with the use of stereotactic CT scan fused with preoperative MR. Three studies reported PHyp coordinates [14,20,21] described by Franzini et al [22], while one study proposed a more anterior and ventral target [18].…”