The amygdala as a therapeutic target for aggressive and disruptive behaviors: Systematic review.

Objective: To identify the effects of amygdala neuromodulation in the management disruptive behavior in patients, as well as changes in their quality of life and its relationship with epilepsy.

Methods: MEDLINE, OVID, WoS, Central Cochrane, and Scopus databases were systematically searched up to March 2023 for studies examining extremely aggressive patients who underwent ablative surgeries or deep brain stimulation (DBS) of the amygdala as the unique therapeutic target, with a six-month follow-up at least.

Results: The search yielded 1352 studies excluding duplicates, but only 11 case series, and 3 case reports met the inclusion criteria. They were published between 1963-2023 with a total of 1033 patients, mostly male, aged between 5 and 61 years. Most studies implemented amygdalotomy and only one DBS. More than 70% of the patients improved their behavior; approximately 30% had seizures, of which 40% presented improvement. Two studies reported worsening behavior.

Conclusions: Although we found that amygdalotomy has a positive effect on the behavior of patients and the control of their seizures, it is necessary to carry out updated studies with greater epidemiological power. Future research should analyze the DBS use and the role of connectomics of the different neural networks involved with this brain structure.