Deep Brain Stimulation of the Anterior Limb of the Internal Capsule May Be Efficacious for Explosive Aggressive Behaviour

Flavio Giordano, Michele Cavallo, Barbara Spacca, Stefano Pallanti, Francesco Tomaiuolo, Fulvio Pieraccini, Andrea Fagiolini, Manuela Grandoni, Federico Melani, Anna Zicca, Stelvio Sestini, Lorenzo Genitori

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Background: Intermittent explosive disease (IED) is a psychiatric disorder characterized by intermittent attacks of rage and violence frequently resistant to pharmacological therapy. Deep brain stimulation (DBS) of the posteromedial hypothalamus has been applied with fair results and clinical improvement with some surgical morbidity due to neurovegetative side effects. The anterior limb of the internal capsule/ventral capsule/ventral striatum (VC/VS) has never been used alone as a target for this disease. Objectives: The aim of this study is to evaluate the efficacy of bilateral DBS of the VC/VS for the treatment of IED. Methods: We performed bilateral DBS of the VC/VS in a 21-year-old patient with IED. This young man had a traumatic birth complicated by hypoxia, and he showed a mild mental impairment. Different pharmacological treatments were carried out with no results before DBS was proposed to the patient's relatives after multidisciplinary approval. Results: After 22 months of high-frequency monopolar bilateral DBS of the VC/VS, the patient showed a significant improvement. Postoperative 18F-FDG PET-CT studies ruled out a reduction of the hypermetabolic areas located in the limbic system previously detected in pre-operative investigations. Conclusions: Bilateral DBS of the VC/VS may be considered for the treatment of IED without the risk of neurovegetative side effects.

Original languageEnglish
Pages (from-to)371-378
Number of pages8
JournalStereotactic and Functional Neurosurgery
Issue number6
StatePublished - 1 Jan 2017
Externally publishedYes


  • Aggressiveness
  • Anterior limb of internal capsule
  • Deep brain stimulation
  • Intermittent explosive disorder
  • Obsessive-compulsive disorder
  • Psychosurgery


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