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

Gouveia, Flavia Venetucci; Germann, Jürgen; Morais, Rosa de; Fonoff, Erich Talamoni; Hamani, Clement; Alho, Eduardo Joaquim Lopes; Brentani, Helena; Martins, Ana Paula; Devenyi, Gabriel A.; Steele, Christopher; Gramer, Robert; Chakravarty, M. Mallar; Martinez, Raquel Chacon Ruiz

doi:10.1093/neuros/nyaa378_s097

Cited by 6 publications

(22 citation statements)

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“…dorsal and medial raphe nuclei [serotonin]; substantia nigra [dopamine]; Figure 5) and are known to be components within the neurocircuitry of aggressive behaviour (e.g. amygdala; nucleus accumbens, rostral anterior cingulate cortex; bed nucleus of the stria terminalis; hypothalamus; dorsal anterior cingulate cortex, insula, periaqueductal grey; Figure 5) (1, 2, 5, 6). Functional connectivity mapping after Threshold-Free Cluster Enhancement (TFCE) analysis FDR corrected at q<0.0001 is presented in Supplementary Figure 2.…”

Section: Resultsmentioning

confidence: 99%

“…Aggressive behaviours are highly prevalent among psychiatric patients, presenting a major obstacle to patient care. In addition to suffering, these symptoms constitute a leading cause for institutionalization (1–3). Standard treatments for aggressive behaviours involve behavioural and pharmacological therapies that mainly act on the dopaminergic and serotonergic systems (e.g.…”

Section: Introductionmentioning

confidence: 99%

“…Standard treatments for aggressive behaviours involve behavioural and pharmacological therapies that mainly act on the dopaminergic and serotonergic systems (e.g. serotonin reuptake inhibitors, antipsychotics) (1–3). Despite their efficacy, a substantial proportion (30%) of patients fail to respond and are considered to be treatment refractory (4–6).…”

Section: Introductionmentioning

confidence: 99%

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Networks and genes modulated by posterior hypothalamic stimulation in patients with aggressive behaviours: Analysis of probabilistic mapping, normative connectomics, and atlas-derived transcriptomics of the largest international multi-centre dataset

Gouveia

Germann

Elias

et al. 2022

Preprint

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Deep brain stimulation targeting the posterior hypothalamus (pHyp-DBS) is being investigated as treatment for refractory aggressive behaviour, but its mechanisms of action remain elusive. We conducted an integrated imaging analysis of a large multi-centre dataset, incorporating volume of activated tissue modeling, probabilistic mapping, normative connectomics, and atlas-derived transcriptomics. 91% of the patients responded positively to treatment, with a more striking improvement recorded in the pediatric population. Probabilistic mapping revealed an optimized surgical target within the posterior-inferior-lateral posterior hypothalamic area and normative connectomic analyses identified fiber tracts and interconnected brain areas associated with sensorimotor function, emotional regulation, and monoamine production. Functional connectivity between the target, periaqueductal gray and the amygdala, together with patient age, was highly predictive of treatment outcome. Finally, transcriptomic analysis showed that genes involved in mechanisms of aggressive behaviour, neuronal communication, plasticity and neuroinflammation may underlie this functional network.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Networks and genes modulated by posterior hypothalamic stimulation in patients with aggressive behaviours: Analysis of probabilistic mapping, normative connectomics, and atlas-derived transcriptomics of the largest international multi-centre dataset

Gouveia

Germann

Elias

et al. 2022

Preprint

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“…In this study, the indication for surgery for 11 patients who underwent DBS or RA targeting the amygdala was aggression, and those patients gained satisfactory results. Stereotactic neurosurgery targeting the amygdala improves aggression, possibly by reducing the activity of the nucleus to restore homeostatic patterns of the brain [4,9] .…”

Section: Discussionmentioning

confidence: 99%

The role of stereotactic neurosurgery as a symptomatic treatment for autism spectrum disorders: a systematic review

