title: Deep Brain Stimulation in Pathological Aggression.
abstract: BACKGROUND
  We describe a case of deep brain stimulation in a patient with severe aggression refractory to conservative treatment. The targets of the stimulation were set bilaterally in the posteromedial hypothalamus and - in a second procedure due to its ineffectiveness - in the nucleus accumbens (NAcc) bilaterally.
  
  
  METHODS
  In the first stage, we implanted electrodes into the posteromedial hypothalamus, after obtaining consent of the Bioethics Committee. In the early postoperative period, we observed significant improvement in the range of 50-90% in terms of quantity and quality of the attacks of aggression. After about 3 weeks, attacks of aggression started to return. Despite changes in the stimulation parameters there was no improvement. For this reason, based on the experience of surgery in patients with obsessive-compulsive disorder, Tourette syndrome and with morbid obesity, we decided to implant electrodes into the NAcc.
  
  
  RESULTS
  After 15 months of follow-up, the patient has no aggressive behavior, with no side effects.
  
  
  CONCLUSIONS
  Although the stimulation of the posterior-medial hypothalamus did not bring long-term benefits, its combination with bilateral stimulation of the NAcc practically freed the patient from aggressive disorders. It significantly improved the patient's quality of life.
authors.affiliation: Department of Public Health, Collegium Medicum, Nicolaus Copernicus University, Torun, Poland.
authors.forename: Marek
authors.initials: M
authors.lastname: Harat
authors.forename: Marcin
authors.initials: M
authors.lastname: Rudaś
authors.forename: Piotr
authors.initials: P
authors.lastname: Zieliński
authors.forename: Julita
authors.initials: J
authors.lastname: Birska
authors.forename: Pawel
authors.initials: P
authors.lastname: Sokal
mesh_terms: D000328:Adult; D000374:Aggression / Q000523:psychology*; D046690:Deep Brain Stimulation; D005260:Female; D006801:Humans; D007031:Hypothalamus / Q000601:surgery*; D008607:Intellectual Disability / Q000523:psychology*; D009771:Obsessive-Compulsive Disorder / Q000523:psychology / Q000628:therapy*; D011788:Quality of Life / Q000523:psychology*; D016896:Treatment Outcome