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World J Psychiatry. May 19, 2023; 13(5): 174-181
Published online May 19, 2023. doi: 10.5498/wjp.v13.i5.174
Deep brain stimulation for autism spectrum disorder
Stefano Marini, Lucia D'Agostino, Carla Ciamarra, Alessandro Gentile
Stefano Marini, Lucia D'Agostino, Carla Ciamarra, Alessandro Gentile, Department of Mental Health, National Health Service, Termoli 86039, Italy
Author contributions: Marini S and D'Agostino L wrote the article; Ciamarra C performed the research; Gentile A designed the research study. All authors have read and approved the final manuscript.
Conflict-of-interest statement: This paper was entirely funded by the authors, and no pharmaceutical companies were informed of or were involved in the paper. The authors have no potential conflicts of interest that are directly relevant to the contents of the paper.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Stefano Marini, MD, Doctor, Department of Mental Health, National Health Service, Via del Molinello n. 1, Termoli 86039, Italy. sfnmarini@gmail.com
Received: December 23, 2022
Peer-review started: December 23, 2022
First decision: March 1, 2023
Revised: March 9, 2023
Accepted: March 29, 2023
Article in press: March 29, 2023
Published online: May 19, 2023
Processing time: 147 Days and 4.8 Hours
Abstract

Deep brain stimulation (DBS) is a medical treatment that aims to obtain therapeutic effects by applying chronic electrical impulses in specific brain structures and neurological circuits. Over the years, DBS has been studied for the treatment of many psychiatric disorders. Scientific research on the use of DBS in people with autism has focused this interest mainly on treatment-resistant obsessive-compulsive disorder, drug-resistant epilepsy, self-injurious behaviors (SIB), and aggressive behaviors toward the self. Autism spectrum disorder (ASD) includes a group of developmental disabilities characterized by patterns of delay and deviance in the development of social, communicative, and cognitive skills and the presence of repetitive and stereotyped behaviors as well as restricted interests. People with autism often have numerous medical and psychiatric comorbidities that worsen the quality of life of patients and their caregivers. Obsessive-compulsive symptoms can be found in up to 81.3% of people with autism. They are often severe, refractory to treatment, and particularly difficult to treat. SIB has a high prevalence in severely retarded individuals and is often associated with autism. Drug treatment of both autism and SIB presents a therapeutic challenge. To describe the current state of the art regarding the efficacy of DBS in people with ASD, a literature search was conducted for relevant studies using the PubMed database. Thirteen studies have been considered in this paper. Up to date, DBS has been used for the stimulation of the nucleus accumbens, globus pallidus internus, anterior limb of the internal capsule, ventral anterior limb of the internal capsule, basolateral amygdala, ventral capsule and ventral striatum, medial forebrain bundle, and posterior hypothalamus. In the total sample of 16 patients, 4 were adolescents, and 12 were adults. All patients had symptoms resistant to multiple drug therapy. Many patients taken into consideration by the studies showed clinical improvements as evidenced by the scores of the psychopathological scales used. In some cases, clinical improvements have varied over time, which may require further investigation. Among the new therapeutic perspectives, DBS could be a valid option. However, further, and more in-depth research is needed in this field.

Keywords: Deep brain stimulation; Autism spectrum disorder; Comorbidities; Drug resistant; New therapeutic perspectives

Core Tip: Deep brain stimulation (DBS) is a medical treatment that aims at obtaining therapeutic effects by applying chronic electrical impulses in specific brain structures and neurological circuits. Autism spectrum disorder comprises a group of developmental disabilities that are often associated with numerous medical and psychiatric comorbidities that worsen the quality of life of patients and their caregivers. Comorbidities often require multiple drug treatments with an increasing rate of treatment resistance. Thirteen studies have been considered in this paper. Up to date, DBS has been used for the stimulation of the nucleus accumbens, globus pallidus internus, anterior limb of the internal capsule, ventral anterior limb of the internal capsule, basolateral amygdala, ventral capsule and ventral striatum, medial forebrain bundle, and posterior hypothalamus. In the total sample of 16 patients, 4 were adolescents (all males), and 12 were adults (5 males and 7 females). All patients had symptoms resistant to multiple drug therapy. Only one patient was considered not a responder to DBS. Among the new therapeutic perspectives, as evidenced by the studies presented in this article, DBS could be a valid option. However, further, and more in-depth research is needed in this field.