Shi

et al. 2022

Preprint

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Although stereotactic neurosurgery has been applied in autism spectrum disorders (ASD), its safety and efficacy remain elusive due to the limited sample size. We aimed to investigate the safety and efficacy of stereotactic neurosurgery for ASD by systematically reviewing the literature through the PubMed, EMBASE and Cochrane databases. A total of 11 studies with 36 patients were included. 16 patients (44.44%) received deep brain stimulation (DBS), 10 patients (27.78%) underwent radiofrequency ablation (RA), and 10 patients (27.78%) underwent gamma knife radiosurgery and RA. The therapeutic targets of 11 patients (42.31%) were the amygdala, and the surgical indication of 10 patients was aggression; the ventral anterior limb of the internal capsule or medial forebrain bundle was regarded as the target for 6 patients (23.08%), and the surgical indication was OCD. The mean Yale-Brown-Obsessive-Compulsive Scale (Y-BOCS) score of 19 patients was 31.37 at baseline. After a median follow-up time of 48 months, the mean Y-BOCS score decreased to 18.32, and the mean improvement rate was 42.74%. After a median follow-up duration of 48 months (range: 2-120), the mean Overt Aggression Scale score of 15 patients was reduced from 11.20 to 4.40, and the mean improvement rate was 59.59%. There were a total of 8 patients whose cardinal symptoms benefited from the surgery. Seven patients (19.44%) suffered adverse events after stereotactic neurosurgery. Stereotactic neurosurgery is an effective and safe therapy to alleviate the symptoms of aggressive behaviors and OCD in ASD patients. DBS has the potential to improve the social contact difficulty and communication disorders of ASD.

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“…Methods that allow stronger causal inferences on the role of the amygdala in mood include electrical brain stimulation and changes that occur in the setting of acquired brain lesions. Scangos and colleagues recently demonstrated that gamma power within the amygdala correlated with depression severity, and the reduction of gamma power by electrical stimulation corresponded with a robust mood improvement (Scangos et al ., 2021), While there are historical data on the effects of amygdala removal in psychosurgery, much of this work was focused on aggression (Mpakopoulou et al ., 2008; Zhang et al ., 2017; Gouveia et al ., 2021), and the effects on mood are not well characterized.…”

Section: Introductionmentioning

confidence: 99%

Right amygdala lesions are associated with improved mood after epilepsy surgery

Albazron

Tranel

Howard

et al. 2022

Preprint

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Neuroimaging studies in healthy and clinical populations strongly associate the amygdala with emotion, especially negative emotions. The consequences of surgical lesions of the amygdala on mood are not well characterized. We tested the hypothesis that amygdala lesions would result in mood improvement. In this study we evaluated a cohort of 52 individuals with medial temporal lobectomy for intractable epilepsy who had resections variably involving the amygdala. All individuals achieved good post-surgical seizure control and had pre- and post-surgery mood assessment with the Beck Depression Inventory (BDI) ratings. We manually segmented the surgical resection cavities and performed multivariate lesion-symptom mapping of change in BDI. Our results showed a significant improvement in average mood ratings from pre- to post-surgery across all patients. In partial support of our hypothesis, resection of the right amygdala was significantly associated with mood improvement (r = 0.5, p = 0.008). The lesion-symptom map also showed that resection of the right hippocampus and parahippocampal gyrus was associated with worsened post-surgical mood. Future studies could evaluate this finding prospectively in larger samples while including other neuropsychological outcome measures.

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

Cited by 6 publications

References 0 publications

Networks and genes modulated by posterior hypothalamic stimulation in patients with aggressive behaviours: Analysis of probabilistic mapping, normative connectomics, and atlas-derived transcriptomics of the largest international multi-centre dataset

Networks and genes modulated by posterior hypothalamic stimulation in patients with aggressive behaviours: Analysis of probabilistic mapping, normative connectomics, and atlas-derived transcriptomics of the largest international multi-centre dataset

The role of stereotactic neurosurgery as a symptomatic treatment for autism spectrum disorders: a systematic review

Right amygdala lesions are associated with improved mood after epilepsy surgery

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