Deep brain stimulation for autism spectrum disorder

Table 1 Summary of deep brain stimulation studies for autism spectrum disorder

Ref.	Patients’ age/sex	Diagnosis and comorbidities	Indications for DBS	DBS targets	Pre-BDS scores	Post-BDS scores	Main outcomes
Segar et al[34]	24, F	KS, OCD, ASD, epilepsy	Biting hands, picking skin	NAc	GAF 20	GAF 50-60	Clinical improvements mainly for compulsive behaviors, coprolalia, language and social interaction
Doshi et al[35]	42, F	OCD, ASD, epilepsy	OCD, aggression	NAc	Y-BOCS 19, HAMD 20, HAS 30, SCQ 26	Y-BOCS 5, HAMD 15, HAS 18, SCQ 16	Marked improvements in OCD symptoms, aggressive behavior, eye contact and appropriate laughter
Park et al[40]	13, M	ASD, Developmental Delay	Self-mutilation, face-hitting	NAc	CGI-S 6; ABC 106; CY-BOCS 22; K-ARS 54; SRS 101	CGI-S 4; ABC 40; CY- BOCS 7; K-ARS 36; SRS 98	Decreased in SIB and improvement in verbal communication
Stocco et al[39]	19, F	ASD, ID, monosomy 2q and trisomy 20p	Self-picking, Severe stereotypes	GPi	JHMRS 46	JHMRS 4	Marked improvement in the SIB and dystonia
	17, M	ASD, ID, anxiety	Punching of arms and legs, biting, Severe stereotypes	GPi and ALIC	JHMRS 67	JHMRS 19	Substantial initial improvement in SIB, but the benefit disappeared after 6 mo and was not regained
Kakko et al[42]	19, M	ASD, ID, epilepsy, TD	Aggression, self-mutilation, lacerations	GPi	NR	NR	TD symptoms were markedly improved. The anxiety, behavioral symptoms had ceased
Sturm et al[38]	13, M	Kanner’s Autism, ID, infantile cerebral palsy	Self-aggression	Basolateral amygdala	Parental score of 6	Parental score of 2	Decreased in SIB and core symptoms of the autism spectrum in the emotional, social, and cognitive domains
Davis et al[36]	44, M	OCD, ASD, MDD, tics, epilepsy	OCD, aggression	Ventral capsule/ventral striatum	Y-BOCS, MADRS, YGTSS	Y-BOCS, MADRS and YGTSS scores decreased by 68%, 66%, and 75% respectively	The clinical improvements were maintained, albeit with fluctuations, after 3 yr. No effect on core symptoms of ASD
Graat et al[37]	39, F	OCD, ASD, Depressive episodes	OCD	vALIC	Y-BOCS 33, HAMD 27	Y-BOCS 12, HAMD 7	50% reduction of OCD symptoms following DBS, especially obsessions
	54, F	OCD, ASD	OCD	vALIC, then MFB	Y-BOCS 38, HAMD 30	Y-BOCS 18, HAMD 4	Initially did not benefit from DBS. Thereafter OCD symptoms improved and decreased by more than 50%
	32, M	OCD, ASD, ADHD	OCD, aggressive intrusions	vALIC	Y-BOCS 31, HAMD 18	Y-BOCS 23, HAMD 12	Partial responder probably due to several transient side effects of DBS
	31, F	OCD, ASD, DD, OCPD, AN	OCD	vALIC	Y-BOCS 34, HAMD 30	Y-BOCS 32, HAMD 27	Only some subjective improvements
	51, M	OCD, ASD	OCD	MFB	Y-BOCS 34, HAMD 5	Y-BOCS 0, HAMD 2	Obsessive-compulsive symptoms disappeared entirely. Improved confidence and less social shyness
	30, F	OCD, ASD, PDD, GAD, UPD	OCD,	MFB	Y-BOCS 34, HAMD 23	Y-BOCS 22, HAMD 22	35% reduction of OCD symptoms following DBS
Benedetti-Isaac et al[41]	27, M	ASD, TBI, epilepsy	Aggressive behavior towards self	PHyp	OAS 9	OAS 1	Improvements in seizures, in aggressive behavior, in quality of life, in daily living skills
	16, M	ASD, epilepsy, Developmental Delay	Self-aggression	PHyp	OAS 8	OAS 1	Aggressive behavior controlled for a month. After 2 mo it reappeared as before surgery

ABC: Antecedent, behavior, consequence; ADHD: Attention deficit hyperactive disorder; ALIC: Anterior limb of internal capsule; AN: Anorexia nervosa; ASD: Autism spectrum disorder; CGI-S: Clinical global impressions-severity; CY-BOCS: Children’s Yale-Brown obsessive-compulsive scale; DBS: Deep brain stimulation; DD: Depressive disorder; F: Female; GAD: Generalized anxiety disorder; GAF: Global assessment of functioning; GPi: Globus Pallidus internus; HAMD: Hamilton depression scale; HAS: Hamilton anxiety scale; ID: Intellectual disability; JHMRS: Johns Hopkins motor stereotypy rating scale; K-ARS: Korea attention deficit hyperactive disorder rating scale; KS: Kleefstra syndrome; M: Male; MADRS: Montgomery-Asberg depression rating scale; MDD: Major depressive disorder; MFB: Medial forebrain bundle; NAc: Nucleus accumbens; NR: Not reported; OAS: Overt aggression scale; OCD: Obsessive-compulsive disorder; OCPD: Obsessive-compulsive personality disorder; PDD: Persistent depressive disorder; PHyp: Posterior hypothalamus; SCQ: Social communication questionnaire; SRS: Social responsiveness scale; TBI: Traumatic brain injury; TD: Tardive dyskinesia; UPD: Unspecified personality disorder; vALIC: Ventral anterior limb of the internal capsule; Y-BOCS: Yale-Brown obsessive-compulsive scale; YGTSS: Yale global tic severity scale.