Deep brain stimulation of the nucleus accumbens for severe self-injurious behaviour in children: long-term outcomes from a first-in-human pilot trial.
Karim Mithani, Sara Breitbart, Thiemo Dinger et al.
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In 30 seconds
This prospective, single-centre, first-in-human clinical trial assessed bilateral nucleus accumbens deep brain stimulation in six children and adolescents aged 7–14 years with profound autism and treatment-refractory self-injurious behaviour. Participants were followed for at least 24 months (mean 32.5 months; range 25.8–56.0). The study reports sustained reductions in the frequency and severity of self-injury, repetitive and obsessive-compulsive behaviours, alongside clinically meaningful quality-of-life improvements. One device-related infection required hardware removal; self-injury returned to baseline and improved rapidly after re-implantation in that participant.
Key findings
- All six participants had sustained reductions in self-injury frequency and severity during follow-up of at least 24 months.
- The cohort also showed reductions in repetitive and obsessive-compulsive behaviours and clinically meaningful quality-of-life improvements.
- One serious adverse event was a device-related infection requiring explantation; self-injury relapsed to baseline and improved rapidly after re-implantation.
Why it matters
Severe self-injury in children with profound autism can cause permanent injury, and the abstract describes limited effective treatment options. These long-term observations suggest that targeting reward and behavioural regulation circuitry may be associated with durable improvement in self-injury and related outcomes. The small, uncontrolled pilot provides an early signal rather than definitive evidence of efficacy or safety.
What to keep in mind
The trial was a single-centre pilot involving only six participants, with no comparator group described in the abstract.