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Clinical and Physiological Effects of Stereotaxic Bilateral Amygdalotomy for Intractable Aggression

Received July 18, 1997; revised September 29, 1997; accepted October 23, 1997. From the Section of Neurosurgery and the Departments of Psychiatry/Health Behavior and Neurology, Medical College of Georgia, Augusta, Georgia; and the Department of Neurology, Division of Cognitive Neuroscience, University of Iowa College of Medicine, Iowa City, Iowa. Address correspondence to Dr. Lee, Section of Neurosurgery, BIW-348, Medical College of Georgia, Augusta, GA 30912-4010; e-mail: deptsurg.glee{at}mail.mcg.edu

The amygdala is thought to be an important neural structure underlying the "fight-or-flight" response, but information on its role in humans is scarce. The clinical and psychophysiological effects of amygdalar destruction were studied in 2 patients who underwent bilateral amygdalotomy for intractable aggression. After surgery, both patients showed a reduction in autonomic arousal levels to stressful stimuli and in the number of aggressive outbursts, although both patients continued to have difficulty controlling aggression. The "taming effect" reported after bilateral amygdalar destruction may be due to the amygdala's inadequate processing of perceived threat stimuli that would normally produce a fight-or-flight response.

Key Words: Psychosurgery • Amygdala • Aggression

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