Deep Brain Stimulation for Medication-Refractory Aggressive and Injurious Behavior

Aggressiveness, defined as violent and angry behavior, is a special and challenging condition that is encountered in medicine. There is frequently involvement of the patient with self-aggressiveness and automutilation, and there may be a history in relatives. Allied health personal and others may be affected by injuries and trauma caused by the patient. Lesioning of the posterior hypothalamus (PHyp) is a technique that was used successfully to control aggressiveness 40 years ago. Deep brain stimulation (DBS) has been recently used for treatment of motor symptoms of movement disorders as well as for some psychiatric diseases, and groups have also suggested that it may be useful for aggressive behavior in select circumstances. This chapter reports the case of a patient with uncontrollable aggressiveness and the implantation of DBS in the PHyp. In this case, the DBS also helped to control epilepsy and to focus attention.