estimulación cerebral profunda como tratamiento de la agresividad refractaria: una revisión bibliográfica

Abstract

Introduction

Deep brain stimulation (DBS) consists of the administration of electrical micropulses towards specific subcortical locations. Initially used as a treatment for motor disorders; It is also effective in neuropsychiatric pathologies, including aggressiveness refractory to conventional treatment. This study aims to review experiences with DBS for refractory aggressiveness and identify the most frequent stimulation parameters.

Methods

A review of databases Scopus, Cochrane, ScienceDirect and PubMed was carried out, identifying reports or case series in humans where DBS was used to manage refractory aggressive behavior and which contained stimulation parameters.

Results

17 papers with a total of 58 patients were included, according to the established criteria. The posteromedial hypothalamus was the most frequently used target. Most of the patients improved significantly after starting DBS. The predominant frequency range was between 180-185 Hz (75.8% of cases) and the predominant pulse width range was between 60-90 μs (84.4% of cases).

Conclusions

DBS of the posteromedial hypothalamus at high frequencies and relatively low pulse width seems to be effective for the treatment of refractory aggression; but the optimal setting for treatment is unknown. More studies are required on the physiological basis on which it operates, as well as larger cohorts of individuals for follow-up.