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Santin MDN, Tempier N, Belaid H, Zenoni M, Dumas S, Wallén-Mackenzie Å, Bardinet E, Destrieux C, François C, Karachi C. Anatomical characterisation of three different psychosurgical targets in the subthalamic area: from the basal ganglia to the limbic system. Brain Struct Funct 2023; 228:1977-1992. [PMID: 37668733 DOI: 10.1007/s00429-023-02691-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 07/24/2023] [Indexed: 09/06/2023]
Abstract
Effective neural stimulation for the treatment of severe psychiatric disorders needs accurate characterisation of surgical targets. This is especially true for the medial subthalamic region (MSR) which contains three targets: the anteromedial STN for obsessive compulsive disorder (OCD), the medial forebrain bundle (MFB) for depression and OCD, and the "Sano triangle" for pathological aggressiveness. Blocks containing the subthalamic area were obtained from two human brains. After obtaining 11.7-Tesla MRI, blocks were cut in regular sections for immunohistochemistry. Fluorescent in situ hybridisation was performed on the macaque MSR. Electron microscopic observation for synaptic specialisation was performed on human and macaque subthalamic fresh samples. Images of human brain sections were reconstructed in a cryoblock which was registered on the MRI and histological slices were then registered. The STN contains glutamatergic and fewer GABAergic neurons and has no strict boundary with the adjacent MSR. The anteromedial STN has abundant dopaminergic and serotoninergic innervation with very sparse dopaminergic neurons. The MFB is composed of dense anterior dopaminergic and posterior serotoninergic fibres, and fewer cholinergic and glutamatergic fibres. Medially, the Sano triangle presumably contains orexinergic terminals from the hypothalamus, and neurons with strong nuclear oestrogen receptor-alpha staining with a decreased anteroposterior and mediolateral gradient of staining. These findings provide new insight regarding MSR cells and their fibre specialisation, forming a transition zone between the basal ganglia and the limbic systems. Our 3D reconstruction enabled us to visualize the main histological features of the three targets which should enable better targeting and understanding of neuromodulatory stimulation results in severe psychiatric conditions.
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Affiliation(s)
- Marie des Neiges Santin
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute- ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, 75013, Paris, France
| | - Nicolas Tempier
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute- ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, 75013, Paris, France
| | - Hayat Belaid
- Service de Neurochirurgie, Hôpital Fondation Adolphe de Rothschild, 29 rue Manin, Paris, France
| | - Matthieu Zenoni
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute- ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, 75013, Paris, France
| | | | - Åsa Wallén-Mackenzie
- Department of Organismal Biology, Unit of Comparative Physiology, Uppsala University, S-756 32, Uppsala, Sweden
| | - Eric Bardinet
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute- ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, 75013, Paris, France
| | - Christophe Destrieux
- UMR Inserm U1253, IBrain, Université de Tours, Tours, France
- Laboratoire d'Anatomie, Faculté de Médecine, Université François Rabelais, Tours, France
| | - Chantal François
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute- ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, 75013, Paris, France
| | - Carine Karachi
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute- ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, 75013, Paris, France.
- AP-HP, Hôpital de la Pitié-Salpêtrière, Service de Neurochirurgie, Paris, France.
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2
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Vega-Zelaya L, Pastor J. The Network Systems Underlying Emotions: The Rational Foundation of Deep Brain Stimulation Psychosurgery. Brain Sci 2023; 13:943. [PMID: 37371421 DOI: 10.3390/brainsci13060943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
Science and philosophy have tried to understand the origin of emotions for centuries. However, only in the last 150 years have we started to try to understand them in a neuroscientific scope. Emotions include physiological changes involving different systems, such as the endocrine or the musculoskeletal, but they also cause a conscious experience of those changes that are embedded in memory. In addition to the cortico-striato-thalamo-cortical circuit, which is the most important of the basal ganglia, the limbic system and prefrontal circuit are primarily involved in the process of emotion perceptions, thoughts, and memories. The purpose of this review is to describe the anatomy and physiology of the different brain structures involved in circuits that underlie emotions and behaviour, underlying the symptoms of certain psychiatric pathologies. These circuits are targeted during deep brain stimulation (DBS) and knowledge of them is mandatory to understand the clinical-physiological implications for the treatment. We summarize the main outcomes of DBS treatment in several psychiatric illness such as obsessive compulsive disorder, refractory depression, erethism and other conditions, aiming to understand the rationale for selecting these neural systems as targets for DBS.
