Directional deep brain stimulation of the posteromedial hypothalamus for refractory intermittent explosive disorder: a case series using a novel neurostimulation device and intraoperative microdialysis

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dc.contributorLab. Bioquímicapt_BR
dc.contributorPrograma de Pós-Graduação em Ciências – Toxinologia (PPGTox)pt_BR
dc.contributor.authorLopez, William Omar Contreraspt_BR
dc.contributor.authorNavarro, Paula Alejandrapt_BR
dc.contributor.authorGouveia, Flavia Venetuccipt_BR
dc.contributor.authorFonoff, Erich Talamonipt_BR
dc.contributor.authorLebrun, Ivopt_BR
dc.contributor.authorAuada, Aline Vivian Vattipt_BR
dc.contributor.authorAlho, Eduardo Joaquim Lopespt_BR
dc.contributor.authorMartinez, Raquel C.R.pt_BR
dc.date.accessioned2021-08-05T13:22:57Z-
dc.date.available2021-08-05T13:22:57Z-
dc.date.issued2021pt_BR
dc.identifier.citationLopez WOC, Navarro PA, Gouveia FV, Fonoff ET, Lebrun I, Auada AVV, et al. Directional deep brain stimulation of the posteromedial hypothalamus for refractory intermittent explosive disorder: a case series using a novel neurostimulation device and intraoperative microdialysis. World. Neurosurg.. 2021 July;155:e19-e33. doi:10.1016/j.wneu.2021.07.086.pt_BR
dc.identifier.urihttps://repositorio.butantan.gov.br/handle/butantan/3911-
dc.description.abstractIntermittent Explosive Disorder (IED) is a psychiatric disorder characterized by recurrent outbursts of aggressive behaviour. Deep brain stimulation (DBS) in the posteromedial nucleus of the hypothalamus (pHyp) is an alternative therapy for extreme cases and shows promising results. Intraoperative microdialysis can help elucidate the neurobiological mechanism of pHyp-DBS. Objective To evaluate efficacy and safety of pHyp-DBS using eight-contact directional leads in patients with refractory IED (rIED) and the accompanying changes in neurotransmitters. Methods A prospective study in which patients with a diagnosis of rIED were treated with pHyp-DBS for symptom alleviation. Bilateral pHyp-DBS was performed with eight-contact directional electrodes. Follow-up was performed at 3, 6 and 12 months after surgery. Results Four patients (3 men, mean age 27 ± 2.8 yr) were included. All patients were diagnosed with rIED and severe intellectual disability. Two patients had congenital rubella, one has co-diagnosis of infantile autism and the fourth presents with drug-resistant epilepsy. There was a marked increase in the levels of GABA and glycine during intraoperative stimulation. The average improvement in aggressive behaviour in the last follow-up was 6 points (Δ: 50%, p= 0.003) while also documenting an important improvement of the SF-36 in all domains except bodily pain. No adverse events associated with pHyp-DBS were observed. Conclusions This is the first study to show the safety and beneficial effect of directional lead pHyp-DBS in patients with refractory Intermittent Explosive Disorder and to demonstrate the corresponding mechanism of action through increases in GABA and glycine concentration in the pHyp.pt_BR
dc.language.isoEnglishpt_BR
dc.relation.ispartofWorld Neurosurgerypt_BR
dc.rightsRestricted accesspt_BR
dc.titleDirectional deep brain stimulation of the posteromedial hypothalamus for refractory intermittent explosive disorder: a case series using a novel neurostimulation device and intraoperative microdialysispt_BR
dc.typeArticlept_BR
dc.identifier.doi10.1016/j.wneu.2021.07.086pt_BR
dc.identifier.urlhttps://doi.org/10.1016/j.wneu.2021.07.086pt_BR
dc.contributor.external(UNAB) Universidad Autónoma de Bucaramangapt_BR
dc.contributor.externalFOSCAL Clinicpt_BR
dc.contributor.externalUniversidad de los Andespt_BR
dc.contributor.externalSunnybrook Research Institutept_BR
dc.contributor.external(USP) Universidade de São Paulopt_BR
dc.contributor.externalHospital Sírio Libanêspt_BR
dc.identifier.citationvolume155pt_BR
dc.identifier.citationissuee19-e33pt_BR
dc.subject.keywordAggressive Behaviourpt_BR
dc.subject.keyworddeep brain stimulationpt_BR
dc.subject.keywordHypothalamuspt_BR
dc.subject.keywordIntermittent explosive disorderpt_BR
dc.subject.keywordNeuromodulationpt_BR
dc.relation.ispartofabbreviatedWorld. Neurosurg.pt_BR
dc.identifier.citationabntv. 155, p. e19-e33, jul. 2021pt_BR
dc.identifier.citationvancouver2021 July;155:e19-e33pt_BR
dc.contributor.butantanLebrun, Ivo|:Pesquisador:Docente PPGTox|:Lab. Bioquímicapt_BR
dc.contributor.butantanAuada, Aline Vivian Vatti|:Aluno Egresso|:Lab. Bioquímicapt_BR
dc.identifier.bvsccBR78.1pt_BR
dc.identifier.bvsdbIBProdpt_BR
dc.description.dbindexedYespt_BR
item.grantfulltextembargo_29990101-
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