title: Seizure frequency reduction after posteromedial hypothalamus deep brain stimulation in drug-resistant epilepsy associated with intractable aggressive behavior.
abstract: OBJECTIVE
  The aim of this study was to analyze the impact of deep brain stimulation (DBS) of the posteromedial hypothalamus (pHyp) on seizure frequency in patients with drug-resistant epilepsy (DRE) associated with intractable aggressive behavior (IAB).
  
  
  METHODS
  Data were collected retrospectively from nine patients, who received bilateral stereotactic pHyp-DBS for the treatment of medically intractable aggressive behavior, focusing on five patients who also had DRE. All patients were treated at the Colombian Center and Foundation of Epilepsy and Neurological Diseases-FIRE (Chapter of the International Bureau for Epilepsy), in Cartagena de Indias, Colombia from 2010 to 2014. Each case was evaluated previously by the institutional ethical committee, assessing the impact of aggressive behavior on the patient's family and social life, the humanitarian aspects of preserving the safety and physical integrity of caregivers, and the need to prevent self-harm. Epilepsy improvement was measured by a monthly seizure reduction percentage, comparing preoperative state and outcome. Additional response to epilepsy was defined by reduction of the antiepileptic drugs (AEDs). Aggressive behavior response was measured using the Overt Aggression Scale (OAS).
  
  
  RESULTS
  All the patients with DRE associated with IAB presented a significant decrease of the rate of epileptic seizures after up to 4 years follow-up, achieving a general 89.6% average seizure reduction from the state before the surgery. Aggressiveness was significantly controlled, with evident improvement in the OAS, enhancing the quality of life of patients and families.
  
  
  CONCLUSIONS
  In well-selected patients, DBS of the pHyp seems to be a safe and effective procedure for treatment of DRE associated with refractory aggressive behavior. Larger and prospective series are needed to define the pHyp as a target for DRE in different contexts.
authors.affiliation: Latin American Center for Research in Epilepsy: CLIE, Cartagena de Indias, Colombia.|Colombian Center and Foundation of Epilepsy and Neurological Diseases: FIRE, Cartagena de Indias, Colombia.
authors.forename: Juan C
authors.initials: JC
authors.lastname: Benedetti-Isaac
authors.affiliation: Latin American Center for Research in Epilepsy: CLIE, Cartagena de Indias, Colombia.|Colombian Center and Foundation of Epilepsy and Neurological Diseases: FIRE, Cartagena de Indias, Colombia.
authors.forename: Martin
authors.initials: M
authors.lastname: Torres-Zambrano
authors.affiliation: Latin American Center for Research in Epilepsy: CLIE, Cartagena de Indias, Colombia.|Colombian Center and Foundation of Epilepsy and Neurological Diseases: FIRE, Cartagena de Indias, Colombia.
authors.forename: Andres
authors.initials: A
authors.lastname: Vargas-Toscano
authors.affiliation: Department of Psychiatry, Cartagena University, Cartagena, Colombia.
authors.forename: Esther
authors.initials: E
authors.lastname: Perea-Castro
authors.affiliation: Latin American Center for Research in Epilepsy: CLIE, Cartagena de Indias, Colombia.|Colombian Center and Foundation of Epilepsy and Neurological Diseases: FIRE, Cartagena de Indias, Colombia.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Alcalá-Cerra
authors.affiliation: Department of Stereotactic and Functional Neurosurgery, Freiburg Medical Center, Freiburg im Breisgau, Germany.
authors.forename: Luciano L
authors.initials: LL
authors.lastname: Furlanetti
authors.affiliation: Department of Neurosurgery, Städtisches Klinikum München, Munchen, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Reithmeier
authors.affiliation: Department of Neurosurgery, Division of Functional and Stereotactic Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, U.S.A.
authors.forename: Travis S
authors.initials: TS
authors.lastname: Tierney
authors.affiliation: Department of Neuroradiology, Freiburg Medical Center, Freiburg im Breisgau, Germany.
authors.forename: Constantin
authors.initials: C
authors.lastname: Anastasopoulos
authors.affiliation: Department of Neurology, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil.|Department of Stereotactic and Functional Neurosurgery, University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Erich T
authors.initials: ET
authors.lastname: Fonoff
authors.affiliation: Department of Neurosurgery, Division of Functional and Stereotactic Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, U.S.A.|Department of Neurology, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil.|Department of Stereotactic and Functional Neurosurgery, University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: William Omar
authors.identifier: http://orcid.org/0000-0002-3150-0257
authors.initials: WO
authors.lastname: Contreras Lopez
mesh_terms: D000293:Adolescent; D000328:Adult; D000374:Aggression / Q000502:physiology / Q000523:psychology*; D046690:Deep Brain Stimulation / Q000639:trends; D004827:Epilepsy / Q000150:complications / Q000523:psychology / Q000628:therapy; D005260:Female; D006801:Humans; D007033:Hypothalamus, Middle / Q000502:physiology*; D007034:Hypothalamus, Posterior / Q000502:physiology*; D008297:Male; D012189:Retrospective Studies; D012640:Seizures / Q000150:complications / Q000523:psychology* / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Deep brain stimulation; Drug-resistant epilepsy; International Bureau for Epilepsy; International League Against Epilepsy; Overt aggression scale; Posterior hypothalamus