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Affiliation(s)
- Lorena Vega-Zelaya
- Clinical Neurophysiology, Instituto de Investigación Biomédica Hospital, Universitario de La Princesa, C/Diego de León 62, 28006 Madrid, Spain
| | - Jesús Pastor
- Clinical Neurophysiology, Instituto de Investigación Biomédica Hospital, Universitario de La Princesa, C/Diego de León 62, 28006 Madrid, Spain
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3
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Heiden P, Weigel DT, Loução R, Hamisch C, Gündüz EM, Ruge MI, Kuhn J, Visser-Vandewalle V, Andrade P. Connectivity in deep brain stimulation for self-injurious behavior: multiple targets for a common network? Front Hum Neurosci 2022; 16:958247. [PMID: 36092644 PMCID: PMC9448926 DOI: 10.3389/fnhum.2022.958247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
Self-injurious behavior (SIB) is associated with diverse psychiatric conditions. Sometimes (e.g., in patients with autism spectrum disorder or acquired brain injuries), SIB is the most dominant symptom, severely restricting the psychosocial functioning and quality of life of the patients and inhibiting appropriate patient care. In severe cases, it can lead to permanent physical injuries or even death. Primary therapy consists of medical treatment and if implementable, behavioral therapy. For patients with severe SIB refractory to conventional therapy, neuromodulation can be considered as a last recourse. In scientific literature, several successful lesioning and deep brain stimulation targets have been described that can indicate a common underlying neuronal pathway. The objectives of this study were to evaluate the short- and long-term clinical outcome of patients with severe, therapy refractory SIB who underwent DBS with diverse underlying psychiatric disorders and to correlate these outcomes with the activated connectivity networks. We retrospectively analyzed 10 patients with SIB who underwent DBS surgery with diverse psychiatric conditions including autism spectrum disorder, organic personality disorder after hypoxic or traumatic brain injury or Tourette syndrome. DBS targets were chosen according to the underlying disorder, patients were either stimulated in the nucleus accumbens, amygdala, posterior hypothalamus, medial thalamus or ventrolateral thalamus. Clinical outcome was measured 6 months after surgery and at long-term follow-up after 10 or more years using the Early Rehabilitation Barthel index (ERBI) and time of restraint. Connectivity patterns were analyzed using normative connectome. Based on previous literature the orbitofrontal cortex, superior frontal gyrus, the anterior cingulate cortex, the amygdala and the hippocampus were chosen as regions of interest. This analysis showed a significant improvement in the functionality of the patients with DBS in the short- and long-term follow-up. Good clinical outcome correlated with higher connectivity to the amygdala and hippocampus. These findings may suggest a common pathway, which can be relevant when planning a surgical procedure in patients with SIB.
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Affiliation(s)
- Petra Heiden
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Department of Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Daniel Tim Weigel
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ricardo Loução
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Department of Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christina Hamisch
- Department of Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Enes M. Gündüz
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Maximilian I. Ruge
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jens Kuhn
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatic, Johanniter Hospital Oberhausen, Oberhausen, Germany
| | - Veerle Visser-Vandewalle
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Pablo Andrade
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- *Correspondence: Pablo Andrade
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Kelly R, Pearce J, Sani S. Commentary: Posteromedial Hypothalamic Deep Brain Stimulation for Refractory Aggressiveness in a Patient With Weaver Syndrome: Clinical, Technical Report, and Operative Video. Oper Neurosurg (Hagerstown) 2021; 21:E454-E456. [PMID: 34467982 PMCID: PMC8510845 DOI: 10.1093/ons/opab293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 07/06/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Ryan Kelly
- Rush University Medical Center, Department of Neurosurgery, Rush University, Chicago, Illinois, USA
| | - John Pearce
- Rush University Medical Center, Department of Neurosurgery, Rush University, Chicago, Illinois, USA
| | - Sepher Sani
- Rush University Medical Center, Department of Neurosurgery, Rush University, Chicago, Illinois, USA
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Coenen VA, Döbrössy MD, Teo SJ, Wessolleck J, Sajonz BEA, Reinacher PC, Thierauf-Emberger A, Spittau B, Leupold J, von Elverfeldt D, Schlaepfer TE, Reisert M. Diverging prefrontal cortex fiber connection routes to the subthalamic nucleus and the mesencephalic ventral tegmentum investigated with long range (normative) and short range (ex-vivo high resolution) 7T DTI. Brain Struct Funct 2021; 227:23-47. [PMID: 34482443 PMCID: PMC8741702 DOI: 10.1007/s00429-021-02373-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/24/2021] [Indexed: 11/30/2022]
Abstract
Uncertainties
concerning anatomy and function of cortico-subcortical projections have arisen during the recent years. A clear distinction between cortico-subthalamic (hyperdirect) and cortico-tegmental projections (superolateral medial forebrain bundle, slMFB) so far is elusive. Deep Brain Stimulation (DBS) of the slMFB (for major depression, MD and obsessive compulsive disorders, OCD) has on the one hand been interpreted as actually involving limbic (prefrontal) hyperdirect pathways. On the other hand slMFB’s stimulation region in the mesencephalic ventral tegmentum is said to impact on other structures too, going beyond the antidepressant (or anti OCD) efficacy of sole modulation of the cortico-tegmental reward-associated pathways. We have here used a normative diffusion MRT template (HCP, n = 80) for long-range tractography and augmented this dataset with ex-vivo high resolution data (n = 1) in a stochastic brain space. We compared this data with histological information and used the high resolution ex-vivo data set to scrutinize the mesencephalic tegmentum for small fiber pathways present. Our work resolves an existing ambiguity between slMFB and prefrontal hyperdirect pathways which—for the first time—are described as co-existent. DBS of the slMFB does not appear to modulate prefrontal hyperdirect cortico-subthalamic but rather cortico-tegmental projections. Smaller fiber structures in the target region—as far as they can be discerned—appear not to be involved in slMFB DBS. Our work enfeebles previous anatomical criticism and strengthens the position of the slMFB DBS target for its use in MD and OCD.
