Saman Arfaie1, Richard Ruan2, Sahana Sarin3, Dinglun Luo4, Lauren Clawson5, Raphael Fabre6, Yinchi Wang6, Abdulkadir Mohamed7, Negin Amini8, Kamran Mir Moghtadaei9, Yohann Pilon9, Michael Maalouf9, Mohammad Mashayekhi10, Mohammad Mofatteh11
1McGill University, Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital (MNI), 2Broad Institute of MIT and Harvard, Cambridge, Massachusetts, 3The University of Iowa Roy J and Lucille A Carver College of Medicine, 4University of California, Department of Molecular and Cell Biology, 5University of California, Berkeley, School of Public Health, 6University of California, Berkeley, Department of Molecular & Cell Biology, 7University of Oxford, Medical Sciences Division, 8Concordia University, Faculty of Arts and Science, Department of Psychology, 9McGill University Faculty of Medicine, 10University of Ottawa, Department of Surgery (Division of Neurosurgery) and The Ottawa Hospital, 11Queen’s University Belfast, School of Medicine, Dentistry and Biomedical Sciences, Belfast
Objective:
This study analyzed the efficacy of Deep Brain Stimulation (DBS) as a therapeutic option for patients with aggressive behavior associated with a variety of neurological and psychiatric conditions. We reviewed the published literature and identified the brain anatomical structures targeted in the last 54 years.
Background:
Intractable aggression is refractory to pharmacological and behavioral therapies, remaining difficult to manage. DBS is a neurosurgical procedure enabling focused circuit-based neuromodulation employed in various neurological, psychiatric, and behavioral conditions.
Design/Methods:
We followed the PRISMA-ScR guidelines using MEDLINE, Embase, and Web of Science from inception to June 4th, 2023. English-language studies investigating DBS for aggression were included. Of 1,905 records identified, 37 met inclusion criteria after screening and eligibility assessment.
Results:
A total of 37 studies from 12 countries, including 976 patients, were included after screening 1,905 records. Of these, 882 were adults (90%) and 43 were pediatric (4%), with a mean age of 55.3 years (range 15.2–68.5). The mean follow-up was 32.3 ± 36.3 months (range 3–144). Before DBS, 799 patients (82%) received medication. The most common indications were movement disorders (24%) and aggression (20%). The hypothalamus (17%) and nucleus accumbens (4%) were the predominant DBS targets. Among 160 patients with individual outcome data, 144 (90%) experienced measurable improvement in aggression, while 9 showed no change, 6 had transient worsening, and 1 had increased aggression. Common adverse events included apathy (3.2%), headaches (2.0%), and device-related complications (1.6%). Serious events were rare, with suicide attempts (0.51%) and one completion (0.1%) reported. The Overt Aggression Scale (OAS) was the most frequently applied outcome measure (24% of studies).
Conclusions:
DBS shows promising efficacy for managing treatment-resistant aggression across diverse neurological and psychiatric conditions. Outcomes vary by target and indication, highlighting the need for standardized measures and long-term, controlled studies to refine patient selection and optimize therapeutic benefit.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.