Deep brain stimulation for aggressiveness: long-term follow-up and tractography study of the stimulated brain areas.
| Autor: | Torres CV; Departments of1Neurosurgery., Blasco G; Departments of1Neurosurgery., Navas García M; Departments of1Neurosurgery., Ezquiaga E; 5Department of Psychiatry, University Hospital La Princesa, Madrid, Spain., Pastor J; 3Clinical Neurophysiology, University Hospital La Princesa, Madrid., Vega-Zelaya L; 3Clinical Neurophysiology, University Hospital La Princesa, Madrid., Pulido Rivas P; Departments of1Neurosurgery., Pérez Rodrigo S; 4Department of Neuroradiology, Clínica Anderson, Madrid; and., Manzanares R; 2Neuroradiology, and. |
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| Jazyk: | angličtina |
| Zdroj: | Journal of neurosurgery [J Neurosurg] 2020 Feb 07; Vol. 134 (2), pp. 366-375. Date of Electronic Publication: 2020 Feb 07 (Print Publication: 2021). |
| DOI: | 10.3171/2019.11.JNS192608 |
| Abstrakt: | Objective: Initial studies applying deep brain stimulation (DBS) of the posteromedial hypothalamus (PMH) to patients with pathological aggressiveness have yielded encouraging results. However, the anatomical structures involved in its therapeutic effect have not been precisely identified. The authors' objective was to describe the long-term outcome in their 7-patient series, and the tractography analysis of the volumes of tissue activated in 2 of the responders. Methods: This was a retrospective study of 7 subjects with pathological aggressiveness. The findings on MRI with diffusion tensor imaging (DTI) in 2 of the responders were analyzed. The authors generated volumes of tissue activated according to the parameters used, and selected those volumes as regions of interest to delineate the tracts affected by stimulation. Results: The series consisted of 5 men and 2 women. Of the 7 patients, 5 significantly improved with stimulation. The PMH, ventral tegmental area, dorsal longitudinal fasciculus, and medial forebrain bundle seem to be involved in the stimulation field. Conclusions: In this series, 5 of 7 medication-resistant patients with severe aggressiveness who were treated with bilateral PMH DBS showed a significant long-lasting improvement. The PMH, ventral tegmental area, dorsal longitudinal fasciculus, and medial forebrain bundle seem to be in the stimulation field and might be responsible for the therapeutic effect of DBS. |
| Databáze: | MEDLINE |
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