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Affiliation(s)
- Volker A Coenen
- Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Breisacher STraße 64, 79106, Freiburg, Germany. .,Medical Faculty of Freiburg University, Freiburg, Germany. .,Center for Deep Brain Stimulation, Medical Center of Freiburg University, Freiburg, Germany. .,Laboratory of Stereotaxy and Interventional Neurosciences, Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Freiburg, Germany.
| | - Máté D Döbrössy
- Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Breisacher STraße 64, 79106, Freiburg, Germany.,Medical Faculty of Freiburg University, Freiburg, Germany.,Laboratory of Stereotaxy and Interventional Neurosciences, Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Freiburg, Germany
| | - Shi Jia Teo
- Medical Faculty of Freiburg University, Freiburg, Germany.,Department of Diagnostic and Interventional Radiology, Medical Physics, Medical Center, University of Freiburg, Freiburg, Germany
| | - Johanna Wessolleck
- Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Breisacher STraße 64, 79106, Freiburg, Germany.,Laboratory of Stereotaxy and Interventional Neurosciences, Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Freiburg, Germany
| | - Bastian E A Sajonz
- Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Breisacher STraße 64, 79106, Freiburg, Germany.,Medical Faculty of Freiburg University, Freiburg, Germany
| | - Peter C Reinacher
- Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Breisacher STraße 64, 79106, Freiburg, Germany.,Medical Faculty of Freiburg University, Freiburg, Germany.,Fraunhofer Institute for Laser Technology (ILT), Aachen, Germany
| | - Annette Thierauf-Emberger
- Medical Faculty of Freiburg University, Freiburg, Germany.,Institute of Forensic Medicine, Medical Center of Freiburg University, Freiburg, Germany
| | - Björn Spittau
- Anatomy and Cell Biology, Medical School OWL, Bielefeld University, Bielefeld, Germany.,Institute for Anatomy and Cell Biology, Department of Molecular Embryologie, Faculty of Medicine, Freiburg University, Freiburg, Germany
| | - Jochen Leupold
- Medical Faculty of Freiburg University, Freiburg, Germany.,Department of Diagnostic and Interventional Radiology, Medical Physics, Medical Center, University of Freiburg, Freiburg, Germany
| | - Dominik von Elverfeldt
- Medical Faculty of Freiburg University, Freiburg, Germany.,Department of Diagnostic and Interventional Radiology, Medical Physics, Medical Center, University of Freiburg, Freiburg, Germany
| | - Thomas E Schlaepfer
- Medical Faculty of Freiburg University, Freiburg, Germany.,Center for Deep Brain Stimulation, Medical Center of Freiburg University, Freiburg, Germany.,Division of Interventional Biological Psychiatry, Department of Psychiatry and Psychotherapy, Medical Center of Freiburg University, Freiburg, Germany
| | - Marco Reisert
- Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Breisacher STraße 64, 79106, Freiburg, Germany.,Medical Faculty of Freiburg University, Freiburg, Germany.,Department of Diagnostic and Interventional Radiology, Medical Physics, Medical Center, University of Freiburg, Freiburg, Germany
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6
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Coenen VA. Commentary: Posteromedial Hypothalamic Deep Brain Stimulation for Refractory Aggressiveness in a Patient With Weaver Syndrome: Clinical, Technical Report and Operative Video. Oper Neurosurg (Hagerstown) 2021; 21:E226-E228. [PMID: 34038954 DOI: 10.1093/ons/opab165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 03/28/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Volker A Coenen
- Department of Stereotactic and Functional Neurosurgery, Freiburg University Medical Center and Medical Faculty, Freiburg University, Freiburg, Germany.,Center for Deep Brain Stimulation, Freiburg University, Freiburg, Germany
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7
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Contreras Lopez WO, Navarro PA, Gouveia FV, Fonoff ET, Lebrun I, Auada AVV, Lopes Alho EJ, Martinez RCR. Directional Deep Brain Stimulation of the Posteromedial Hypothalamus for Refractory Intermittent Explosive Disorder: A Case Series Using a Novel Neurostimulation Device and Intraoperative Microdialysis. World Neurosurg 2021; 155:e19-e33. [PMID: 34325026 DOI: 10.1016/j.wneu.2021.07.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/17/2021] [Accepted: 07/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Intermittent explosive disorder (IED) is a psychiatric disorder characterized by recurrent outbursts of aggressive behavior. Deep brain stimulation (DBS) in the posteromedial nucleus of the hypothalamus (pHyp) is an alternative therapy for extreme cases and shows promising results. Intraoperative microdialysis can help elucidate the neurobiological mechanism of pHyp-DBS. We sought to evaluate efficacy and safety of pHyp-DBS using 8-contact directional leads in patients with refractory IED (rIED) and the accompanying changes in neurotransmitters. METHODS This was a prospective study in which patients with a diagnosis of rIED were treated with pHyp-DBS for symptom alleviation. Bilateral pHyp-DBS was performed with 8-contact directional electrodes. Follow-up was performed at 3, 6, and 12 months after surgery. RESULTS Four patients (3 men, mean age 27 ± 2.8 years) were included. All patients were diagnosed with rIED and severe intellectual disability. Two patients had congenital rubella, one had a co-diagnosis of infantile autism, and the fourth presented with drug-resistant epilepsy. There was a marked increase in the levels of gamma-aminobutyric acid and glycine during intraoperative stimulation. The average improvement in aggressive behavior in the last follow-up was 6 points (Δ: 50%, P = 0.003) while also documenting an important improvement of the Short Form Health Survey in all domains except bodily pain. No adverse events associated with pHyp-DBS were observed. CONCLUSIONS This is the first study to show the safety and beneficial effect of directional lead pHyp-DBS in patients with rIED and to demonstrate the corresponding mechanism of action through increases in gamma-aminobutyric acid and glycine concentration in the pHyp.
