Results of stimulation and destruction of the posterior hypothalamus in man

Abstract

Autonomic and somatomotor responses to electrical stimulation of the posterior hypothalamus are reported in 51 patients with pathologically aggressive behavior. The stimulated area causing rise in blood pressure, tachycardia, and maximal pupillary dilatation lies in the posteromedial hypothalamus, more than 1 mm and less than 5 mm lateral to the lateral wall of the third ventricle, occupying a triangle formed by the midpoint of the intercommissural line, the rostral end of the aqueduct, and the anterior border of the mammillary body. Electrical stimulation of this (ergotropic) triangle resulted in desyncbronization of the electroencephalogram (EEG) with hippocampal theta waves, or diffuse irregular delta waves of high voltage.Cases with violent behavior showed higher plasma levels of non-esterified fatty acids (NEFA) in the fasting stage; these were markedly elevated by electrical stimulation of the ergotropic triangle.Points in the ergotropic triangle where signs of sympathetic discharge were most marked were electrocauterized bilaterally. This procedure produced marked calming effects (95% of the cases) during the follow-up period of more than 2 years. Postoperatively there was a tendency to a decrease in sympathicotonia or an increase in parasympathicotonia. The follow-up plasma level of NEFA was found to have decreased to approximately the normal value.Y. Neurosurg. / Volume 33 / December, 1970 69]

Deep brain stimulation for psychiatric disorders: where we are now

“…273 Another site of interest in the treatment of aggressive behavior has been the posterior hypothalamic region (pHr), a region that shows strong interconnection with the amygdalae. 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.…”

Angiotensin-II Is a Putative Neurotransmitter in Lactate-Induced Panic-Like Responses in Rats with Disruption of GABAergic Inhibition in the Dorsomedial Hypothalamus

“…Within the "panic circuit" (Gorman et al, 2000;Shekhar et al, 2002), the hypothalamus plays a key role in initiating panic-like responses (Sano et al, 1970;Abelson and Curtis, 1996;Schreiber et al, 1996;Javanmard et al, 1999;Lipp et al, 2005). The dorsomedial hypothalamus (DMH) plays an important role coordinating the neuroendocrine, autonomic, and behavioral responses to emotional stress Chou et al, 2003).…”

Exploring the brain through posterior hypothalamus surgery for aggressive behavior

“…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.…”

“…They developed a functional atlas of hypothalamic responses to stimulation using the Schaltenbrand-Bailey atlas. Following these considerations, Sano et al 54 developed the concept of the "ergotropic triangle," in which sympathetic activity was elicited through intraoperative high-frequency stimulation, which became a sign of correct electrode placement. It is not clear if the stimulation covered the pHyp, the dorsal longitudinal fasciculus that arises there, or both.…”