RESUMO
Aggressive behavior in patients with intellectual disability can be resistant to pharmacological treatment and have detrimental consequences to themselves, family members, and caregivers. Hypothalamic deep brain stimulation (DBS) has been used to improve this type of behavior in severe and refractory cases. Here, we present the description and analysis of DBS of the posteromedial hypothalamus (PMH) and its long-term impact as treatment to improve severe and refractory aggressive behaviors, even with previous bilateral hypothalamotomy without improvement in patients with intellectual disability. Eleven patients underwent bilateral DBS of the PMH. Their medical records were reviewed, and the impact on behavior was measured using preoperative and postoperative Modified Overt Aggression Scale (MOAS) during the last follow-up medical visit. Nine of 11 patients presented a significant decrease in the severity of aggressive behavior, with a preoperative and postoperative MOAS average value of 50.5 and 18.7, respectively. An overall improvement of 63% was seen with a mean follow-up time of 4 years. A patient who previously underwent a bilateral hypothalamotomy via radiofrequency was included in this group. During follow-up, 3 patients presented deterioration of symptoms subsequent to pulse generator depletion but made a full clinical recovery after battery replacement. We posit that DBS of the PMH may be a safe and effective in improving severe and refractory aggressive behavior in patients with long-term intellectual disability.
Assuntos
Estimulação Encefálica Profunda , Deficiência Intelectual , Agressão , Humanos , Deficiência Intelectual/cirurgia , Resultado do TratamentoRESUMO
RESUMEN Los trastornos del control de impulsos (TCI) son complicaciones psiquiátricas de la enfermedad de Parkinson (EP), cada vez más reconocidos, pero que persisten subdiagnosticados y pueden llegar a ser muy disruptivos para la vida familiar del paciente, en especial si no son detectados a tiempo. Si bien uno de sus principales riesgos es el uso de agonistas dopaminérgicos, estos no son su única causa, se pueden ver sin relación con medicamentos o con cualquier tratamiento para la EP. Por lo tanto, se debe interrogar sistemáticamente por su presencia y educar al paciente y su familia para que sean reportados en cualquier momento. El objetivo de este capítulo es describir los diferentes tipos de TCI, sus factores de riesgo y tratamiento.
SUMMARY Impulse Control Disorders (ICD) are psychiatric complications of Parkinson's Disease (PD), increasingly recognized, but which persist underdiagnosed and can be vert disruptive to the patient's family life, especially if they are not detected in time. Although one of its main risks is the use of dopamine agonists, these are not the only cause, they can be seen without realtion to medications ot any treatment for PD, therefore it should be questioned systematically by their presence and educate the patient and his family to be reported at any time. The objective of this chapter is to describe the different types of ICD, their risk factors and treatment.