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Affiliation(s)
- William Omar Contreras Lopez
- Nemod Research Group, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia; Division of Functional Neurosurgery, Department of Neurosurgery, FOSCAL Clinic, Bucaramanga, Colombia.
| | - Paula Alejandra Navarro
- Division of Functional Neurosurgery, Department of Neurosurgery, FOSCAL Clinic, Bucaramanga, Colombia; Department of Epidemiology, School of Medicine, Universidad de los Andes, Bogotá, Colombia
| | | | - Erich Talamoni Fonoff
- Department of Neurology, University of São Paulo School of Medicine and Integrated Clinic of Neuroscience, São Paulo, Brazil
| | - Ivo Lebrun
- Biochemistry and Biophysics Laboratory, Butantan Institute, University of Sao Paulo, Sao Paulo, Brazil
| | - Aline V V Auada
- Biochemistry and Biophysics Laboratory, Butantan Institute, University of Sao Paulo, Sao Paulo, Brazil
| | - Eduardo Joaquim Lopes Alho
- Department of Neurology, University of São Paulo School of Medicine and Integrated Clinic of Neuroscience, São Paulo, Brazil
| | - Raquel C R Martinez
- LIM 23, Institute of Psychiatry, University of Sao Paulo, School of Medicine, Sao Paulo, Brazil; Division of Neuroscience, Sírio-Libanês Hospital, São Paulo, Brazil
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Blasco García de Andoain G, Navas García M, González Aduna Ó, Bocos Portillo A, Ezquiaga Terrazas E, Ayuso-Mateos JL, Pastor J, Vega-Zelaya L, Torres CV. Posteromedial Hypothalamic Deep Brain Stimulation for Refractory Aggressiveness in a Patient With Weaver Syndrome: Clinical, Technical Report and Operative Video. Oper Neurosurg (Hagerstown) 2021; 21:165-171. [PMID: 34017998 DOI: 10.1093/ons/opab149] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 03/14/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Deep brain stimulation of the posteromedial hypothalamus (PMH DBS) appears to be an effective treatment for drug-resistant aggressiveness. Weaver syndrome (WS) is a rare genetic disorder in which patients develop some degree of intellectual disability and rarely severe behavioral alterations that may benefit from this procedure. CLINICAL PRESENTATION We present the case of a 26-yr-old man diagnosed with WS presenting with uncontrollable self and heteroaggressiveness and disruptive behavior refractory to pharmacological treatment and under severe physical and mechanical restraining measures. The patient was successfully treated with bilateral PMH DBS resulting in affective improvement, greater tolerance for signs of affection, regularization in his sleep pattern and appetite disturbances at 12-mo follow-up. A detailed description and video of the procedure are presented, and a review of the clinical characteristics of WS and the utility and benefits of PMH DBS for refractory aggressiveness are reviewed. CONCLUSION To our knowledge, this is the first case of refractory aggressiveness described in WS as well as the first patient with WS successfully treated with PMH DBS.
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Affiliation(s)
| | - Marta Navas García
- Department of Neurosurgery, La Princesa University Hospital, Madrid, Spain
| | | | | | | | | | - Jesús Pastor
- Department of Clinical Neurophysiology, La Princesa University Hospital, Madrid, Spain
| | - Lorena Vega-Zelaya
- Department of Clinical Neurophysiology, La Princesa University Hospital, Madrid, Spain
| | - Cristina V Torres
- Department of Neurosurgery, La Princesa University Hospital, Madrid, Spain
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9
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Rizzi M, Gambini O, Marras CE. Posterior hypothalamus as a target in the treatment of aggression: From lesioning to deep brain stimulation. HANDBOOK OF CLINICAL NEUROLOGY 2021; 182:95-106. [PMID: 34266615 DOI: 10.1016/b978-0-12-819973-2.00007-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Intermittent explosive disorder can be described as a severe "affective aggression" condition, for which drugs and other supportive therapies are not fully effective. In the first half of the 19th century, experimental studies progressively increased knowledge of aggressive disorders. A neurobiologic approach revealed the posterior hypothalamic region as a key structure for the modulation of aggression. In the 1960s, patients with severe aggressive disorder, frequently associated with intellectual disability, were treated by bilateral stereotactic lesioning of the posterior hypothalamic area, with efficacy. This therapy was later abandoned because of issues related to the misuse of psychosurgery. In the last 2 decades, however, the same diencephalic target has been selected for the reversible treatment by deep brain stimulation, with success. This chapter presents a comprehensive approach to posterior hypothalamic surgery for the treatment of severely aggressive patients and discusses the experimental steps that allowed this surgical target to be selected. Surgical experiences are reported, together with considerations on target features and related encephalic circuits.
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Affiliation(s)
- Michele Rizzi
- "C.Munari" Epilepsy Surgery Center, Department of Neuroscience, ASST GOM Niguarda, Milan, Italy.
| | - Orsola Gambini
- Department of Health of Sciences, University of Milan, Milan, Italy; CRC "Aldo Ravelli" for Neurotechnology and Experimental Brain Therapeutics, University of Milan Medical School, Milan, Italy
| | - Carlo Efisio Marras
- Neurosurgery Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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10
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Torres CV, Blasco G, Navas García M, Ezquiaga E, Pastor J, Vega-Zelaya L, Pulido Rivas P, Pérez Rodrigo S, Manzanares R. Deep brain stimulation for aggressiveness: long-term follow-up and tractography study of the stimulated brain areas. J Neurosurg 2020; 134:366-375. [PMID: 32032944 DOI: 10.3171/2019.11.jns192608] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 11/26/2019] [Indexed: 01/14/2023]
Abstract
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.
