Longitudinal Changes After Amygdala Surgery for Intractable Aggressive Behavior: Clinical, Imaging Genetics, and Deformation-Based Morphometry Study-A Case Series

Author(s):Show less -

Gouveia, Flavia Venetucci ^{[1, 2]} ; Germann, Jurgen ^[3] ; de Morais, Rosa ^[4] ; Fonoff, Erich Talamoni ^[5] ; Hamani, Clement ^{[6, 2, 5]} ; Alho, Eduardo Joaquim ^[5] ; Brentani, Helena ^{[7, 8]} ; Martins, Ana Paula ^[4] ; Devenyi, Gabriel ^[3] ; Patel, Raihaan ^[3] ; Steele, Christopher ^[3] ; Gramer, Robert ^[9] ; Chakravarty, Mallar ^[3] ; Ruiz Martinez, Raquel Chacon ^[1]

Affiliation

^[1] Hosp Sirio Libanes, Teaching & Res Inst, Lab Neuromodulat, Sao Paulo - Brazil

^[2] Sunnybrook Res Inst, 2075 Bayview Ave, S126, Toronto, ON M4N 3M5 - Canada

^[3] McGill Univ, Douglas Mental Hlth Univ Inst, CIC, Montreal, PQ - Canada

^[4] Univ Sao Paulo, Sch Med, Dept Psychiat, PROTEA, Sao Paulo - Brazil

^[5] Univ Sao Paulo, Med Sch, Inst Psychiat, Dept Neurol, Div Funct Neurosurg, Sao Paulo - Brazil

^[6] Univ Toronto, Sunnybrook Hlth Sci Ctr, Div Neurosurg, Toronto, ON - Canada

^[7] CNPq, Natl Inst Dev Psychiat Children & Adolescents, Sao Paulo - Brazil

^[8] Univ Sao Paulo, Med Sch, Dept Psychiat, Sao Paulo - Brazil

^[9] Duke Univ, Med Ctr, Dept Neurosurg, Durham, NC - USA

• Document type: Journal article
• Source: NEUROSURGERY; v. 88, n. 2, p. E158-E169, FEB 2021.
• Web of Science Citations: 0

Abstract

BACKGROUND: Intractable aggressive behavior (iAB) is a devastating behavioral disorder that may affect psychiatric patients. These patients have reduced quality of life, are more challenging to treat as they impose a high caregiver burden and require specialized care. Neuromodulatory interventions targeting the amygdala, a key hub in the circuitry of aggressive behavior (AB), may provide symptom alleviation. OBJECTIVE: To Report clinical and imaging findings from a case series of iAB patients treated with bilateral amygdala ablation. METHODS: This series included 4 cases (3 males, 19-32 years old) who underwent bilateral amygdala radiofrequency ablation for iAB hallmarked by life-threatening self-injury and social aggression. Pre- and postassessments involved full clinical, psychiatric, and neurosurgical evaluations, including scales quantifying AB, general agitation, quality of life, and magnetic resonance imaging (MRI). RESULTS: Postsurgery assessments revealed decreased aggression and agitation and improved quality of life. AB was correlated with testosterone levels and testosterone/cortisol ratio in males. No clinically significant side effects were observed. Imaging analyses showed preoperative amygdala volumes within normal populational range and confirmed lesion locations. The reductions in aggressive symptoms were accompanied by significant postsurgical volumetric reductions in brain areas classically associated with AB and increases in regions related to somatosensation. The local volumetric reductions are found in areas that in a normal brain show high expression levels of genes related to AB (eg, aminergic transmission) using gene expression data provided by the Allen brain atlas. CONCLUSION: These findings provide new insight into the whole brain neurocircuitry of aggression and suggest a role of altered somatosensation and possible novel neuromodulation targets. (AU)

• FAPESP's process: 13/20602-5 - Prospective analyses of the functional results of philanthropist bilateral amygdalectomy in patients with refractory aggression
• Grantee: Flavia Venetucci Gouveia
• Support Opportunities: Scholarships in Brazil - Doctorate
• FAPESP's process: 17/10466-8 - Towards revealing aggression: imaging the aggressive brain
• Grantee: Flavia Venetucci Gouveia
• Support Opportunities: Scholarships abroad - Research Internship - Doctorate
• FAPESP's process: 11/08575-7 - The role of dopaminergic modulation in the lateral nucleus of amygdala during active avoidance response
• Grantee: Raquel Chacon Ruiz Martinez
• Support Opportunities: Research Grants - Young Investigators Grants