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This page is an AI-assisted Turkish summary of the study presented at the 26th World Congress of Psychiatry. The study belongs to the presenting authors; please refer to the original source when citing it.

EV0899

Beyond medication and behavioral therapy: deep brain stimulation as an adjunctive treatment for treatment-resistant pediatric pathological aggression

BEYOND MEDICATIONS AND BEHAVIORAL THERAPY DEEP BRAIN STIMULATION AS AN ADJUNCT FOR REFRACTORY PEDIATRIC PATHOLOGICAL AGGRESSION

In two treatment-resistant pediatric cases, bilateral posterolateral hypothalamic deep brain stimulation was associated with a 70% reduction in aggression severity at 18 months.

The aim is to report the psychiatric outcomes of posterolateral hypothalamic deep brain stimulation and perioperative contributions to target localization in two treatment-resistant cases of severe pathological aggression in the context of neurodevelopmental and epileptic encephalopathy, with limited response to medication, behavioral therapy, or vagus nerve stimulation. Two children with treatment-resistant severe pathological aggression underwent bilateral posterolateral hypothalamic deep brain stimulation under general anesthesia. Aggression severity was measured before surgery and throughout follow-up using the Modified Overt Aggression Scale (MOAS); the anesthetic plan prioritized stable electroencephalographic and hemodynamic conditions to support microstimulation mapping. At baseline, the mean MOAS score was 14.5 (range 13 to 16). At 18 months, the mean MOAS score had decreased to 4.8, corresponding to a 70% reduction. Families reported that severe outbursts of anger had ceased, with improvements in sleep, feeding, and participation in rehabilitation, as well as a reduction in caregiver burden. Macrostimulation was confirmed by reproducible autonomic responses consistent with heart rate changes, and no complications were observed. In this two-case series, the procedures were completed under general anesthesia without major perioperative complications; coordinated neuropsychiatric assessment and perioperative facilitation of stimulation mapping may support safe and accurate intervention.

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