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

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dc.contributor Sistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.author GOUVEIA, Flavia Venetucci
FONOFF, Erich Talamoni FMUSP-HC
ALHO, Eduardo Joaquim FMUSP-HC
MARTINS, Ana Paula
DEVENYI, Gabriel
PATEL, Raihaan
STEELE, Christopher
GRAMER, Robert
MARTINEZ, Raquel Chacon Ruiz
dc.date.issued 2021
dc.identifier.citation NEUROSURGERY, v.88, n.2, p.E158-E169, 2021
dc.identifier.issn 0148-396X
dc.identifier.uri https://observatorio.fm.usp.br/handle/OPI/39907
dc.description.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.
dc.description.sponsorship · Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP)Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP) [11/08575-7, 13/20602-5, 17/10466-8]
· Brazil's government
dc.language.iso eng
dc.relation.ispartof Neurosurgery
dc.rights restrictedAccess
dc.subject Aggressive behavior; Amygdala; Deformation-based morphometry; Magnetic resonance imaging; Neurosurgery; Testosterone
dc.subject.other autism spectrum disorders; stereotaxic amygdalotomy; testosterone; adolescents; traits; pain
dc.title Longitudinal Changes After Amygdala Surgery for Intractable Aggressive Behavior: Clinical, Imaging Genetics, and Deformation-Based Morphometry Study-A Case Series
dc.type article
dc.rights.holder Copyright OXFORD UNIV PRESS INC
dc.description.group LIM/23
dc.description.group LIM/45
dc.identifier.doi 10.1093/neuros/nyaa378
dc.identifier.pmid 33026432
dc.type.category original article
dc.type.version publishedVersion
hcfmusp.author MORAIS, Rosa de:HC:IPQ
hcfmusp.author FONOFF, Erich Talamoni:FM:MNE
hcfmusp.author HAMANI, Clement:HC:ICHC
hcfmusp.author ALHO, Eduardo Joaquim:FM:
hcfmusp.author BRENTANI, Helena:FM:MPS
hcfmusp.author.external · GOUVEIA, Flavia Venetucci:Hosp Sirio Libanes, Teaching & Res Inst, Lab Neuromodulat, Sao Paulo, Brazil; Sunnybrook Res Inst, 2075 Bayview Ave,S126, Toronto, ON M4N 3M5, Canada
· GERMANN, Jurgen:McGill Univ, Douglas Mental Hlth Univ Inst, CIC, Montreal, PQ, Canada
· MARTINS, Ana Paula:Univ Sao Paulo, Sch Med, Dept Psychiat, PROTEA, Sao Paulo, Brazil
· DEVENYI, Gabriel:McGill Univ, Douglas Mental Hlth Univ Inst, CIC, Montreal, PQ, Canada
· PATEL, Raihaan:McGill Univ, Douglas Mental Hlth Univ Inst, CIC, Montreal, PQ, Canada
· STEELE, Christopher:McGill Univ, Douglas Mental Hlth Univ Inst, CIC, Montreal, PQ, Canada
· GRAMER, Robert:Duke Univ, Med Ctr, Dept Neurosurg, Durham, NC USA
· CHAKRAVARTY, Mallar:McGill Univ, Douglas Mental Hlth Univ Inst, CIC, Montreal, PQ, Canada
· MARTINEZ, Raquel Chacon Ruiz:Hosp Sirio Libanes, Teaching & Res Inst, Lab Neuromodulat, Sao Paulo, Brazil
hcfmusp.origem.id WOS:000610550900009
hcfmusp.origem.id 2-s2.0-85100069870
hcfmusp.publisher.city CARY
hcfmusp.publisher.country USA
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dc.description.index MEDLINE
dc.identifier.eissn 1524-4040
hcfmusp.citation.scopus 2
hcfmusp.scopus.lastupdate 2021-08-27

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