Pathological aggression is a symptom that appears as a consequence of brain damage, for example, damage secondary to lack of oxygen in childbirth, in some patients with autism, after a major head injury, or after encephalitis, to give some examples.
It is associated with aggressive reactions which, in many cases, do not respond to specific stimuli, appear spontaneously, or are manifestations of very extreme aggressiveness in response to minimal stimuli.
This behavior usually improves with drugs, but sometimes it can be refractory to them, and the patient continues to show these alterations despite all types of treatment with medication and psychotherapy.
In these cases, mechanical restraint is sometimes necessary for some or all activities, and the quality of life of caregivers and patients is dramatically reduced.
What treatments are available?
For these patients, there are very effective surgical treatments, such as hypothalamic deep brain stimulation or bilateral tonsillectomy and capsulotomy, which achieve in 80% of well selected cases a very significant improvement in symptoms. In this way, the patient can return to a much more adequate social activity and his cognitive qualities improve, since he can interact with the environment in a more effective way.
These treatments require a great deal of experience and are performed in very few centers. At the Ruber Internacional Hospital we have the most extensive experience in this field, and we also have a multidisciplinary team, made up of neurosurgeons, psychiatrists, anesthesiologists, intensivists, and nurses, among others, which is essential for the proper management of these patients and their return to normal activities.
The choice of one technique or another depends on the characteristics of the patient, and is evaluated with a thorough preoperative study by the team. In any case, these treatments are still considered experimental and are off-label, but can be applied if the other options have failed.