title: Deep Brain Stimulation of the Anterior Limb of the Internal Capsule May Be Efficacious for Explosive Aggressive Behaviour.
abstract: Intermittent explosive disease (IED) is a psychiatric disorder characterized by intermittent attacks of rage and violence frequently resistant to pharmacological therapy. Deep brain stimulation (DBS) of the posteromedial hypothalamus has been applied with fair results and clinical improvement with some surgical morbidity due to neurovegetative side effects. The anterior limb of the internal capsule/ventral capsule/ventral striatum (VC/VS) has never been used alone as a target for this disease.
  
  
  
  The aim of this study is to evaluate the efficacy of bilateral DBS of the VC/VS for the treatment of IED.
  
  
  
  We performed bilateral DBS of the VC/VS in a 21-year-old patient with IED. This young man had a traumatic birth complicated by hypoxia, and he showed a mild mental impairment. Different pharmacological treatments were carried out with no results before DBS was proposed to the patient's relatives after multidisciplinary approval.
  
  
  
  After 22 months of high-frequency monopolar bilateral DBS of the VC/VS, the patient showed a significant improvement. Postoperative 18F-FDG PET-CT studies ruled out a reduction of the hypermetabolic areas located in the limbic system previously detected in pre-operative investigations.
  
  
  
  Bilateral DBS of the VC/VS may be considered for the treatment of IED without the risk of neurovegetative side effects.
authors: Division of Neurosurgery, Anna Meyer Hospital, University of Firenze, Firenze, Italy.
authors: Flavio
authors: F
authors: Giordano
authors: Michele
authors: M
authors: Cavallo
authors: Barbara
authors: B
authors: Spacca
authors: Stefano
authors: S
authors: Pallanti
authors: Francesco
authors: F
authors: Tomaiuolo
authors: Fulvio
authors: F
authors: Pieraccini
authors: Andrea
authors: A
authors: Fagiolini
authors: Manuela
authors: M
authors: Grandoni
authors: Federico
authors: F
authors: Melani
authors: Anna
authors: A
authors: Zicca
authors: Stelvio
authors: S
authors: Sestini
authors: Lorenzo
authors: L
authors: Genitori
mesh_terms: D000374:Aggression / Q000523:psychology; D046690:Deep Brain Stimulation / Q000379:methods*; D007174:Disruptive, Impulse Control, and Conduct Disorders / Q000000981:diagnostic imaging* / Q000523:psychology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D020772:Internal Capsule / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D016896:Treatment Outcome; D055815:Young Adult