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Seizure frequency reduction after posteromedial hypothalamus deep brain stimulation in drug‐resistant epilepsy associated with intractable aggressive behavior
Author(s) -
BenedettiIsaac Juan C.,
TorresZambrano Martin,
VargasToscano Andres,
PereaCastro Esther,
AlcaláCerra Gabriel,
Furlanetti Luciano L.,
Reithmeier Thomas,
Tierney Travis S.,
Anastasopoulos Constantin,
Fonoff Erich T.,
Contreras Lopez William Omar
Publication year - 2015
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/epi.13025
Subject(s) - deep brain stimulation , epilepsy , drug resistant epilepsy , medicine , epilepsy surgery , quality of life (healthcare) , aggression , psychology , anesthesia , pediatrics , psychiatry , disease , parkinson's disease , nursing
Summary Objectives The aim of this study was to analyze the impact of deep brain stimulation ( DBS ) of the posteromedial hypothalamus ( pH yp) 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 pH yp‐ 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 ( AED s). 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. Significance In well‐selected patients, DBS of the pH yp 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 pH yp as a target for DRE in different contexts.