We followed the PRISMA-ScR guidelines using MEDLINE, Embase, and Web of Science from inception to June 4th, 2023. English-language studies investigating DBS for aggression were included. Of 1,905 records identified, 37 met inclusion criteria after screening and eligibility assessment.

A total of 37 studies from 12 countries, including 976 patients, were included after screening 1,905 records. Of these, 882 were adults (90%) and 43 were pediatric (4%), with a mean age of 55.3 years (range 15.2–68.5). The mean follow-up was 32.3 ± 36.3 months (range 3–144). Before DBS, 799 patients (82%) received medication. The most common indications were movement disorders (24%) and aggression (20%). The hypothalamus (17%) and nucleus accumbens (4%) were the predominant DBS targets. Among 160 patients with individual outcome data, 144 (90%) experienced measurable improvement in aggression, while 9 showed no change, 6 had transient worsening, and 1 had increased aggression. Common adverse events included apathy (3.2%), headaches (2.0%), and device-related complications (1.6%). Serious events were rare, with suicide attempts (0.51%) and one completion (0.1%) reported. The Overt Aggression Scale (OAS) was the most frequently applied outcome measure (24% of studies).