gms | German Medical Science

73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

Neuromodulation for aggressiveness and self-injurious behavior – a case report and review of the literature

Neuromodulation für Aggressivität und selbstverletzendes Verhalten – ein Fallbericht und Literaturübersicht

Meeting Abstract

  • presenting/speaker Petra Heiden - Universitätsklinikum Köln, Köln, Deutschland
  • Pablo Andrade - Universitätsklinikum Köln, Köln, Deutschland
  • Veerle Visser-Vandewalle - Universitätsklinikum Köln, Köln, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocV116

doi: 10.3205/22dgnc117, urn:nbn:de:0183-22dgnc1170

Published: May 25, 2022

© 2022 Heiden et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at



Objective: Patients with pathological aggressiveness display stereotypical behavior that can manifest through aggressive language and sound; damaging objects; or hurting animals, other people (hetero-aggression) or themselves (auto-aggression). Conventional treatment consists of psychotropic medication, behavioral therapy and electroconvulsive therapy. For patients with refractory aggressive behavior, functional neurosurgery could be considered. In this study we describe the case of a patient with mental retardation and hetero-, and auto-aggressive behavior. Further, we performed a systematic literature review of the effects of functional neurosurgery in pathological aggressiveness.

Methods: The 24 years old, female patient displayed progressive aggressive behavior since early childhood. Conservative therapy did not have any effect, after which bilateral stereotactic capsulotomy and hypothalamotomy were performed. Clinical assessment was performed prior to surgery, 6 weeks and 6 months after the intervention. Level of aggressivity was assessed using the Modified Overt Aggression Scale (MOAS; higher scores represent worse condition) and level of functionality was assessed using the Global Assessment of Functioning Scale (GAF; higher scores represent better functioning).

To review existing literature on functional neurosurgery in pathological aggressiveness, we performed a systematic literature review using PubMed.

Results: There was a significant improvement of the functionality of the patient from 10 points on GAF prior to surgery, to 61 points 6 months after the intervention. There was also a relevant improvement on the MOAS from 33 points prior to surgery to 10 points after 6 months. 42 studies could be included in the review, 27 studies with lesioning procedures and 15 with deep brain stimulation (DBS). The amygdala was the most common target for stereotactic lesioning, followed by the hypothalamus. The most common target for DBS was the hypothalamus, followed by the nucleus accumbens. Measurement of the clinical outcome was very heterogenous, however most studies described an improvement in over 50% of the patients.

Conclusion: Bilateral stereotactic capsulotomy and hypothalamotomy proved to be an effective treatment in this patient’s case.

Review of the existing literature showed a heterogenous treatment of patients with pathological aggressivity. However, the underlying disorder of the patient should always be considered when choosing the right therapy.