Postero-Medial Hypothalamotomy in the Treatment of Aggressive Behaviors

Sano, K; Yoshioka, Minoru; Ogashiwa, Motohide; Ishijima, Buichi; Ohye, C.

doi:10.1159/000103949

Cited by 58 publications

(52 citation statements)

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“…The results in this study could not be compared to information previously reported by Sano et al [13], Narabayashi and Uno [10], Kiloh et al [11] or Schvarcz et al [14], since the aforementioned researchers did not include sufficiently detailed information on their measuring instruments, side effects or appropriate methodology in their reports. In the past, the decision to modify patient behavior by neurosurgery has led to excesses and treatment errors.…”

Section: Discussionmentioning

confidence: 72%

“…The main complications described in this study were seizures and hemiparesis [11,12]. In 1966, Sano et al [13] described the use of hypothalamotomy in 22 patients, with favorable outcome; mild complications were reported at a follow-up of 2 months to 3 years. In 1972, Schvarcz et al [14] reported hypothalamotomy in 11 patients without specifying the results or complications, with a follow-up of 6 months to 4 years.…”

Section: Introductionmentioning

confidence: 81%

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Bilateral Cingulotomy and Anterior Capsulotomy Applied to Patients with Aggressiveness

Jiménez

Soto

Velasco

et al. 2012

Stereotact Funct Neurosurg

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Objective: To perform a preliminary study on the effects and safety of bilateral cingulotomy and anterior capsulotomy in patients with aggressive behavior. Patients and Methods: Twenty-three psychiatric patients showing aggressive behavior refractory to conventional treatment were initially evaluated. The subjects were clinically selected using the Overt Aggression Scale (OAS) and the Global Assessment of Functioning Scale (GAF). Each case was carefully reviewed by the Ethics Committee of Mexico’s General Hospital. Once selection criteria were met, stereotactic lesions were made using radiofrequency on the anterior limb of the internal capsule and supragenual cingulum. Statistical differences were evaluated with a Wilcoxon test at 6 months and at 4 years. Results: Ten patients underwent surgery. Their OAS and GAF scores decreased after the procedure at the 6-month (p < 0.05) and at the 4-year (p = 0.068) follow-up. Four patients showed mild and transitory postsurgical complications (hyperphagia and somnolence). Conclusions: Bilateral anterior capsulotomy in combination with cingulotomy may reduce aggressive behavior and improve clinical evaluations. Very strict clinical and ethical evaluations were applied prior to considering patients for this treatment.

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Section: Discussionmentioning

confidence: 72%

Section: Introductionmentioning

confidence: 81%

Bilateral Cingulotomy and Anterior Capsulotomy Applied to Patients with Aggressiveness

Jiménez

Soto

Velasco

et al. 2012

Stereotact Funct Neurosurg

View full text Add to dashboard Cite

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“…Aggressive behaviour related to schizophrenia or to mental retardation has been a classical indication for psychosurgery. Prefrontal leucotomy, amygdalotomy and lesions of the posteromedial hypothalamus have been effective in reducing aggressive behaviour [111,112,136]. DBS has been successfully applied to the posteromedial hypothalamus to treat aggressive behaviour in a few patients [137].…”

Section: Reviewmentioning

confidence: 99%

Deep brain stimulation: from neurology to psychiatry?

Krack

Hariz

Baunez

et al. 2010

Trends in Neurosciences

268

186

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International audienceFunctional stereotaxy was introduced in the late 1940s to reduce the morbidity of lobotomy in psychiatric disease by using more focal lesions. The advent of neuroleptics led to a drastic decline in psychosurgery for several decades. Functional stereotactic neurosurgery has recently been revitalized, starting with treatment of Parkinson's disease, in which deep brain stimulation (DBS) facilitates reversible focal neuromodulation of altered basal ganglia circuits. DBS is now being extended to treatment of neuropsychiatric conditions such as Gilles de la Tourette syndrome, obsessive-compulsive disorder, depression and addiction. In this review, we discuss the concept that dysfunction of motor, limbic and associative cortico-basal ganglia-thalamocortical loops underlies these various disorders, which might now be amenable to DBS treatment

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“…11,83 This procedure, initially called "sedative neurosurgery," was more efficient than other approaches, leading to calming effects in the first 22 cases. 83,86 These results were confirmed in a series of 42 cases in which the patients were followed for 2 to 7 years, with outcomes categorized as "excellent" (12 patients became calm, with no violent, aggressive, or restless behavior, requiring no care or supervision) or "good" (28 patients became calm and tractable with only occasional irritability, requiring no constant care or supervision). 85 In 1988, Sano and Mayanagi reported on the long-term outcome (10-25 years) for 37 of the 60 patients operated on from 1962 to 1977.…”

Section: The Hypothalamus As a Stereotactic Target Lessons From The Pmentioning

confidence: 85%

The hypothalamus at the crossroads of psychopathology and neurosurgery

Barbosa

Oliveira‐Souza

Santo

et al. 2017

Neurosurgical Focus

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The neurosurgical endeavor to treat psychiatric patients may have been part of human history since its beginning. The modern era of psychosurgery can be traced to the heroic attempts of Gottlieb Burckhardt and Egas Moniz to alleviate mental symptoms through the ablation of restricted areas of the frontal lobes in patients with disabling psychiatric illnesses. Thanks to the adaptation of the stereotactic frame to human patients, the ablation of large volumes of brain tissue has been practically abandoned in favor of controlled interventions with discrete targets.Consonant with the role of the hypothalamus in the mediation of the most fundamental approach-avoidance behaviors, some hypothalamic nuclei and regions, in particular, have been selected as targets for the treatment of aggressiveness (posterior hypothalamus), pathological obesity (lateral or ventromedial nuclei), sexual deviations (ventromedial nucleus), and drug dependence (ventromedial nucleus). Some recent improvements in outcomes may have been due to the use of stereotactically guided deep brain stimulation and the change of therapeutic focus from categorical diagnoses (such as schizophrenia) to dimensional symptoms (such as aggressiveness), which are nonspecific in terms of formal diagnosis. However, agreement has never been reached on 2 related issues: 1) the choice of target, based on individual diagnoses; and 2) reliable prediction of outcomes related to individual targets. Despite the lingering controversies on such critical aspects, the experience of the past decades should pave the way for advances in the field. The current failure of pharmacological treatments in a considerable proportion of patients with chronic disabling mental disorders is reminiscent of the state of affairs that prevailed in the years before the early psychosurgical attempts.This article reviews the functional organization of the hypothalamus, the effects of ablation and stimulation of discrete hypothalamic regions, and the stereotactic targets that have most often been used in the treatment of psychopathological and behavioral symptoms; finally, the implications of current and past experience are presented from the perspective of how this fund of knowledge may usefully contribute to the future of hypothalamic psychosurgery.

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Postero-Medial Hypothalamotomy in the Treatment of Aggressive Behaviors

Cited by 58 publications

References 0 publications

Bilateral Cingulotomy and Anterior Capsulotomy Applied to Patients with Aggressiveness

Bilateral Cingulotomy and Anterior Capsulotomy Applied to Patients with Aggressiveness

Deep brain stimulation: from neurology to psychiatry?

The hypothalamus at the crossroads of psychopathology and neurosurgery

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