1
|
Herrera-Pino J, Benedetti-Isaac J, Ripoll-Córdoba D, Camargo L, Castillo-Tamara EE, Morales-Asencio B, Perea-Castro E, Torres Zambrano M, Ducassou A, Flórez Y, Porto MF, Gargiulo PA, Zurita-Cueva B, Caldichoury N, Coronado JC, Castellanos C, Ramírez-Penso C, López N. Effectiveness of deep brain stimulation on refractory aggression in pediatric patients with autism and severe intellectual disability: meta-analytic review. BMC Pediatr 2024; 24:487. [PMID: 39080575 PMCID: PMC11290060 DOI: 10.1186/s12887-024-04920-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 07/01/2024] [Indexed: 08/02/2024] Open
Abstract
Some patients with autism and severe intellectual disability may experience uncontrolled aggression, causing serious injury or harm to others, and the therapeutic ineffectiveness of traditional pharmacological and behavioral treatment may aggravate symptoms. Deep brain stimulation (DBS) has been tested in patients with little evidence in children and adolescents. Therefore, we analyzed the efficacy and safety of DBS in refractory aggression in pediatric subjects with autism (ASD) and severe intelligence deficit (ID).Methods A meta-analytic review of Web of Science (WOS) and Scopus articles, following Prisma criteria. A total of 555 articles were identified, but after applying the inclusion criteria, only 18 were analyzed. The review of the registries and the extraction of information was performed by 2 independent groups, to reduce the evaluator's bias. For the description of the results, pediatric patients with ASD or ID present in each registry, with an application of specialized scales (Overt aggression scale, OAS, and THE modified version of the OAS, MOAS) pre and post-DBS, with a clinical follow-up of at least 12 months, were considered valid. Clinical improvement was calculated using tests of aggressiveness. In each registry with available data and then pooling the means of all patients in the OAS and MOAS, the effect size of DBS (overall and per study) was estimated. Finally, the adapted NOS scale was applied to rate the studies' quality and level of bias.Results In the studies analyzed, 65/100 were pediatric patients, with a mean age of 16.8 years. Most of the studies were conducted in South America and Europe. In all teams, aggressive behavior was intractable, but only 9 groups (53/65) applied specialized scales to measure aggressiveness, and of these, only 51 subjects had a follow-up of at least 12 months. Thus, in 48/51 a clinical improvement of patients was estimated (94.2%), with a considerable overall effect size (OAS: d = 4.32; MOAS: d = 1.46). However, adverse effects and complications were found in 13/65 subjects undergoing DBS. The brain target with the most evidence and the fewest side effects was the posteromedial hypothalamic nuclei (pHypN). Finally, applying the adapted NOS scale, quality, and bias, only 9 studies show the best indicators.Conclusion An optimal level of efficacy was found in only half of the publications. This is mainly due to design errors and irrelevant information in the reports. We believe that DBS in intractable aggressiveness in children and adolescents with ASD and severe ID can be safe and effective if working groups apply rigorous criteria for patient selection, interdisciplinary assessments, objective scales for aggressiveness, and known surgical targets.
