Multi-centre analysis of networks and genes modulated by hypothalamic stimulation in patients with aggressive behaviours
Flavia Venetucci Gouveia, Jürgen Germann, Gavin J.B. Elias, Alexandre Boutet, Aaron Loh, Adriana Lucia López Ríos, Cristina V. Torres, William Omar Contreras López, Raquel Chacon Ruiz Martinez, Erich Talamoni Fonoff, Juan Carlos Benedetti‐Isaac, Peter Giacobbe, Pablo M Arango Pava, Han Yan, George M. Ibrahim, Nir Lipsman, Andrés M. Lozano, Clement Hamani
Abstract
Deep brain stimulation targeting the posterior hypothalamus (pHyp-DBS) is being investigated as a treatment for refractory aggressive behavior, but its mechanisms of action remain elusive. We conducted an integrated imaging analysis of a large multi-centre dataset, incorporating volume of activated tissue modeling, probabilistic mapping, normative connectomics, and atlas-derived transcriptomics. Ninety-one percent of the patients responded positively to treatment, with a more striking improvement recorded in the pediatric population. Probabilistic mapping revealed an optimized surgical target within the posterior-inferior-lateral region of the posterior hypothalamic area. Normative connectomic analyses identified fiber tracts and functionally connected with brain areas associated with sensorimotor function, emotional regulation, and monoamine production. Functional connectivity between the target, periaqueductal gray and key limbic areas - together with patient age - were highly predictive of treatment outcome. Transcriptomic analysis showed that genes involved in mechanisms of aggressive behavior, neuronal communication, plasticity and neuroinflammation might underlie this functional network.