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Affiliation(s)
| | | | | | - Elena Ezquiaga
- 5Department of Psychiatry, University Hospital La Princesa, Madrid, Spain
| | - Jesús Pastor
- 3Clinical Neurophysiology, University Hospital La Princesa, Madrid
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11
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The anatomo-functional organization of the hyperdirect cortical pathway to the subthalamic area using in vivo structural connectivity imaging in humans. Brain Struct Funct 2019; 225:551-565. [DOI: 10.1007/s00429-019-02012-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 12/12/2019] [Indexed: 12/20/2022]
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12
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Hernández Salazar M, Zarate Méndez A, Meneses Luna O, Ledesma Torres L, Paniagua Sierra R, Sánchez Moreno MC, Serrato Avila JL. Ablative stereotactic neurosurgery for irreducible neuroaggressive disorder in pediatric patients. Neurocirugia (Astur) 2018; 29:296-303. [PMID: 29914842 DOI: 10.1016/j.neucir.2018.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 05/07/2018] [Accepted: 05/10/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND OBJECTIVES The irreducible neuroaggressive disorder (IND) is a well-described entity known to be associated with impulsive and aggressive behavior. While various studies have assessed available pharmacological and non-pharmacological treatment regimens, patients with IND continue to pose a major threat to themselves and society. While targeted stereotactic therapy for IND has gained traction in recent years, there is a paucity of information describing comparative effectiveness of different validated anatomic regions. In this paper, we discuss the surgical results for patients with IND following targeted lesional therapy with a special focus on selection criteria and operative methods. The objective is to analyze the efficacy and safety of the different described targets for this disorder in pediatric patients. MATERIALS AND METHODS Eight pediatric patients met strict criteria for IND and were enrolled in this study. Electroencephalography (EEG), video electroencephalography (VEEG) and magnetic resonance imaging (MRI) were performed in all patients prior to surgery. Irreducible neuroagressive symptom was approached by lesional therapy based on most described targets for this disorder and assessed by The Overt Agressive Scale (OAS) pre-operatively and 6 months following surgery, using Wilcoxon test for statistical analysis. RESULTS AND CONCLUSIONS The average patient age was 13 years 2 months. 7 of the 8 patients enrolled had intellectual disabilities, 1 patient suffered neurologic sequelae referable to Dandy Walker syndrome and 7 patients had no preoperative anatomical alterations. Following surgery, patients with IND noted improvement in their OAS. On average, the OAS improved by 39.29% (P=.0156), a figure similar in comparison to studies assessing treatment of IND in adult patients. The most satisfactory results were achieved in patients whose ablative therapy involved the Amygdala in their targets. There were no deaths or permanent neurological deficits attributable to procedure. To the author's knowledge, this is the largest series described in the literature for pediatric patients with IND treated with lesional stereotactic therapy.
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Affiliation(s)
| | | | | | | | - Ramón Paniagua Sierra
- Centro Médico Nacional Siglo XXI, Hospital de Especialidades, Ciudad de México, México
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Azuar C, Levy R. Behavioral disorders: The ‘blind spot’ of neurology and psychiatry. Rev Neurol (Paris) 2018; 174:182-189. [DOI: 10.1016/j.neurol.2018.02.083] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/16/2018] [Accepted: 02/20/2018] [Indexed: 11/25/2022]
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Barbosa DAN, de Oliveira-Souza R, Monte Santo F, de Oliveira Faria AC, Gorgulho AA, De Salles AAF. The hypothalamus at the crossroads of psychopathology and neurosurgery. Neurosurg Focus 2017; 43:E15. [DOI: 10.3171/2017.6.focus17256] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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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Affiliation(s)
- Daniel A. N. Barbosa
- 1Department of Clinical Neuroscience, D’Or Institute for Research and Education
- 2Division of Neurosurgery and
| | - Ricardo de Oliveira-Souza
- 1Department of Clinical Neuroscience, D’Or Institute for Research and Education
- 3Department of Neurology and Psychiatry, Gaffrée e Guinle University Hospital, Federal University of the State of Rio de Janeiro
| | - Felipe Monte Santo
- 1Department of Clinical Neuroscience, D’Or Institute for Research and Education
- 4Intensive Care Unit, Icaraí Hospital, Niteroi, RJ
| | - Ana Carolina de Oliveira Faria
- 1Department of Clinical Neuroscience, D’Or Institute for Research and Education
- 3Department of Neurology and Psychiatry, Gaffrée e Guinle University Hospital, Federal University of the State of Rio de Janeiro
| | - Alessandra A. Gorgulho
- 5HCor Neuroscience, São Paulo, Brazil; and
- 6Department of Neurosurgery and Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Antonio A. F. De Salles
- 5HCor Neuroscience, São Paulo, Brazil; and
- 6Department of Neurosurgery and Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, California
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Rizzi M, Trezza A, Messina G, De Benedictis A, Franzini A, Marras CE. Exploring the brain through posterior hypothalamus surgery for aggressive behavior. Neurosurg Focus 2017; 43:E14. [DOI: 10.3171/2017.6.focus17231] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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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Affiliation(s)
- Michele Rizzi
- 1Functional Neurosurgery Unit, Department of Neurosurgery, IRCCS Foundation “Istituto Neurologico Carlo Besta,” Milan
- 3“Claudio Munari” Center for Epilepsy Surgery, Niguarda Hospital, Milan
| | - Andrea Trezza
- 4Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, IRCCS Bambino Gesù Children’s Hospital, Rome; and
- 5Division of Neurosurgery, Department of Surgery and Translational Medicine, Milan Center for Neuroscience, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy
| | - Giuseppe Messina
- 1Functional Neurosurgery Unit, Department of Neurosurgery, IRCCS Foundation “Istituto Neurologico Carlo Besta,” Milan
| | - Alessandro De Benedictis
- 4Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, IRCCS Bambino Gesù Children’s Hospital, Rome; and
| | - Angelo Franzini
