Abstract
Introduction: A subgroup of patients with autism spectrum disorder (ASD) show self or heteroaggression, dyscontrol episodes, and others are of obsessive-compulsive disorder (OCD) profile; some of them are resistant to medical and behavioural treatment. We describe the long-term outcome in a group of these patients, treated with radiofrequency brain lesions or combined stereotactic surgery and Gamma Knife (GK) radiosurgery. Methods: We reviewed the medical records of 10 ASD patients with pathological aggressiveness and OCD, who had undergone radiofrequency lesions and/or radiosurgery with GK in our institution. Results: The 10 patients had a significant reduction of their symptoms (PCQ 39.9 and 33, OAS 11.8 and 5, CYBOCS-ASD 30.4 and 20), preoperatively and in the last follow-up, respectively; p < 0.005 (in all cases), although all but 2 needed more than 1 treatment to maintain this improvement. Conclusions: We observed a marked improvement in behaviour, quality of life, and relationship with the environment in all our 10 patients after the lesioning treatments, without long-lasting side effects.
Journal Section:
Clinical Study
References
1.
Christensen
DL
, Baio
J
, Braun
KVN
, Bilder
D
, Charles
J
, Constantino
JN
, . Prevalence and characteristics of autism spectrum disorder among children aged 8 years: autism and developmental disabilities monitoring network, 11 sites, United States, 2012
. MMWR Surveill Summ
. 2016 Apr 1
;65
(3
):1
–23
. Available from: http://www.cdc.gov/mmwr/volumes/65/ss/ss6503a1.htm.2.
Baio
J
, Wiggins
L
, Christensen
DL
, Maenner
MJ
, Daniels
J
, Warren
Z
, . Prevalence of autism spectrum disorder among children aged 8 years – autism and developmental disabilities monitoring network, 11 sites, United States, 2014
. MMWR Surveill Summ
. 2018 Apr 27
;67
(6
):1
–23
. Available from: http://www.cdc.gov/mmwr/volumes/67/ss/ss6706a1.htm?s_cid=ss6706a1_w.3.
Stevens
T
, Peng
L
, Barnard-Brak
L
. The comorbidity of ADHD in children diagnosed with autism spectrum disorder
. Res Autism Spectr Disord
. 2016 Nov
;31
:11
–8
. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1750946716300769.4.
Volkmar
FR
, Lord
C
, Bailey
A
, Schultz
RT
, Klin
A
. Autism and pervasive developmental disorders
. J Child Psychol Psychiatry
. 2004 Jan
;45
(1
):135
–70
.5.
Menon
K
, Baburaj
R
, Bernard
S
. Use of restraint for the management of challenging behaviour in children with intellectual disabilities
. Adv Mental Hlth Intell Disabil
. 2012 Mar 2
;6
(2
):62
–75
.6.
Bhat
S
, Acharya
UR
, Adeli
H
, Bairy
GM
, Adeli
A
. Autism: cause factors, early diagnosis and therapies
. Rev Neurosci
. 2014 Jan 1
;25
(6
):841
.7.
Baio
J
; (DHHS/PHS) C for DC and P
, Prevalence of autism spectrum disorders: autism and developmental disabilities monitoring network, 14 sites, United States, 2008
. MMWR Surveill Summ
. 2012
;61
(3
):1
–9
.8.
Sinha
S
, McGovern
RA
, Sheth
SA
. Deep brain stimulation for severe autism: from pathophysiology to procedure
. Neurosurg Focus
. 2015 Jun
;38
(6
):E3
.9.
Courchesne
E
, Campbell
K
, Solso
S
. Brain growth across the life span in autism: age-specific changes in anatomical pathology
. Brain Res
. 2011 Mar
;1380
:138
–45
.10.
Keown
CL
, Shih
P
, Nair
A
, Peterson
N
, Mulvey
ME
, Müller
RA
. Local functional overconnectivity in posterior brain regions is associated with symptom severity in autism spectrum disorders
. Cell Rep
. 2013 Nov
;5
(3
):567
–72
.11.
