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

Objective: To identify the effects of amygdala neuromodulation on disruptive behavior and quality of life changes in patients and its relationship with epilepsy.

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

Results: The search yielded 1,352 studies after excluding duplicates. However, only 11 case series and three case reports met the inclusion criteria. The studies were published between 1963 and 2023 and included 1,033 patients, mostly male, aged between 5 and 61 years. All of the studies performed amygdalotomy except one, which performed deep brain stimulation. Behavior improved in > 70% of the patients, and seizures occurred in approximately 30%, of whom 40% presented improvement. Two studies reported worsening behavior.

Conclusions: Although we found that amygdalotomy has a positive effect on patient behavior and seizure control, new studies with greater power are needed. Future studies should investigate deep brain stimulation and the role of connectomics regarding this brain structure.