- 1Functional Neurosurgery Unit, Department of Neurosurgery, IRCCS Foundation “Istituto Neurologico Carlo Besta,” Milan
| | - Carlo Efisio Marras
- 4Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, IRCCS Bambino Gesù Children’s Hospital, Rome; and
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Neumaier F, Paterno M, Alpdogan S, Tevoufouet EE, Schneider T, Hescheler J, Albanna W. Surgical Approaches in Psychiatry: A Survey of the World Literature on Psychosurgery. World Neurosurg 2017; 97:603-634.e8. [DOI: 10.1016/j.wneu.2016.10.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 09/29/2016] [Accepted: 10/01/2016] [Indexed: 12/11/2022]
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Affiliation(s)
- Geoffrey Knight
- Department of Surgery, Royal Postgraduate Medical School, Hammersmith Hospital, London W12
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Lehman RM, Augustine JR. Evolution and Rebirth of Functional Stereotaxy in the Subthalamus. World Neurosurg 2013; 80:521-33. [DOI: 10.1016/j.wneu.2012.03.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Revised: 03/19/2012] [Accepted: 03/27/2012] [Indexed: 11/26/2022]
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Rosa M, Franzini A, Giannicola G, Messina G, Altamura AC, Priori A. Hypothalamic oscillations in human pathological aggressiveness. Biol Psychiatry 2012; 72:e33-5. [PMID: 22789687 DOI: 10.1016/j.biopsych.2012.06.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 06/08/2012] [Accepted: 06/08/2012] [Indexed: 11/16/2022]
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Jiménez F, Nicolini H, Lozano AM, Piedimonte F, Salín R, Velasco F. Electrical stimulation of the inferior thalamic peduncle in the treatment of major depression and obsessive compulsive disorders. World Neurosurg 2012; 80:S30.e17-25. [PMID: 22824558 DOI: 10.1016/j.wneu.2012.07.010] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 06/25/2012] [Accepted: 07/17/2012] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Stimulation of the inferior thalamic peduncle (ITP) is emerging as a promising new therapeutic target in certain psychiatric disorders. The circuitry that includes the nonspecific thalamic system (NSTS), which projects via the ITP to the orbitofrontal cortex (OFC), is involved in the physiopathology of major depression disorder (MDD) and obsessive compulsive disorder (OCD). The safety and efficacy of chronic ITP stimulation in cases of MDD and OCD refractory to medical treatment is presented. MATERIALS AND METHODS Six patients with OCD and one with MDD were implanted with tetrapolar deep brain stimulation electrodes in the ITP (x = 3.5 mm lateral to the ventricular wall, y = 5 mm behind the anterior commissure, and z = at the intercommissural plane, i.e., anterior commissure-posterior commissure [AC-PC] level). The effect of chronic stimulation at 130 Hz, 450 μs, and 5.0 V on OCD was evaluated before and 3, 6, and 12 months after initiation of electrical stimulation through the Yale-Brown Obsessive Compulsive Scale, Hamilton Depression Rating Scale, and Global Assessment of Function scale. RESULTS Chronic ITP electrical stimulation in OCD patients decreased the mean Yale-Brown Obsessive Compulsive Scale score to around 51% for the group at the 12-month follow-up, and increased the mean Global Assessment of Function scale score to 68% for a significant improvement (P = 0.026). Three of 6 patients returned to work. The Hamilton Depression Rating Scale score of the only patient with MDD treated to date went from 42 to 6. This condition of the patient, who had been incapacitated for 5 years prior to surgery, has not relapsed for 9 years. Three OCD patients with drug addiction continued to consume drugs in spite of their improvement in OCD. CONCLUSION Deep brain stimulation in the ITP is safe and may be effective in the treatment of OCD. A multicenter evaluation of the safety and efficacy of ITP in OCD is currently in process.
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Affiliation(s)
- Fiacro Jiménez
- Unit for Stereotactic, Functional Neurosurgery and Radiosurgery, Mexico General Hospital, Mexico City, Mexico
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Franzini A, Cordella R, Messina G, Marras CE, Romito LM, Albanese A, Rizzi M, Nardocci N, Zorzi G, Zekaj E, Villani F, Leone M, Gambini O, Broggi G. Targeting the brain: considerations in 332 consecutive patients treated by deep brain stimulation (DBS) for severe neurological diseases. Neurol Sci 2012; 33:1285-303. [PMID: 22271259 DOI: 10.1007/s10072-012-0937-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Accepted: 12/23/2011] [Indexed: 11/28/2022]
Abstract
Deep brain stimulation (DBS) extends the treatment of some severe neurological diseases beyond pharmacological and conservative therapy. Our experience extends the field of DBS beyond the treatment of Parkinson disease and dystonia, including several other diseases such as cluster headache and disruptive behavior. Since 1993, at the Istituto Nazionale Neurologico "Carlo Besta" in Milan, 580 deep brain electrodes were implanted in 332 patients. The DBS targets include Stn, GPi, Voa, Vop, Vim, CM-pf, pHyp, cZi, Nacc, IC, PPN, and Brodmann areas 24 and 25. Three hundred patients are still available for follow-up and therapeutic considerations. DBS gave a new therapeutic chance to these patients affected by severe neurological diseases and in some cases controlled life-threatening pathological conditions, which would otherwise result in the death of the patient such as in status dystonicus, status epilepticus and post-stroke hemiballismus. The balance of DBS in severe neurological disease is strongly positive even if further investigations and studies are needed to search for new applications and refine the selection criteria for the actual indications.
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Affiliation(s)
- Angelo Franzini
- Fondazione IRCCS Istituto Neurologico "C. Besta", Via Celoria 11, 20133, Milan, Italy
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Abstract
Prairie voles (Microtus ochrogaster) are socially monogamous rodents that form pair bonds-a behavior composed of several social interactions including attachment with a familiar mate and aggression toward conspecific strangers. Therefore, this species has provided an excellent opportunity for the study of pair bonding behavior and its underlying neural mechanisms. In this chapter, we discuss the utility of this unique animal model in the study of aggression and review recent findings illustrating the neurochemical mechanisms underlying pair bonding-induced aggression. Implications of this research for our understanding of the neurobiology of human violence are also discussed.
