Treating Aggression and Self-destructive Behaviors by Stimulating the Nucleus Accumbens: A Case Series

Abstract

Self-destructive and aggressive behaviors can have a significant impact on the quality of life of affected individuals and their carrers. While deep brain stimulation (DBS) has been applied to the treatment of self-destructive and aggressive behaviors in isolated cases, clinical data on this treatment modality are still lacking. We therefore assessed responses to treatment with bilateral DBS of the nucleus accumbens in six patients with severe self-destructive and aggressive behaviors. Three patients had Tourette syndrome and three had other underlying predispositions including obsessive compulsive disorder, cerebral palsy, encephalitis, and epilepsy. Patients were followed up for between 2 and 7 years, and patients were assessed using the Modified Overt Aggression Scale (six patients) and the Buss-Perry Aggression Questionnaire (three patients able to complete the questionnaire on their own). DBS reduced self-destructive and aggressive behaviors by 30–100% and by an average of 74.5%. Patients with Tourette syndrome responded better to DBS and improved by 27.3% according to the Buss-Perry Aggression Questionnaire. These results suggest that nuclei accumbens stimulation may be an effective treatment for aggressive and self-destructive behaviors regardless of etiology.

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

“…There are several studies on the role of DBS in aggressive behavior, which have targeted the posterior hypothalamic region. However, clinical data on this treatment modality are still lacking 24 ; especially, in pediatric populations where evidence is advancing slowly. 25 Therefore, we conducted a follow-up study in…”

Habenula as a Neural Substrate for Aggressive Behavior

“…Moreover, antagonism of both dopamine receptor types 1 and 2 in the nAcc have been described as reducing the rewarding value of aggressive behaviors ( 52 – 54 ). In line with these findings, two case reports ( 55 , 56 ) and one case series ( 57 ) reporting on patients treated with deep brain stimulation of the nAcc for severe refractory aggressive behaviors, have shown long lasting positive results ( 58 ).…”

Effectiveness of deep brain stimulation on refractory aggression in pediatric patients with autism and severe intellectual disability: meta-analytic review

“…Except for 1 study (32), no surgical parameters were determined. In 47.06% of the publications (6, 12, 21-25, 35), the brain target was the posteromedial hypothalamic nuclei (pHypN), a well-known target; while other groups proposed earlier targets (5,34) or ventral regions (27,(29)(30)(31)33) or a combination of short-subcortical brain regions (28, 32, 34). Similarly, in most studies, the technique and electrode implantation coordinates were reported, although, in 4 articles, they were not reported (28, [31][32][33].…”

“…Voltage intensity ranged between 0.5V and 6.5V, frequency between 15 and 185 Hz, and pulse width between 60 and 360µs. In 3 studiesthis information was not recorded (22,28,30). Clinical outcomes, effectiveness, and complications.…”

“…In 2 cases it was necessary to adjust the stimulation parameters, to obtain an optimal response (26), or to reduce adverse symptoms (27). In 6 patients the pulse generator battery ran out (25,26,30,31). Due to it, the initial symptoms of aggressiveness returned.…”