Collapse
Affiliation(s)
- Jorge Herrera-Pino
- College of Medicine, Florida International University, 11200 SW 8Th St, Miami, FL, 33199, USA
| | - Juancarlos Benedetti-Isaac
- Clinica Neurocardiovascular, Neurodinamia, Tv. 54 #21a-75, Cartagena, Colombia
- Misericordia International Clinic, Cra. 74 #76-105, Barranquilla, 080001, Colombia
| | - Daniela Ripoll-Córdoba
- Departamento de Ciencias Sociales, Universidad de La Costa, Cl. 58 #55 - 66, Barranquilla, 080002, Colombia
| | - Loida Camargo
- Facultad de Medicina, Universidad de Cartagena, Campus Zaragocilla, Cartagena de Indias, Bolívar, 130014, Colombia
| | - Edgard E Castillo-Tamara
- Facultad de Medicina, Universidad del Sinú, Provincia de Cartagena, Calle 30 #20-71, Cartagena de Indias, Bolívar, 130001, Colombia
| | - Breiner Morales-Asencio
- Departamento de Ciencias Sociales, Universidad de La Costa, Cl. 58 #55 - 66, Barranquilla, 080002, Colombia
| | - Esther Perea-Castro
- Clinica Neurocardiovascular, Neurodinamia, Tv. 54 #21a-75, Cartagena, Colombia
| | | | | | - Yuliana Flórez
- Departamento de Ciencias Sociales, Universidad de La Costa, Cl. 58 #55 - 66, Barranquilla, 080002, Colombia
| | - María F Porto
- Department of Cognition, Development and Educational Psychology, Universitat de Barcelona and Bellvitge Institute for Biomedical Research (IDIBELL), Carrer de La Feixa Llarga, L'Hospitalet de Llobregat, Barcelona, 08907, Spain
| | - Pascual A Gargiulo
- Laboratorio de Neurociencias y Psicología Experimental (CONICET), Departamento de Patología, Facultad de Ciencias Médicas, Universidad Nacional de Cuyo. Parque General San Martín, Mendoza, M5502JMA, Argentina
| | - Boris Zurita-Cueva
- Departamento de Neurocirugía, Omni Hospital, Avenida abel Romeo Castillo y ave. Tanca Marengo., Guayaquil, 090513, Ecuador
| | - Nicole Caldichoury
- Departamento de Ciencias Sociales, Universidad de Los Lagos, Av Alberto-Hertha Fuchslocher 1305, Osorno, Los Lagos, Chile
| | - Juan-Carlos Coronado
- Facultad de Salud, Universidad Católica de Temuco, Montt 56, Temuco, Araucanía, 4780000, Chile
| | - Cesar Castellanos
- Instituto Dominicano para el Estudio de la Salud Integral y la Psicología Aplicada (IDESIP), C. Eugenio Deschamps No.5, Santo Domingo, 10014, República Dominicana
| | - Cleto Ramírez-Penso
- Departamento de Neurocirugía, Director general del Centro Cardio-Neuro-Oftalmológico y Trasplante (CECANOT), C/ Federico Velázquez #1, Sector Maria Auxiliadora, Santo Domingo, República Dominicana
- Sociedad Dominicana de Neurología y Neurocirugía (Pax- President), F38M+CHM, Santo Domingo, 10106, República Dominicana
| | - Norman López
- Departamento de Ciencias Sociales, Universidad de La Costa, Cl. 58 #55 - 66, Barranquilla, 080002, Colombia.
- Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Manuel Rodríguez 060, Temuco, 4790870, Chile.
| |
Collapse
|
2
|
Krimmel SR, Laumann TO, Chauvin RJ, Hershey T, Roland JL, Shimony JS, Willie JT, Norris SA, Marek S, Van AN, Monk J, Scheidter KM, Whiting F, Ramirez-Perez N, Metoki A, Wang A, Kay BP, Nahman-Averbuch H, Fair DA, Lynch CJ, Raichle ME, Gordon EM, Dosenbach NUF. The brainstem's red nucleus was evolutionarily upgraded to support goal-directed action. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2023.12.30.573730. [PMID: 38260662 PMCID: PMC10802246 DOI: 10.1101/2023.12.30.573730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
The red nucleus is a large brainstem structure that coordinates limb movement for locomotion in quadrupedal animals (Basile et al., 2021). The humans red nucleus has a different pattern of anatomical connectivity compared to quadrupeds, suggesting a unique purpose (Hatschek, 1907). Previously the function of the human red nucleus remained unclear at least partly due to methodological limitations with brainstem functional neuroimaging (Sclocco et al., 2018). Here, we used our most advanced resting-state functional connectivity (RSFC) based precision functional mapping (PFM) in highly sampled individuals (n = 5) and large group-averaged datasets (combined N ~ 45,000), to precisely examine red nucleus functional connectivity. Notably, red nucleus functional connectivity to motor-effector networks (somatomotor hand, foot, and mouth) was minimal. Instead, red nucleus functional connectivity along the central sulcus was specific to regions of the recently discovered somato-cognitive action network (SCAN; (Gordon et al., 2023)). Outside of primary motor cortex, red nucleus connectivity was strongest to the cingulo-opercular (CON) and salience networks, involved in action/cognitive control (Dosenbach et al., 2007; Newbold et al., 2021) and reward/motivated behavior (Seeley, 2019), respectively. Functional connectivity to these two networks was organized into discrete dorsal-medial and ventral-lateral zones. Red nucleus functional connectivity to the thalamus recapitulated known structural connectivity of the dento-rubral thalamic tract (DRTT) and could prove clinically useful in functionally targeting the ventral intermediate (VIM) nucleus. In total, our results indicate that far from being a 'motor' structure, the red nucleus is better understood as a brainstem nucleus for implementing goal-directed behavior, integrating behavioral valence and action plans.
