Non-Invasive Brain Stimulation for the Modulation of Aggressive Behavior-A Systematic Review of Randomized Sham-Controlled Studies

Antony Casula; Bianca M Milazzo; Gabriella Martino; Alessandro Sergi; Chiara Lucifora; Francesco Tomaiuolo; Angelo Quartarone; Michael A Nitsche; Carmelo M Vicario

doi:10.3390/life13051220

Non-Invasive Brain Stimulation for the Modulation of Aggressive Behavior-A Systematic Review of Randomized Sham-Controlled Studies

Life (Basel). 2023 May 20;13(5):1220. doi: 10.3390/life13051220.

Authors

Antony Casula¹, Bianca M Milazzo¹, Gabriella Martino², Alessandro Sergi³, Chiara Lucifora⁴, Francesco Tomaiuolo², Angelo Quartarone⁵, Michael A Nitsche^{6

7}, Carmelo M Vicario¹

Affiliations

¹ Dipartimento di Scienze Cognitive, Psicologiche, Pedagogiche e Degli Studi Culturali, Università di Messina, 98121 Messina, Italy.
² Dipartimento di Medicina e Clinica Sperimentale, Università degli Studi di Messina, A.O.U. "G. Martino", Via Consolare Valeria, 98125 Messina, Italy.
³ Dipartimento di Scienze Matematiche e Informatiche, Scienze Fisiche e Scienze della Terra, Università degli Studi di Messina, Viale F. Stagno d'Alcontres 31, 98166 Messina, Italy.
⁴ Dipartimento di Filosofia e Comunicazione, Università di Bologna, 40131 Bologna, Italy.
⁵ IRCCS Centro Neurolesi Bonino Pulejo, 98121 Messina, Italy.
⁶ Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, 44139 Dortmund, Germany.
⁷ University Clinic of Psychiatry and Psychotherapy and University Clinic of Child and Adolescent Psychiatry and Psychotherapy, Protestant Hospital of Bethel Foundation, University Hospital OWL, Bielefeld University, 33615 Bielefeld, Germany.

Abstract

Intro: Aggressive behavior represents a significant public health issue, with relevant social, political, and security implications. Non-invasive brain stimulation (NIBS) techniques may modulate aggressive behavior through stimulation of the prefrontal cortex.

Aims: To review research on the effectiveness of NIBS to alter aggression, discuss the main findings and potential limitations, consider the specifics of the techniques and protocols employed, and discuss clinical implications.

Methods: A systematic review of the literature available in the PubMed database was carried out, and 17 randomized sham-controlled studies investigating the effectiveness of NIBS techniques on aggression were included. Exclusion criteria included reviews, meta-analyses, and articles not referring to the subject of interest or not addressing cognitive and emotional modulation aims.

Conclusions: The reviewed data provide promising evidence for the beneficial effects of tDCS, conventional rTMS, and cTBS on aggression in healthy adults, forensic, and clinical samples. The specific stimulation target is a key factor for the success of stimulation on aggression modulation. rTMS and cTBS showed opposite effects on aggression compared with tDCS. However, due to the heterogeneity of stimulation protocols, experimental designs, and samples, we cannot exclude other factors that may play a confounding role.

Keywords: aggression; cTBS; non-invasive brain stimulation; rTMS; tDCS.

Publication types

Review

Grants and funding

This work was supported by the Bial Foundation (protocol number 160/18) awarded to C.M.V. and M.A.N. was supported by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation)—project number 316803389—SFB 1280, project A6, and by the German Centre of Mental Health (project number 01EE2302D).