Neurosurgical treatment of irreducible aggressiveness
Stereotaxic posteromedial hypothalamotomy
Abstract
Background: a 30 years old man, carrier of an organic disorder of the personality who presented frequent episodes of pathologic predator subtype aggressive behavior.
Out of control episodes were sporadic during childhood; from 15 years syndrome was worsening even under treatment, unforeseeable became more frequent and violent.
Successive and combined pharmacological treatments were used (neuroleptics, antipsychotics, benzodiacepines, anticonvulsants and beta blockers), electroconvulse therapy and multiple rehabilitation therapies. Neurosurgery was chosen as conventional therapy had failed.
Procedures: posteromedial hypothalamotomy was performed by stereotactic radiofrequency procedure under general anesthesia, and computed tomography localization. No post-operatory complications were found.
Results: during the following weeks after surgery, the patient remained calm and the pharmacological program was changed: the vast doses of psychodrugs (haloperidol, olanzapine, lorazepam) and beta blockers (propranolol) were ceased, but anticonvulsant (valproate) was maintained. He immediately restarted the group therapy without incidents and social activities with his family. During the differed evolution, the patient gradually recovered personal features and abilities prior to the beginning of refractory process. After nine months of follow up, his clinical condition regarding pathologic aggressive behaviour subtype predatory as well as personal and familial quality of life had improved.
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