gms | German Medical Science

Objective: Self-injurious behavior (SIB) is associated with a number of psychiatric disorders like autism, Tourette syndrome or psychosis, especially in combination with cognitive impairment. It is a disorder with a high burden for patients and families. Conservative treatment consists of behavioral therapy and pharmacological treatment with neuroleptic medication. For SIB refractory to conservative treatment deep brain stimulation (DBS) can be considered. Many different stimulation targets are currently being used, depending on the primary disease of the patient. There is little data in scientific literature about the long-term outcome for these patients, mainly consisting of case reports.

In this retrospective study, we present the long-term follow-up outcome of patients with SIB treated with DBS at our clinic. Further, we investigate the connectivity patterns of the involved fibers in order to correlate the modulated cortical areas with the outcome of these patients.

Methods: We included 10 patients with SIB with diverse primary disorders (Tourette syndrome, autism and psychosis after brain injury) that received DBS for SIB at our clinic between 2005 and the present. Stimulation targets were chosen depending on their primary disorders. Clinical outcome was measured using the Barthel index and fixation time. The connectivity patterns of the stimulated areas in different patients were visualized using normative connectome (HCP).

Results: Our study showed a significant improvement in the Barthel index (p<0.005) and fixation time (p<0.01) after 6 months of DBS in patients with SIB. The analysis of the connectivity patterns showed a stimulation of the superior frontal lobe, the orbitofrontal lobe and the precentral area in all patients. Strong connectivity to the medial orbitofrontal cortex was associated with a better clinical outcome.

Conclusion: DBS is a promising treatment option for patients with intractable SIB, with varying targets depending on the primary disease. Furthermore, the results of our connectivity pattern analysis could be a useful tool for preoperative target planning.