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Affiliation(s)
- Kyle L Gobrogge
- Department of Psychology and Program in Neuroscience, Florida StateUniversity, Tallahassee, Florida, USA
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Franzini A, Messina G, Cordella R, Marras C, Broggi G. Deep brain stimulation of the posteromedial hypothalamus: indications, long-term results, and neurophysiological considerations. Neurosurg Focus 2010; 29:E13. [PMID: 20672915 DOI: 10.3171/2010.5.focus1094] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The aim of this study was to review the indications for and results of deep brain stimulation (DBS) of the posterior hypothalamus (pHyp) in the treatment of drug-refractory and severe painful syndromes of the face, disruptive and aggressive behavior associated with epilepsy, and below-average intelligence. The preoperative clinical picture, functional imaging studies, and overall clinical results in the literature are discussed. METHODS All patients underwent stereotactic implantation of deep-brain electrodes within the pHyp. Data from several authors have been collected and reported for each clinical entity, as have clinical results, adverse events, and neurophysiological characteristics of the pHyp. RESULTS The percentage of patients with chronic cluster headache who responded to DBS was 50% in the overall reported series. The response rate was 100% for short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing and for chronic paroxysmal hemicrania, although only 2 patients and 1 patient, respectively, have been described as having these conditions. None of the 4 patients suffering from refractory neuropathic trigeminal pain benefited from the procedure (0% response rate), whereas all 5 patients (100%) affected with refractory trigeminal neuralgia (TN) due to multiple sclerosis (MS) and undergoing pHyp DBS experienced a significant decrease in pain attacks within the first branch of cranial nerve V. Six (75%) of 8 patients presenting with aggressive behavior and mental retardation benefited from pHyp stimulation; 6 patients were part of the authors' series and 2 were reported in the literature. CONCLUSIONS In carefully selected patients, DBS of the pHyp can be considered an effective procedure for the treatment of refractory trigeminal autonomic cephalalgias, aggressive behavior, and MS-related TN in the first trigeminal branch. Only larger and prospective studies along with multidisciplinary approaches (including, by necessity, neuroimaging studies) can lead us to better patient selection that would reduce the rate of nonresponders.
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Affiliation(s)
- Angelo Franzini
- Department of Neurosurgery, Fondazione IRCCS Istituto Nazionale Neurologico Carlo Besta, Milan, Italy.
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Krack P, Hariz MI, Baunez C, Guridi J, Obeso JA. Deep brain stimulation: from neurology to psychiatry? Trends Neurosci 2010; 33:474-84. [PMID: 20832128 DOI: 10.1016/j.tins.2010.07.002] [Citation(s) in RCA: 180] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Revised: 07/14/2010] [Accepted: 07/28/2010] [Indexed: 11/15/2022]
Abstract
Functional stereotaxy was introduced in the late 1940s to reduce the morbidity of lobotomy in psychiatric disease by using more focal lesions. The advent of neuroleptics led to a drastic decline in psychosurgery for several decades. Functional stereotactic neurosurgery has recently been revitalized, starting with treatment of Parkinson's disease, in which deep brain stimulation (DBS) facilitates reversible focal neuromodulation of altered basal ganglia circuits. DBS is now being extended to treatment of neuropsychiatric conditions such as Gilles de la Tourette syndrome, obsessive-compulsive disorder, depression and addiction. In this review, we discuss the concept that dysfunction of motor, limbic and associative cortico-basal ganglia-thalamocortical loops underlies these various disorders, which might now be amenable to DBS treatment.
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Affiliation(s)
- Paul Krack
- Movement Disorders Unit, Department of Psychiatry and Neurology, University Hospital Grenoble, France.
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Young C, Koke S, Kiss Z, Bland B. Deep brain stimulation of the posterior hypothalamic nucleus reverses akinesia in bilaterally 6-hydroxydopamine—lesioned rats. Neuroscience 2009; 162:1-4. [DOI: 10.1016/j.neuroscience.2009.04.053] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Revised: 04/02/2009] [Accepted: 04/22/2009] [Indexed: 11/25/2022]
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Halasz J, Zelena D, Toth M, Tulogdi A, Mikics E, Haller J. Substance P neurotransmission and violent aggression: The role of tachykinin NK1 receptors in the hypothalamic attack area. Eur J Pharmacol 2009; 611:35-43. [DOI: 10.1016/j.ejphar.2009.03.050] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2008] [Revised: 03/12/2009] [Accepted: 03/23/2009] [Indexed: 10/21/2022]
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Gobrogge KL, Liu Y, Jia X, Wang Z. Anterior hypothalamic neural activation and neurochemical associations with aggression in pair-bonded male prairie voles. J Comp Neurol 2007; 502:1109-22. [PMID: 17444499 DOI: 10.1002/cne.21364] [Citation(s) in RCA: 131] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Male prairie voles (Microtus ochrogaster) display mating-induced pair bonding indicated by social affiliation with their female partners and aggression toward unfamiliar conspecifics. In the present study, we characterized their aggression associated with pair bonding and examined the related neuronal activation and neurochemical architecture. Males that were pair-bonded for 2 weeks displayed intense levels of aggression toward a female or male conspecific stranger but maintained a high level of social affiliation with their familiar female partners. These social interactions induced increases in neural activation, indicated by increased density of Fos-immunoreactive staining (Fos-ir) in several brain regions including the bed nucleus of the stria terminalis (BNST), medial preoptic area (MPOA), paraventricular nucleus (PVN), anterior cortical (AcA), and medial nuclei (MeA) of the amygdala. In the anterior hypothalamus (AH), increased density of Fos-ir staining was found specifically to be associated with aggression toward unfamiliar female or male strangers. In addition, higher densities of AH cells that were stained for tyrosine hydroxylase (TH) or vasopressin (AVP) were also labeled with Fos-ir in these males displaying aggression toward a conspecific stranger compared with males displaying social affiliation toward their female partner. Together, our results indicate that dopamine and vasopressin in the AH may be involved in the regulation of enduring aggression associated with pair bonding in male prairie voles.