Collapse
Affiliation(s)
- Samuel R Krimmel
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Timothy O Laumann
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Roselyne J Chauvin
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Tamara Hershey
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Psychological & Brain Sciences, Washington University, St. Louis, Missouri, USA
| | - Jarod L Roland
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Joshua S Shimony
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jon T Willie
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Psychiatry, Weill Cornell Medicine, New York, New York, USA
- Department of Neuroscience, Washington University School of Medicine, St. Louis, Missouri
| | - Scott A Norris
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Scott Marek
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Andrew N Van
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Biomedical Engineering, Washington University, St. Louis, Missouri
| | - Julia Monk
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Kristen M Scheidter
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Forrest Whiting
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Nadeshka Ramirez-Perez
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Athanasia Metoki
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Anxu Wang
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
- Division of Computation and Data Science, Washington University, St. Louis, Missouri, USA
| | - Benjamin P Kay
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Hadas Nahman-Averbuch
- Washington University Pain Center, Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Damien A Fair
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, Minnesota, USA
- Institute of Child Development, University of Minnesota, Minneapolis, Minnesota, USA
| | - Charles J Lynch
- Department of Psychiatry, Weill Cornell Medicine, New York, New York, USA
| | - Marcus E Raichle
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Psychological & Brain Sciences, Washington University, St. Louis, Missouri, USA
- Department of Neuroscience, Washington University School of Medicine, St. Louis, Missouri
- Department of Biomedical Engineering, Washington University, St. Louis, Missouri
| | - Evan M Gordon
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Nico U F Dosenbach
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Psychological & Brain Sciences, Washington University, St. Louis, Missouri, USA
- Department of Biomedical Engineering, Washington University, St. Louis, Missouri
- Program in Occupational Therapy, Washington University, St. Louis, Missouri, USA
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| |
Collapse
|
3
|
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.
Collapse
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.
| |
Collapse
|
4
|
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 PMCID: PMC10296681 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.
Collapse
Affiliation(s)
| | - Jesús Pastor
- Clinical Neurophysiology, Instituto de Investigación Biomédica Hospital, Universitario de La Princesa, C/Diego de León 62, 28006 Madrid, Spain;
| |
Collapse
|
5
|
Gouveia FV, Diwan M, Martinez RCR, Giacobbe P, Lipsman N, Hamani C. Reduction of aggressive behaviour following hypothalamic deep brain stimulation: Involvement of 5-HT 1A and testosterone. Neurobiol Dis 2023:106179. [PMID: 37276987 DOI: 10.1016/j.nbd.2023.106179] [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: 04/25/2023] [Revised: 05/23/2023] [Accepted: 05/30/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Aggressive behaviour (AB) may occur in patients with different neuropsychiatric disorders. Although most patients respond to conventional treatments, a small percentage continue to experience AB despite optimized pharmacological management and are considered to be treatment-refractory. For these patients, hypothalamic deep brain stimulation (pHyp-DBS) has been investigated. The hypothalamus is a key structure in the neurocircuitry of AB. An imbalance between serotonin (5-HT) and steroid hormones seems to exacerbate AB. OBJECTIVES To test whether pHyp-DBS reduces aggressive behaviour in mice through mechanisms involving testosterone and 5-HT. METHODS Male mice were housed with females for two weeks. These resident animals tend to become territorial and aggressive towards intruder mice placed in their cages. Residents had electrodes implanted in the pHyp. DBS was administered for 5 h/day for 8 consecutive days prior to daily encounters with the intruder. After testing, blood and brains were recovered for measuring testosterone and 5-HT receptor density, respectively. In a second experiment, residents received WAY-100635 (5-HT1A antagonist) or saline injections prior to pHyp-DBS. After the first 4 encounters, the injection allocation was crossed, and animals received the alternative treatment during the next 4 days. RESULTS DBS-treated mice showed reduced AB that was correlated with testosterone levels and an increase in 5-HT1A receptor density in the orbitofrontal cortex and amygdala. Pre-treatment with WAY-100635 blocked the anti-aggressive effect of pHyp-DBS. CONCLUSIONS This study shows that pHyp-DBS reduces AB in mice via changes in testosterone and 5-HT1A mechanisms.