Supekar
K
, Uddin
LQ
, Khouzam
A
, Phillips
J
, Gaillard
WD
, Kenworthy
LE
, . Brain hyperconnectivity in children with autism and its links to social deficits
. Cell Rep
. 2013 Nov
;5
(3
):738
–47
.12.
Torres
CV
, Sola
RG
, Pastor
J
, Pedrosa
M
, Navas
M
, García-Navarrete
E
, . Long-term results of posteromedial hypothalamic deep brain stimulation for patients with resistant aggressiveness
. J Neurosurg
. 2013 Aug
;119
(2
):277
–87
.13.
Li
Y
, Zhu
Y
, Nguchu
BA
, Wang
Y
, Wang
H
, Qiu
B
, . Dynamic functional connectivity reveals abnormal variability and hyper-connected pattern in autism spectrum disorder
. Autism Res
. 2019 Oct 15
. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1002/aur.2212.14.
Robertson
CE
, Ratai
EM
, Kanwisher
N
. Reduced GABAergic action in the autistic brain
. Curr Biol
. 2016 Jan
;26
(1
):80
–5
.15.
Gaetz
W
, Bloy
L
, Wang
DJ
, Port
RG
, Blaskey
L
, Levy
SE
, . GABA estimation in the brains of children on the autism spectrum: measurement precision and regional cortical variation
. Neuroimage
. 2014 Feb
;86
:1
–9
.16.
Peterson
BS
, Zargarian
A
, Peterson
JB
, Goh
S
, Sawardekar
S
, Williams
SCR
, . Hyperperfusion of frontal white and subcortical gray matter in autism spectrum disorder
. Biol Psychiatry
. 2019 Apr
;85
(7
):584
–95
.17.
Sano
K
, Mayanagi
Y
. Posteromedial hypothalamotomy in the treatment of violent, aggressive behaviour
. Personality and neurosurgery
. Vienna
: Springer Vienna
; 1988
. p. 145
–51
.18.
Sano
K
, Yoshioka
M
, Ogashiwa
M
, Ishijima
B
, Ohye
C
. Postero-medial hypothalamotomy in the treatment of aggressive behaviors
. Stereotact Funct Neurosurg
. 1966
;27
(1–3
):164
–7
. Available from: https://www.karger.com/Article/FullText/103949.19.
Balasubramaniam
V
, Kanaka
TS
, Ramanujam
PB
, Ramamurthi
B
. Stereotaxic Hypothalamotomy
. Stereotact Funct Neurosurg
. 1973
;35
(3
):138
–43
.20.
Arjona
VE
. Stereotactic hypothalamotomy in erethic children
. Advances in stereotactic and functional neurosurgery
. Vienna
: Springer Vienna
; 1974
. p. 185
–91
.21.
Spatola
G
, Martinez-Alvarez
R
, Martínez-Moreno
N
, Rey
G
, Linera
J
, Rios-Lago
M
, . Results of gamma knife anterior capsulotomy for refractory obsessive-compulsive disorder: results in a series of 10 consecutive patients
. J Neurosurg
. 2018 Aug
;131
(2
):376
–83
.22.
García-Muñoz
L
, Carrillo-Ruiz
JD
, Favila-Bojórquez
J
, López-Valdés
JC
, Jiménez-Ponce
F
. Treatment of refractory aggressiveness by amygdalotomy and posteromedial hypothalamotomy by radiofrequency
. Rev Neurol
. 2019
.23.
Ramamurthi
B
. Stereotactic operation in behaviour disorders. amygdalotomy and hypothalamotomy
. Personality and neurosurgery
. Vienna
: Springer Vienna
; 1988
. p. 152
–7
.24.
Torres
CV
, Sola
RG
, Pastor
J
, Pedrosa
M
, Navas
M
, García-Navarrete
E
, . Long-term results of posteromedial hypothalamic deep brain stimulation for patients with resistant aggressiveness
. JNS
. 2013 Aug
;119
(2
):277
–87
.25.
