Neuropharmacology

Deep  brain  stimulation  is  a  procedure  available  for  movement  disorders,  and  for  some  psychiatric  conditions  non  responding  to  pharmacological  options  such  aggressive  and  uncontrollable behavior.

A  woman  with  perinatal  hypoxia,  delay  of  milestones  and  severe  mental  retardation,  developed hyperfagia, severe impulsivity with uncontrollable aggressive behavior, she was  always under surveillance, required phisycal restriction and she was isolated in her house,  being dependant in all activities of daily living. The second patient is a man, 24 years old,  with  severe  mental  retardation,  impulsivity  and  uncontrollable  aggressive  behavior,  hitting even his parents and anybody nearby. He also has epilepsy with frequent seizures.  The  last  patient  is  an  18  year@old  man,  with  normal  development.  At  the  age  of  14,  he  presented  generalized  epilepsy.  Since  then,  his  behavior  tends  to  be  aggressive  and  impulsive,  manifesting  in  worsening  epilepsy  and  aggressive  behavior.  All  three  patients  received  multiple  medications  including  antipsychotics  and  antiepileptics.  Due  to  the  persistence of symptoms, every case was discussed in a multidisciplinary team, supported  by the criteria for DBS for agressive behavior,  and the ethical committe agreed on a deep  brain stimulation in the posterior medial hypothalamus.

Criteria  for  DBS  for  agressive  and  uncontrollable  behavior  includes:  to  be  diagnosed  by  two  psychiatrists,  non@response  to  treatment  despite  the  highest  dosage  of  at  least  five  antipsychotic medications in an enough period of time to evaluate the response and the  severe  functional  interference  with  the  activities  of  daily  living  and  malanadaptative  behavior. All patients showed improvement after the procedure. The woman was released  of physical restriction and she can now go with her family out of her house without being  a risk for herself or for others.

The  benefits  of  the  second  case  included  control  not  only  of  the  behavior  but  also  of  seizures, diminishing medications for aggresive behavior and also for epilepsy. In this case,  voltage  over  3,4  V  showed  hypoactivity,  with  hyporexia,  becoming  extremely  undernourished and requiring the reduction of the voltage to 3,2 V.The third case showed  benefit and he could go back to school again, being able to control his aggresive behavior  as well as the epilepsy. The benefits amount to around 70% in all cases, with parameters  of stimulation between 3 and 3,4, pulse width of 60 and frequency of 130.