Exploring the brain through posterior hypothalamus surgery for aggressive behavior

• Published in: Neurosurgical focus Vol. 43; no. 3; p. E14
• Main Authors: Rizzi, Michele, Trezza, Andrea, Messina, Giuseppe, De Benedictis, Alessandro, Franzini, Angelo, Marras, Carlo Efisio
• Format: Journal Article
• Language: English
• Published: United States 01.09.2017
• Subjects: Aggression - psychology; Deep Brain Stimulation - history; Deep Brain Stimulation - methods; History, 19th Century; History, 20th Century; Humans; Hypothalamus, Posterior - diagnostic imaging; Hypothalamus, Posterior - surgery; Nerve Net - diagnostic imaging; Nerve Net - surgery; Neurosurgical Procedures - history; Neurosurgical Procedures - methods; NEFA = nonesterified fatty acid; VC/VS = ventral capsule and ventral striatum; lesioning; posterior hypothalamus; deep brain stimulation; emotional system; ID = intellectual disability; OAS = Overt Aggression Scale; autonomic system; DBS; aggressive behavior; DBS = deep brain stimulation; pHyp = posterior hypothalamus
• ISSN: 1092-0684; 1092-0684
• DOI: 10.3171/2017.6.FOCUS17231

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.