Posteromedial Hypothalamotomy in the Treatment of Violent, Aggressive Behaviour

Sano, Keiji; Mayanagi, Yoshiaki

doi:10.1007/978-3-7091-9005-0_28

Cited by 49 publications

(54 citation statements)

References 7 publications

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“…245 As in the amygdala, lesions in the pHr have been used for the combination of epilepsy and aggressive behavior. 244,255 Modern application of DBS to the pHr has mostly been for cases of mental retardation combined with severe aggression, and thus few results have been reported. In the first of 2 cases in the literature, a 22-year-old patient with mental retardation and aggression received bilateral low-frequency stimulation (15 Hz) to the pHr, and at 18-month follow-up the patient's behavior was significantly improved.…”

Section: Aggressive Behaviormentioning

confidence: 99%

Deep brain stimulation for psychiatric disorders: where we are now

Cleary

Ozpinar

Raslan

et al. 2015

FOC

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Fossil records showing trephination in the Stone Age provide evidence that humans have sought to influence the mind through physical means since before the historical record. Attempts to treat psychiatric disease via neurosurgical means in the 20th century provided some intriguing initial results. However, the indiscriminate application of these treatments, lack of rigorous evaluation of the results, and the side effects of ablative, irreversible procedures resulted in a backlash against brain surgery for psychiatric disorders that continues to this day. With the advent of psychotropic medications, interest in invasive procedures for organic brain disease waned. Diagnosis and classification of psychiatric diseases has improved, due to a better understanding of psychiatric patho-physiology and the development of disease and treatment biomarkers. Meanwhile, a significant percentage of patients remain refractory to multiple modes of treatment, and psychiatric disease remains the number one cause of disability in the world. These data, along with the safe and efficacious application of deep brain stimulation (DBS) for movement disorders, in principle a reversible process, is rekindling interest in the surgical treatment of psychiatric disorders with stimulation of deep brain sites involved in emotional and behavioral circuitry. This review presents a brief history of psychosurgery and summarizes the development of DBS for psychiatric disease, reviewing the available evidence for the current application of DBS for disorders of the mind.

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Section: Aggressive Behaviormentioning

confidence: 99%

Deep brain stimulation for psychiatric disorders: where we are now

Cleary

Ozpinar

Raslan

et al. 2015

FOC

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“…The results were considered satisfactory in 29 cases (78%); 18 of these 29 patients presented no violent or aggressive behavior postoperatively, allowing familial and social adaptation. 84 A South American group presented a series of 11 cases in which patients were treated with bilateral or unilateral (1 case) posteromedial (PM) hypothalamotomy: 5 patients suffered from mental retardation, 2 patients were diagnosed with psychopathic personality, and 1 patient was diagnosed with schizophrenia. After 6-48 months of follow-up, 10 patients had satisfactory results, with social adaptation and complete disappearance of violent behavior in 7 cases.…”

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

confidence: 99%

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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“…Sano's explanation for the different outcomes was that surgery on lower-order areas produces more marked and lasting clinical effects than surgery on higher-order areas, because the overlapping of the ergotropic circuit with other circuits is more marked in the neocortex than the allocortex and in the allocortex than the diencephalon. 52 Sano et al [52][53][54][55] reported the most detailed and consistent surgical series concerning patients with aggressive behavior treated by radiofrequency lesioning of the pHyp. Also worth mentioning is that other teams at that time proposed pHyp lesioning for the treatment of aggressive behavior.…”

Section: Human Surgery: the Lesional Era And Neurophysiological Testingmentioning

confidence: 99%

Exploring the brain through posterior hypothalamus surgery for aggressive behavior

Rizzi

Trezza

Messina

et al. 2017

Neurosurgical Focus

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Neurological surgery offers an opportunity to study brain functions, through either resection or implanted neuromodulation devices. Pathological aggressive behavior in patients with intellectual disability is a frequent condition that is difficult to treat using either supportive care or pharmacological therapy. The bulk of the laboratory studies performed throughout the 19th century enabled the formulation of hypotheses on brain circuits involved in the generation of emotions. Aggressive behavior was also studied extensively. Lesional radiofrequency surgery of the posterior hypothalamus, which peaked in the 1970s, was shown to be an effective therapy in many reported series. As with other surgical procedures for the treatment of psychiatric disorders, however, this therapy was abandoned for many reasons, including the risk of its misuse. Deep brain stimulation (DBS) offers the possibility of treating neurological and psychoaffective disorders through relatively reversible and adaptable therapy. Deep brain stimulation of the posterior hypothalamus was proposed and performed successfully in 2005 as a treatment for aggressive behavior. Other groups reported positive outcomes using target and parameter settings similar to those of the original study. Both the lesional and DBS approaches enabled researchers to explore the role of the posterior hypothalamus (or posterior hypothalamic area) in the autonomic and emotional systems.

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Posteromedial Hypothalamotomy in the Treatment of Violent, Aggressive Behaviour

Cited by 49 publications

References 7 publications

Deep brain stimulation for psychiatric disorders: where we are now

Deep brain stimulation for psychiatric disorders: where we are now

The hypothalamus at the crossroads of psychopathology and neurosurgery

Exploring the brain through posterior hypothalamus surgery for aggressive behavior

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