Collapse
Affiliation(s)
- Flavia Venetucci Gouveia
- Biological Sciences Platform, Sunnybrook Research Institute, Toronto, Canada; Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Canada.
| | - Mustansir Diwan
- Biological Sciences Platform, Sunnybrook Research Institute, Toronto, Canada
| | - Raquel C R Martinez
- Division of Neuroscience, Hospital Sírio-Libanês, São Paulo, Brazil; LIM/23, Institute of Psychiatry, University of Sao Paulo School of Medicine, São Paulo, Brazil
| | - Peter Giacobbe
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Nir Lipsman
- Biological Sciences Platform, Sunnybrook Research Institute, Toronto, Canada; Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, Canada; Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, Toronto, Canada; Division of Neurosurgery, University of Toronto, Toronto, Canada
| | - Clement Hamani
- Biological Sciences Platform, Sunnybrook Research Institute, Toronto, Canada; Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, Canada; Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, Toronto, Canada; Division of Neurosurgery, University of Toronto, Toronto, Canada.
| |
Collapse
|
6
|
Zheng Z, Zhu Z, Ying Y, Jiang H, Wu H, Tian J, Luo W, Zhu J. The Accuracy of Imaging Guided Targeting with Microelectrode Recoding in Subthalamic Nucleus for Parkinson's Disease: A Single-Center Experience. JOURNAL OF PARKINSON'S DISEASE 2022; 12:897-903. [PMID: 35124576 PMCID: PMC9108556 DOI: 10.3233/jpd-213095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: Accurate electrode targeting was essential for the efficacy of deep brain stimulation (DBS). There is ongoing debate about the necessary of microelectrode recording (MER) in subthalamic nucleus (STN)-DBS surgery for accurate targeting. Objective: This study aimed to analyze the accuracy of imaging-guided awake DBS with MER in STN for Parkinson’s disease in a single center. Methods: The authors performed a retrospective analysis of 161 Parkinson’s disease patients undergoing STN-DBS at our center from March 2013 to June 2021. The implantation was performed by preoperative magnetic resonance imaging (MRI)-based direct targeting with intraoperative MER and macrostimulation testing. 285 electrode tracks with preoperative and postoperative coordinates were included to calculate the placement error in STN targeting. Results: 85.9% of electrodes guided by preoperative MRI were implanted without intraoperative adjustment. 31 (10.2%) and 12 (3.9%) electrodes underwent intraoperative adjustment due to MER and intraoperative testing, respectively. We found 86.2% (245/285) of electrodes with trajectory error ≤2 mm. The MER physiological signals length < 4 mm and ≥4 mm group showed trajectory error > 2 mm in 38.0% and 8.8% of electrodes, respectively. Compared to non-adjustment electrodes, the final positioning of MER-adjusted electrodes deviated from the center of STN. Conclusion: The preoperative MRI guided STN targeting results in approximately 14% cases that require electrode repositioning. MER physiological signals length < 4 mm at first penetration implied deviation off planned target. MER combined with intraoperative awake testing served to rescue such deviation based on MRI alone.
