Deep brain stimulation for severe secondary stereotypies

Stocco, Amber; Baizabal‐Carvallo, José Fidel

doi:10.1016/j.parkreldis.2014.06.019

Cited by 36 publications

(38 citation statements)

References 4 publications

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“…Sturm et al (2013) report the case of a 13-year old with an ASD and intractable SIB and aggression whose behaviors were ameliorated by DBS at the basolateral amygdala. Stocco and Baizabal-Carvallo (2014) report two similar cases: one patient responded to GPi-DBS and the other had a transient response to stimulation at the GPi and anterior limb of the internal capsule (ALIC). We targeted the STN based on both the similarity of SIB to other conditions that have been successfully treated with STN-DBS and its proposed role in regulating repetitive behaviors.…”

Section: Discussionmentioning

confidence: 98%

High-Frequency Stimulation at the Subthalamic Nucleus Suppresses Excessive Self-Grooming in Autism-Like Mouse Models

Chang

Berges

Chung

et al. 2015

Neuropsychopharmacol

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Approximately one quarter of individuals with an autism spectrum disorder (ASD) display self-injurious behavior (SIB) ranging from head banging to self-directed biting and punching. Sometimes, these behaviors are extreme and unresponsive to pharmacological and behavioral therapies. We have found electroconvulsive therapy (ECT) can produce life-changing results, with more than 90% suppression of SIB frequency. However, these patients typically require frequent maintenance ECT (mECT), as often as every 5 days, to sustain the improvement gained during the acute course. Long-term consequences of such frequent mECT started as early as childhood in some cases are unknown. Accordingly, there is a need for alternative forms of chronic stimulation for these patients. To explore the feasibility of deep brain stimulation (DBS) for intractable SIB seen in some patients with an ASD, we utilized two genetically distinct mouse models demonstrating excessive self-grooming, namely the Viaat-Mecp2 − /y and Shank3B −/− lines, and administered high-frequency stimulation (HFS) via implanted electrodes at the subthalamic nucleus (STN-HFS). We found that STN-HFS significantly suppressed excessive selfgrooming in both genetic lines. Suppression occurs both acutely when stimulation is switched on, and persists for several days after HFS is stopped. This effect was not explained by a change in locomotor activity, which was unaffected by STN-HFS. Likewise, social interaction deficits were not corrected by STN-HFS. Our data show STN-HFS suppresses excessive self-grooming in two autism-like mouse models, raising the possibility DBS might be used to treat intractable SIB associated with ASDs. Further studies are required to explore the circuitry engaged by STN-HFS, as well as other potential stimulation sites. Such studies might also yield clues about pathways, which could be modulated by non-invasive stimulatory techniques.

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Section: Discussionmentioning

confidence: 98%

High-Frequency Stimulation at the Subthalamic Nucleus Suppresses Excessive Self-Grooming in Autism-Like Mouse Models

Chang

Berges

Chung

et al. 2015

Neuropsychopharmacol

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“…Three case-reports of DBS in four patients with treatment-refractory autism spectrum disorder (ASD) have been published (Stocco & Baizabal-Carvallo, 2014;Sturm et al, 2012). Sturm et al (2012) were the first to apply DBS to a patient with Kanner's autism and life-threatening self-injurious behaviour (SIB).…”

Section: Autismmentioning

confidence: 99%

The application of deep brain stimulation in the treatment of psychiatric disorders

Graat

Figee

Denys

2017

International Review of Psychiatry

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Deep brain stimulation (DBS) is a last-resort treatment for neurological and psychiatric disorders that are refractory to standard treatment. Over the last decades, the progress of DBS in psychiatry has been slower than in neurology, in part owing to the heterogenic symptomatology and complex neuroanatomy of psychiatric disorders. However, for obsessive-compulsive disorder (OCD) DBS is now an accepted treatment. This study first reviews clinical outcomes and mechanisms of DBS for OCD, and then discusses these results in an overview of current and future psychiatric applications, including DBS for mood disorders, Tourette's syndrome, addiction, anorexia nervosa, autism, schizophrenia, and anxiety disorders. In addition, it will focus on novel techniques that may enhance the application of DBS in psychiatry.ARTICLE HISTORY

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“…So far, 3 cases of DBS treatment for managing severe autism have been reported (Table 1). 86,88 All 3 patients were experiencing prominent, life-threatening SIB that was not alleviated by multiple trials of antipsychotic medication. A 17-year-old male received DBS of the bilateral anterior limb of the internal capsule and of the globus pallidus internus.…”

Section: Role For Dbsmentioning

confidence: 99%

“…A 17-year-old male received DBS of the bilateral anterior limb of the internal capsule and of the globus pallidus internus. 86 A 19-year-old female received bilateral DBS to the globus pallidus internus only, 86 and a male, at age 13 years, received DBS to the BLA bilaterally. 88 In the first patient, some improvement in SIB was observed over the first 6 months, but the patient's condition gradually deteriorated back to his original baseline.…”

Section: Role For Dbsmentioning

confidence: 99%

“…Although application of DBS was pioneered in the treatment of movement disorders, its indications have continued to expand within both neurological and psychiatric diseases, including depression 39 and obsessive-compulsive disorder (OCD). 37 In fact, use of DBS for severe autism has been previously reported in 3 patients with some success, 86,88 although it has not been otherwise significantly discussed in the literature.…”

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confidence: 99%

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Deep brain stimulation for severe autism: from pathophysiology to procedure

Sinha

McGovern

Sheth

2015

FOC

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Autism is a heterogeneous neurodevelopmental disorder characterized by early-onset impairment in social interaction and communication and by repetitive, restricted behaviors and interests. Because the degree of impairment may vary, a spectrum of clinical manifestations exists. Severe autism is characterized by complete lack of language development and potentially life-threatening self-injurious behavior, the latter of which may be refractory to medical therapy and devastating for affected individuals and their caretakers. New treatment strategies are therefore needed. Here, the authors propose deep brain stimulation (DBS) of the basolateral nucleus of the amygdala (BLA) as a therapeutic intervention to treat severe autism. The authors review recent developments in the understanding of the pathophysiology of autism. Specifically, they describe the genetic and environmental alterations that affect neurodevelopment. The authors also highlight the resultant microstructural, macrostructural, and functional abnormalities that emerge during brain development, which create a pattern of dysfunctional neural networks involved in socioemotional processing. They then discuss how these findings implicate the BLA as a key node in the pathophysiology of autism and review a reported case of BLA DBS for treatment of severe autism. Much progress has been made in recent years in understanding the pathophysiology of autism. The BLA represents a logical neurosurgical target for treating severe autism. Further study is needed that considers mechanistic and operative challenges.

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Deep brain stimulation for severe secondary stereotypies

Cited by 36 publications

References 4 publications

High-Frequency Stimulation at the Subthalamic Nucleus Suppresses Excessive Self-Grooming in Autism-Like Mouse Models

High-Frequency Stimulation at the Subthalamic Nucleus Suppresses Excessive Self-Grooming in Autism-Like Mouse Models

The application of deep brain stimulation in the treatment of psychiatric disorders

Deep brain stimulation for severe autism: from pathophysiology to procedure

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