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Connectivity in deep brain stimulation for self-injurious behavior: multiple targets for a common network?

Petra Heiden1,2, Daniel Tim Weigel1, Ricardo Loução1,2

  • 1Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.

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|September 12, 2022
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Summary

Deep brain stimulation (DBS) improved function in severe self-injurious behavior (SIB) patients. Good outcomes correlated with amygdala and hippocampus connectivity, suggesting a common neural pathway for SIB treatment.

Keywords:
aggressivenessconnectivitydeep brain stimulationpsychosurgeryself-injurious behavior

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Area of Science:

  • Neuroscience
  • Psychiatry
  • Neurosurgery

Background:

  • Self-injurious behavior (SIB) severely impacts quality of life and is linked to psychiatric conditions like autism spectrum disorder and brain injuries.
  • Conventional therapies often fail for severe, refractory SIB, necessitating alternative treatments.
  • Neuromodulation, specifically deep brain stimulation (DBS), is explored as a last resort for intractable SIB.

Purpose of the Study:

  • To assess the short- and long-term clinical outcomes of patients with severe, therapy-refractory SIB treated with DBS.
  • To correlate DBS outcomes with activated neural connectivity networks.

Main Methods:

  • Retrospective analysis of 10 patients with severe SIB undergoing DBS for various psychiatric conditions.
  • DBS targets included nucleus accumbens, amygdala, posterior hypothalamus, and thalamic nuclei.
  • Clinical outcomes measured by Early Rehabilitation Barthel Index (ERBI) and restraint time; connectivity analyzed using normative connectome.

Main Results:

  • Significant functional improvement observed in patients post-DBS at short-term (6 months) and long-term (10+ years) follow-ups.
  • Positive clinical outcomes correlated with enhanced connectivity to the amygdala and hippocampus.
  • Identified potential common neuronal pathways implicated in SIB.

Conclusions:

  • DBS is an effective treatment for severe, refractory SIB across diverse psychiatric disorders.
  • Connectivity patterns, particularly with the amygdala and hippocampus, are crucial indicators of successful DBS outcomes.
  • Findings suggest a shared neural substrate for SIB, guiding future surgical interventions.