Collapse
Affiliation(s)
- Zhe Zheng
- Department of Neurosurgery, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, Zhejiang Province, China
| | - Zhoule Zhu
- Department of Neurosurgery, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, Zhejiang Province, China
| | - Yuqi Ying
- Department of Neurosurgery, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, Zhejiang Province, China
| | - Hongjie Jiang
- Department of Neurosurgery, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, Zhejiang Province, China
| | - Hemmings Wu
- Department of Neurosurgery, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, Zhejiang Province, China
| | - Jun Tian
- Department of Neurology, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, Zhejiang Province, China
| | - Wei Luo
- Department of Neurology, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, Zhejiang Province, China
| | - Junming Zhu
- Department of Neurosurgery, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, Zhejiang Province, China
| |
Collapse
|
7
|
Neurophysiological Characterization of Posteromedial Hypothalamus in Anaesthetized Patients. Brain Sci 2021; 12:brainsci12010043. [PMID: 35053786 PMCID: PMC8773588 DOI: 10.3390/brainsci12010043] [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: 12/13/2021] [Revised: 12/25/2021] [Accepted: 12/27/2021] [Indexed: 11/23/2022] Open
Abstract
Deep brain stimulation (DBS) requires a precise localization, which is especially difficult at the hypothalamus, because it is usually performed in anesthetized patients. We aimed to characterize the neurophysiological properties posteromedial hypothalamus (PMH), identified by the best neurophysiological response to electrical stimulation. We obtained microelectrode recordings from four patients with intractable aggressivity operated under general anesthesia. We pooled data from 1.5 mm at PMH, 1.5 mm upper (uPMH) and 1.5 mm lower (lPMH). We analyzed 178 units, characterized by the mean action potential (mAP). Only 11% were negative. We identified the next types of units: P1N1 (30.9%), N1P1N2 (29.8%), P1P2N1 (16.3%), N1P1 and N1N2P1 (6.2%) and P1N1P2 (5.0%). Besides, atypical action potentials (amAP) were recorded in 11.8%. PMH was highly different in cell composition from uPMH and lPMH, exhibiting also a higher percentage of amAP. Different kinds of cells shared similar features for the three hypothalamic regions. Although features for discharge pattern did not show region specificity, the probability mass function of inter-spike interval were different for all the three regions. Comparison of the same kind of mAP with thalamic neurons previously published demonstrate that most of cells are different for derivatives, amplitude and/or duration of repolarization and depolarization phases and also for the first phase, demonstrating a highly specificity for both brain centers. Therefore, the different properties described for PMH can be used to positively refine targeting, even under general anesthesia. Besides, we describe by first time the presence of atypical extracellular action potentials.
Collapse
|
8
|
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
| |
Collapse
|
9
|
Benedetti-Isaac JC, Camargo L, Gargiulo P, López N. Deep Brain Stimulation in the Posteromedial Hypothalamic Nuclei in Refractory Aggressiveness: Post-Surgical Results of 19 Cases. Int J Neuropsychopharmacol 2021; 24:977-978. [PMID: 34448852 PMCID: PMC8653869 DOI: 10.1093/ijnp/pyab059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 08/25/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Loida Camargo
- Universidad del Sinú, Medical School, Cartagena de Indias, Colombia
| | - Pascual Gargiulo
- Laboratorio de Neurociencias y Psicología Experimental, CONICET, Departamento de Patología, Facultad de Ciencias Médicas, Universidad Nacional de Cuyo, Mendoza, Argentina
| | - Norman López
- Universidad de La Costa, Barranquilla, Colombia,Correspondence: Prof. Norman López, PhD, Universidad de La Costa, S.58 # 55 – 66, Barranquilla, Colombia ()
| |
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
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 2021; 134:366-375. [PMID: 32032944 DOI: 10.3171/2019.11.jns192608] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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.
Collapse
Affiliation(s)
| | | | | | - Elena Ezquiaga
- 5Department of Psychiatry, University Hospital La Princesa, Madrid, Spain
| | - Jesús Pastor
- 3Clinical Neurophysiology, University Hospital La Princesa, Madrid
| | | | | | | | | |
Collapse
|
12
|
Chandler JA, Cabrera LY, Doshi P, Fecteau S, Fins JJ, Guinjoan S, Hamani C, Herrera-Ferrá K, Honey CM, Illes J, Kopell BH, Lipsman N, McDonald PJ, Mayberg HS, Nadler R, Nuttin B, Oliveira-Maia AJ, Rangel C, Ribeiro R, Salles A, Wu H. International Legal Approaches to Neurosurgery for Psychiatric Disorders. Front Hum Neurosci 2021; 14:588458. [PMID: 33519399 PMCID: PMC7838635 DOI: 10.3389/fnhum.2020.588458] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/30/2020] [Indexed: 11/17/2022] Open
Abstract
Neurosurgery for psychiatric disorders (NPD), also sometimes referred to as psychosurgery, is rapidly evolving, with new techniques and indications being investigated actively. Many within the field have suggested that some form of guidelines or regulations are needed to help ensure that a promising field develops safely. Multiple countries have enacted specific laws regulating NPD. This article reviews NPD-specific laws drawn from North and South America, Asia and Europe, in order to identify the typical form and contents of these laws and to set the groundwork for the design of an optimal regulation for the field. Key challenges for this design that are revealed by the review are how to define the scope of the law (what should be regulated), what types of regulations are required (eligibility criteria, approval procedures, data collection, and oversight mechanisms), and how to approach international harmonization given the potential migration of researchers and patients.