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Affiliation(s)
- Kyle L Gobrogge
- Department of Psychology and Program in Neuroscience, Florida State University, Tallahassee, Florida 32306, USA
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Hrabovszky E, Halász J, Meelis W, Kruk MR, Liposits Z, Haller J. Neurochemical characterization of hypothalamic neurons involved in attack behavior: glutamatergic dominance and co-expression of thyrotropin-releasing hormone in a subset of glutamatergic neurons. Neuroscience 2005; 133:657-66. [PMID: 15908131 DOI: 10.1016/j.neuroscience.2005.03.042] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2005] [Revised: 03/11/2005] [Accepted: 03/17/2005] [Indexed: 11/23/2022]
Abstract
The electrical stimulation of a specific hypothalamic area rapidly evokes attacks in rats. Noteworthy, attack-related hypothalamic structures were identified in all species studied so far. The area has been extensively mapped in rats, and its anatomical connections have been studied in detail. However, technical difficulties precluded earlier the precise identification of the neural elements mediating the aggressive effects of stimulation. It now appears that a dense and distinct group of glutamatergic cells expressing vesicular glutamate transporter 2 mRNA extends over the entire hypothalamic attack area. Rostral parts overwhelmingly contained glutamatergic neurons. In more caudal parts, glutamatergic and fewer GABAergic neurons were found. The remarkable similarity in the distribution of hypothalamic attack area and glutamatergic cell groups suggests that these cells mediate the aggressive effects of stimulation. Surprisingly, thyrotropin releasing hormone mRNA was co-localized in a subset of glutamatergic neurons. Such neurons were present at all rostro-caudal levels of the hypothalamic attack area, except for that part of the hypothalamic attack area extending into the ventro-lateral part of the ventromedial hypothalamic nucleus. Earlier data on the projections of hypothalamic thyrotropin releasing hormone neurons suggest that this subpopulation plays a specific role in attack behavior. Thus, we identified three neuronal phenotypes in the hypothalamic structure that is involved in the induction of attacks: glutamatergic neurons co-expressing thyrotropin releasing hormone, glutamatergic neurons without thyrotropin releasing hormone, and GABAergic neurons dispersed among the glutamatergic cells. Assessing the specific roles and connections of these neuron subpopulations would contribute to our understanding of the mechanisms underlying attack behavior and aggression.
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Affiliation(s)
- E Hrabovszky
- Department of Endocrine Neurobiology, Institute of Experimental Medicine, Hungarian Academy of Sciences, P.O. Box 67, 1450 Budapest, Hungary
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Krack P, Kumar R, Ardouin C, Dowsey PL, McVicker JM, Benabid AL, Pollak P. Mirthful laughter induced by subthalamic nucleus stimulation. Mov Disord 2001; 16:867-75. [PMID: 11746616 DOI: 10.1002/mds.1174] [Citation(s) in RCA: 225] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
High-frequency stimulation of the subthalamic nucleus (STN) improves the motor signs of Parkinson's disease (PD). The three main components (motor, associative, and limbic) of the cortical-basal ganglia-cortical circuits pass through the STN. It is not known whether STN stimulation can influence the limbic loop. We present two PD patients in whom acute stimulation of an electrode located in the STN using high stimulation parameters (50% higher than therapeutic) induced funny associations, leading to infectious laughter and hilarity, whereas the therapeutic parameters induced a hypomanic behavior and marked improvement of akinesia. Our report suggests that the STN, with its sensorimotor, cognitive, and limbic parts is not only involved in motor, but also in psychomotor regulation.
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Affiliation(s)
- P Krack
- Neuroscience Department, University of Grenoble, Grenoble, France
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Rage Attacks and Episodic Violent Behavior: Electroencephalographic Findings and General Considerations. ACTA ACUST UNITED AC 1978. [DOI: 10.1177/155005947800900306] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Schvarcz JR, Driollet R, Rios E, Betti O. Stereotactic hypothalamotomy for behaviour disorders. J Neurol Neurosurg Psychiatry 1972; 35:356-9. [PMID: 5035309 PMCID: PMC494076 DOI: 10.1136/jnnp.35.3.356] [Citation(s) in RCA: 34] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Posterior hypothalamotomy is a relatively simple stereotactic procedure. The radiological determination of the target and its physiological corroboration by electrical stimulation are accurate. The lesions have always been made in the site of maximum sympathetic response. In this respect, the cardiovascular changes (hypertension and tachycardia), which are always elicited from a more restricted area, are of particular importance. Depth recordings, however, have been less useful. Undesirable side-effects, if present, were mild and transitory. There was no postoperative intelligence deficit, at least with the standard tests.
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Sano K, Mayanagi Y, Sekino H, Ogashiwa M, Ishijima B. Results of stimulation and destruction of the posterior hypothalamus in man. J Neurosurg 1970; 33:689-707. [PMID: 5488801 DOI: 10.3171/jns.1970.33.6.0689] [Citation(s) in RCA: 154] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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 desynchronization 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.
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