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61st Annual Meeting of the German Society of Neurosurgery (DGNC) as part of the Neurowoche 2010
Joint Meeting with the Brazilian Society of Neurosurgery on the 20 September 2010

German Society of Neurosurgery (DGNC)

21 - 25 September 2010, Mannheim

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Deep brain stimulation for patients with self-injurious behavior

Meeting Abstract

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  • Maximilian I. Ruge - Department of Stereotactic and Functional Neurosurgery, University Clinics of Cologne, Germany
  • C. Hamisch - Department of Stereotactic and Functional Neurosurgery, University Clinics of Cologne, Germany
  • D. Lenartz - Department of Stereotactic and Functional Neurosurgery, University Clinics of Cologne, Germany
  • J. Kuhn - Department of Psychiatry and Psychotherapy, University Clinics of Cologne, Germany
  • J. K. Mai - Institute for Anatomy 1, University of Düsseldorf, Germany
  • Harald Treuer - Department of Stereotactic and Functional Neurosurgery, University Clinics of Cologne, Germany
  • Thomas Rommel - Clinic for Neurological and Neurosurgical Rehabilitation, RehaNova, Cologne, Germany
  • Volker Sturm - Department of Stereotactic and Functional Neurosurgery, University Clinics of Cologne, Germany

Deutsche Gesellschaft für Neurochirurgie. 61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010. Mannheim, 21.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocV1671

doi: 10.3205/10dgnc144, urn:nbn:de:0183-10dgnc1440

Published: September 16, 2010

© 2010 Ruge et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Self-injurious behavior (SIB) or self-mutilation is defined as self inflicting physical harm to the own body purposefully for unrecognized reasons. This rare, devastating and difficult to treat condition is in some cases associated with severe Gilles de la Tourette syndrome and autism but can also arise from traumatic or hypoxic brain injury of specific structures in the thalamus. This pilot study reports for the first time the rationale, the feasibility and outcome of these patients after Deep Brain Stimulation (DBS) of nucl. accumbens and thalamus/hypothalamus.

Methods: Patients suffering from SIB which was rated severe and irresponsive to medicamentous and behavioral treatment were selected as candidates for DBS. Target for DBS was nucl. accumbens in SBI associated with Tourette's Syndrome and thalamus/hypothalamus for the other indications. Early Rehabilitation Barthel Index (ERI), patient's fixation and observation time/day, need for closed psychiatric-/nursing home accommodation and changes in psychiatric medication were rated prior and 6 months after DBS. For statistical analysis the Wilcoxon test was used.

Results: Between 2003 and 2009 a total of 10 patients underwent DBS in bilateral nucl. accumbens in 5 cases (Tourette patients) and bilateral hypothalamic/thalamic structures in the other cases. The ERI, patients daily need for fixation and observation to prevent SIB improved highly significant (p<0.008; p<0.03; p<0.01) 6 month after DBS as compared to the initial status while psychiatric medication remained unchanged or reduced. Closed psychiatric-/nursing home accommodation was necessary for 8/10 patients before DBS and for 3/10 afterwards.

Conclusions: These pilot data demonstrate that bilateral DBS of nucl. accumbens or thalamus/hypothalamus might represent an effective and reversible tool for the treatment of severe SIB in select patients. However, further investigation of this rare and complex disorder and the effect of DBS for it's treatment have to be performed.