Collapse
Affiliation(s)
| | - Laura Y. Cabrera
- Center for Ethics & Humanities in the Life Sciences and Dept. Translational Neuroscience, Michigan State University, East Lansing, MI, United States
| | - Paresh Doshi
- Department of Neurosurgery, Jaslok Hospital and Research Center, Mumbai, India
| | - Shirley Fecteau
- Department of Psychiatry and Neurosciences, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
- CERVO Brain Research Center, Center Intégré Universitaire en Santé et Services Sociaux de la Capitale-Nationale, Quebec City, QC, Canada
| | - Joseph J. Fins
- Weill Cornell Medical College, Consortium for the Advanced Study of Brain Injury, Weill Cornell and the Rockefeller University, New York, NY, United States
- Solomon Center for Health Law & Policy, Yale Law School, New Haven, CT, United States
| | | | - Clement Hamani
- Harquail Center for Neuromodulation, Sunnybrook Research Institute, Division of Neurosurgery, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada
| | | | - C. Michael Honey
- Section of Neurosurgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Judy Illes
- Neuroethics Canada, Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Brian H. Kopell
- Departments of Neurosurgery, Neurology, Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Nir Lipsman
- Division of Neurosurgery, Harquail Center for Neuromodulation, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada
| | - Patrick J. McDonald
- Division of Neurosurgery, Faculty of Medicine, BC Children's Hospital, University of British Columbia, Head, Vancouver, BC, Canada
| | - Helen S. Mayberg
- Departments of Neurology, Neurosurgery, Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Roland Nadler
- Peter A. Allard School of Law, University of British Columbia, Vancouver, BC, Canada
| | - Bart Nuttin
- Neurosurgeon, Katholieke Universiteit (KU) Leuven, Universitair Ziekenhuis (UZ) Leuven, Leuven, Belgium
| | - Albino J. Oliveira-Maia
- Champalimaud Research and Clinical Center, Champalimaud Center for the Unknown, Lisbon, Portugal
- NOVA Medical School, NMS, Universidade Nova De Lisboa, Lisbon, Portugal
| | - Cristian Rangel
- Department of Innovation in Medical Education, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | - Arleen Salles
- Center for Research Ethics and Bioethics, Uppsala University, Uppsala, Sweden
| | - Hemmings Wu
- Department of Neurosurgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
13
|
Features of Action Potentials from Identified Thalamic Nuclei in Anesthetized Patients. Brain Sci 2020; 10:brainsci10121002. [PMID: 33348660 PMCID: PMC7766545 DOI: 10.3390/brainsci10121002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 11/24/2020] [Accepted: 12/14/2020] [Indexed: 11/23/2022] Open
Abstract
Our objective was to describe the electrophysiological properties of the extracellular action potential (AP) picked up through microelectrode recordings (MERs). Five patients were operated under general anesthesia for centromedian deep brain stimulation (DBS). APs from the same cell were pooled to obtain a mean AP (mAP). The amplitudes and durations for all 2/3 phases were computed from the mAP, together with the maximum (dVmax) and minimum (dVmin) values of the first derivative, as well as the slopes of different phases during repolarization. The mAPs are denominated according to the phase polarity (P/N for positive/negative). We obtained a total of 1109 mAPs, most of the positive (98.47%) and triphasic (93.69%) with a small P/N deflection (Vphase1) before depolarization. The percentage of the different types of mAPs was different for the nuclei addressed. The relationship between dVmax and the depolarizing phase is specific. The descending phase of the first derivative identified different phases during the repolarizing period. We observed a high correlation between Vphase1 and the amplitudes of either depolarization or repolarization phases. Human thalamic nuclei differ in their electrophysiological properties of APs, even under general anesthesia. Capacitive current, which is probably responsible for Vphase1, is very common in thalamic APs. Moreover, subtle differences during repolarization are neuron-specific.
