Functional Neurosurgery Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Stereotact Funct Neurosurg. 2024;102(2):74-82. doi: 10.1159/000535105. Epub 2024 Jan 25.
Aggressive disorders, in patients with intellectual disability, are satisfactorily managed with an educational, psychological, and pharmacological approach. Posterior hypothalamic region deep brain stimulation emerged in the last two decades as a promising treatment for patients with severe aggressive disorders. However, limited experiences are reported in the literature.
A systematic review was performed following PRISMA guidelines and recommendations by querying PubMed and Embase on August 24th, 2022, with the ensuing string parameters: ([deep brain stimulation] OR [DBS]) AND ([aggressiv*] OR disruptive). Cochrane Library, DynaMed, and ClinicalTrials.gov were consulted using the combination of keywords "deep brain stimulation" and "aggressive" or "aggression". The clinical outcome at the last follow-up and the rate of complications were considered primary and secondary outcomes of interest.
The initial search identified 1,080 records, but only 10 studies met the inclusion criteria and were considered. The analysis of clinical outcome and complications was therefore performed on a total of 60 patients. Quality of all selected studies was classified as high, but one. Mean Overt Aggression Scale (OAS) improvement was 68%, while Inventory for Client Agency Planning (ICAP) improvement ranged between 38.3% and 80%. Complications occurred in 4 patients (6.7%).
Posterior hypothalamic region deep brain stimulation may be considered a valuable option for patients with severe aggression disorders and ID. This review can represent a mainstay for those who will be engaged in the surgical treatment of these patients.
在智力障碍患者中，攻击性障碍可以通过教育、心理和药物治疗得到很好的控制。在后下丘脑深部脑刺激技术在过去的二十年中出现，作为一种治疗严重攻击性障碍患者的有前途的方法。然而，文献中报道的经验有限。
我们按照 PRISMA 指南和建议，于 2022 年 8 月 24 日通过查询 PubMed 和 Embase 进行了系统评价，并使用了以下字符串参数：（[深部脑刺激]或[DBS]）和（[攻击性]或[破坏性行为]）。我们还使用了“深部脑刺激”和“攻击性”或“攻击”的关键词组合，咨询了 Cochrane 图书馆、DynaMed 和 ClinicalTrials.gov。临床结局在最后一次随访时和并发症发生率被认为是主要和次要的观察结果。
最初的搜索确定了 1080 条记录，但只有 10 项研究符合纳入标准，并被认为是相关的。因此，对总共 60 名患者的临床结果和并发症进行了分析。所有选定研究的质量均被归类为高，但有一项研究除外。Overt Aggression Scale（OAS）的平均改善率为 68%，而 Client Agency Planning（ICAP）的改善率在 38.3%至 80%之间。有 4 名患者（6.7%）发生了并发症。
在后下丘脑深部脑刺激可能被认为是严重攻击性障碍和智力障碍患者的一种有价值的选择。这篇综述可以为那些将参与这些患者手术治疗的人提供一个主要的依据。
