Gabapentin in the Treatment of Self-Injurious Behaviours - A Case Report

Autism spectrum disorder (ASD) is a neurodevelopmental condition affecting 1 in 36 children, characterized by deficits in social communication and restricted, repetitive behaviors. Self-injurious behaviors (SIBs), such as head-banging and biting, are prevalent in ASD, affecting up to 50% of individuals. These behaviors pose significant risks, including physical injury and social isolation. While behavioural therapies are the first-line treatment, their effectiveness is often limited, necessitating the use of pharmacological interventions. However, there is a paucity of evidence regarding the effective pharmacological management of SIBs in this population. Gabapentin, an anticonvulsant also used for neuropathic pain, has shown potential in managing SIBs, despite limited evidence in pediatric populations thus far. It acts as a GABA analog, inhibiting voltage-dependent calcium channels. Gabapentin is generally well-tolerated, with mild adverse effects like fatigue and dizziness. In this report, we present a case detailing the use of gabapentin in a 13-year-old non-verbal male with ASD and severe SIBs. Despite extensive subspeciality evaluations and various treatments, his SIBs persisted, significantly negatively impacting his quality of life. Oral gabapentin was introduced and progressively titrated up to 600mg TID, leading to a notable reduction in the frequency and severity of SIBs within days. The patient's episodes became shorter and more manageable, with no adverse effects reported. This case highlights gabapentin's potential as an effective treatment for severe SIBs in pediatric patients with ASD, particularly when chronic pain is suspected as a contributing factor. Further research is warranted to explore its effectiveness in this population and establish guidelines for its use.