Collapse
|
14
|
Can We Put Aside Microelectrode Recordings in Deep Brain Stimulation Surgery? Brain Sci 2020; 10:brainsci10090571. [PMID: 32825301 PMCID: PMC7564183 DOI: 10.3390/brainsci10090571] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 08/14/2020] [Accepted: 08/18/2020] [Indexed: 12/01/2022] Open
Abstract
Microelectrode recording (MER) in deep brain stimulation (DBS) surgery has long been a recognized and efficient method for defining a target. However, in recent decades, imaging techniques, including DBS surgery, have experienced significant growth. There is convincing evidence that imaging-guided surgery can be helpful for targeting anatomically well-defined nuclei (e.g., subthalamic nucleus (STN) or internal globus pallidus (GPi)), and reductions in secondary effects have also been claimed. It has even been proposed that MER is not necessary to perform DBS, identifying in this way asleep surgery and imaging-guided DBS. However, there are several reasons why this is not the case. Neurophysiological techniques can efficiently and safely help to identify neural structures even in sleeping patients (e.g., different types of evoked potentials or motor stimulation). Deep nuclei are not homogeneous structures (even STN), so it is important to identify different places inside the putative target. Evidently, this is more relevant in the case of thalamic or hypothalamic surgery. Moreover, it is important to remember that the clinical and scientific knowledge acquired during DBS surgery can be important to gain further insight into pathologies and develop more effective treatments. Finally, the cost/efficiency of medical technology should be considered.
Collapse
|
15
|
Kakusa B, Saluja S, Dadey DYA, Barbosa DAN, Gattas S, Miller KJ, Cowan RP, Kouyoumdjian Z, Pouratian N, Halpern CH. Electrophysiology and Structural Connectivity of the Posterior Hypothalamic Region: Much to Learn From a Rare Indication of Deep Brain Stimulation. Front Hum Neurosci 2020; 14:164. [PMID: 32670034 PMCID: PMC7326144 DOI: 10.3389/fnhum.2020.00164] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 04/15/2020] [Indexed: 12/18/2022] Open
Abstract
Cluster headache (CH) is among the most common and debilitating autonomic cephalalgias. We characterize clinical outcomes of deep brain stimulation (DBS) to the posterior hypothalamic region through a novel analysis of the electrophysiological topography and tractography-based structural connectivity. The left posterior hypothalamus was targeted ipsilateral to the refractory CH symptoms. Intraoperatively, field potentials were captured in 1 mm depth increments. Whole-brain probabilistic tractography was conducted to assess the structural connectivity of the estimated volume of activated tissue (VAT) associated with therapeutic response. Stimulation of the posterior hypothalamic region led to the resolution of CH symptoms, and this benefit has persisted for 1.5-years post-surgically. Active contacts were within the posterior hypothalamus and dorsoposterior border of the ventral anterior thalamus (VAp). Delta- (3 Hz) and alpha-band (8 Hz) powers increased and peaked with proximity to the posterior hypothalamus. In the posterior hypothalamus, the delta-band phase was coupled to beta-band amplitude, the latter of which has been shown to increase during CH attacks. Finally, we identified that the VAT encompassing these regions had a high proportion of streamlines of pain processing regions, including the insula, anterior cingulate gyrus, inferior parietal lobe, precentral gyrus, and the brainstem. Our unique case study of posterior hypothalamic region DBS supports durable efficacy and provides a platform using electrophysiological topography and structural connectivity, to improve mechanistic understanding of CH and this promising therapy.
Collapse
Affiliation(s)
- Bina Kakusa
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Sabir Saluja
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, United States
| | - David Y A Dadey
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Daniel A N Barbosa
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Sandra Gattas
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Kai J Miller
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, United States
| | - Robert P Cowan
- Department of Neurology and Neurosciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Zepure Kouyoumdjian
- Department of Neurology, South Valley Neurology, Morgan Hill, CA, United States
| | - Nader Pouratian
- Department of Neurosurgery, School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Casey H Halpern
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, United States
| |
Collapse
|
16
|
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.
Collapse
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
| |
Collapse
|