Emergence of Self- and Other-Directed Aggression After Thalamic Stimulation in Epilepsy: A Case-Control Analysis of Risk Factors
Abstract number :
1.258
Submission category :
3. Neurophysiology / 3E. Brain Stimulation
Year :
2025
Submission ID :
1068
Source :
www.aesnet.org
Presentation date :
12/6/2025 12:00:00 AM
Published date :
Authors :
Presenting Author: Jacob Sloan, MD – Emory University
Diane Teagarden, NP – Emory University
Hannah Villarreal, NP – Emory University
Greydon Gilmore, PhD – Emory University School of Medicine
Nealen Laxpati, MD, PhD – Emory University School of Medicine
Ezequiel Gleichgerrcht, M.D., Ph.D. – Emory University
Rationale: Deep brain stimulation (DBS) of the anterior nucleus of the thalamus (ANT) is an established therapy for drug-resistant epilepsy (DRE), but little is known about neuropsychiatric complications beyond mood and apathy. We identified a subset of patients who developed new-onset or exacerbated self- or other-directed aggressive behaviors following ANT DBS and sought to identify associated clinical and anatomical risk factors.
Methods: We retrospectively screened 97 patients treated with ANT DBS at our center and identified 11 (11%) who developed self- or other-directed aggressive behaviors post-implantation. These were compared to 86 patients without such behaviors. Variables extracted from pre-operative records included seizure type and frequency, prior epilepsy surgeries, and psychiatric history (measured through the Beck Depression Inventory [BDI] and the Beck Anxiety Inventory [BAI] and medical history of depression, suicidality, or prior aggression). Electrode localization, volume of tissue activated (VTA) at time of symptom emergence, and tractography were performed using Lead-DBS. Aggressive behaviors were defined as documented clinically meaningful ideation, threats, or acts with intent to harm self or others, with onset following DBS initiation.
Results: The aggression group had significantly higher rates of psychiatric comorbidities, including pre-implant BAI scores 15.4 ± 11.9 vs. 8.0 ± 9.3 (U = 290.0, p < .05), a history of suicidal attempt and/or ideation (55% vs. 19%, χ
Neurophysiology