Howland
RH
. Editorial: deep brain stimulation and aggression
. J Neurosurg
. 2013 Aug
;119
(2
):273
–6
. Available from: https://thejns.org/view/journals/j-neurosurg/119/2/article-p273.xml.26.
Hall
RC
. Global assessment of functioning. A modified scale
. Psychosomatics
. 1995 May
;36
(3
):267
–75
.27.
McGrew
S
, Malow
BA
, Henderson
L
, Wang
L
, Song
Y
, Stone
WL
. Developmental and behavioral questionnaire for autism spectrum disorders
. Pediatr Neurol
. 2007 Aug
;37
(2
):108
–16
.28.
Scahill
L
, Mcdougle
CJ
, Williams
SK
, Dimitropoulos
A
, Aman
MG
, Mccracken
JT
, . Children’s yale-brown obsessive compulsive scale modified for pervasive developmental disorders
. J Am Acad Child Adolesc Psychiatry
. 2006 Sep
;45
(9
):1114
–23
.29.
Jiménez
F
, Soto
JE
, Velasco
F
, Andrade
P
, Bustamante
JJ
, Gómez
P
, . Bilateral cingulotomy and anterior capsulotomy applied to patients with aggressiveness
. Stereotact Funct Neurosurg
. 2012
;90
(3
):151
–60
.30.
Rasmussen
SA
, Noren
G
, Greenberg
BD
, Marsland
R
, McLaughlin
NC
, Malloy
PJ
, . Gamma ventral capsulotomy in intractable obsessive-compulsive disorder
. Biol Psychiatry
. 2018 Sep
;84
(5
):355
–64
.31.
Miguel
EC
, Lopes
AC
, McLaughlin
NCR
, Norén
G
, Gentil
AF
, Hamani
C
, . Evolution of gamma knife capsulotomy for intractable obsessive-compulsive disorder
. Mol Psychiatry
. 2019 Feb 9
;24
(2
):218
–40
.32.
Lopes
AC
, Greenberg
BD
, Canteras
MM
, Batistuzzo
MC
, Hoexter
MQ
, Gentil
AF
, . Gamma ventral capsulotomy for obsessive-compulsive disorder
. JAMA Psychiatry
. 2014 Sep 1
;71
(9
):1066
.33.
Santos
BFO
, Gorgulho
A
, Saraiva
CWC
, Lopes
AC
, Gomes
JGR
, Pássaro
AM
, . Understanding gamma ventral capsulotomy: Potential implications of diffusion tensor image tractography on target selectivity
. Surg Neurol Int
. 2019 Jul 5
;10
:136
.34.
Régis
J
, Carron
R
, Park
M
. Is radiosurgery a neuromodulation therapy
. J Neurooncol
. 2010 Jun 29
;98
(2
):155
–62
.35.
Altschuler
E
, Lunsford
LD
, Kondziolka
D
, Wu
A
, Maitz
AH
, Sclabassi
R
, . Radiobiologic Models for Radiosurgery
. Neurosurg Clin N Am
. 1992 Jan
;3
(1
):61
–77
.36.
Franzini
A
, Marras
C
, Ferroli
P
, Bugiani
O
, Broggi
G
. Stimulation of the posterior hypothalamus for medically intractable impulsive and violent behavior
. Stereotact Funct Neurosurg
. 2005
;83
(2–3
):63
–6
.37.
Stocco
A
, Baizabal-Carvallo
JF
. Deep brain stimulation for severe secondary stereotypies
. Parkinsonism Relat Disord
. 2014 Sep
;20
(9
):1035
–6
.38.
Segar
DJ
, Chodakiewitz
YG
, Torabi
R
, Cosgrove
GR
. Deep brain stimulation for the obsessive-compulsive and Tourette-like symptoms of Kleefstra syndrome
. Neurosurg Focus
. 2015 Jun
;38
(6
):E12
.39.
Graat
I
, Figee
M
, Denys
D
. The application of deep brain stimulation in the treatment of psychiatric disorders
. Int Rev Psychiatry
. 2017 Mar 4
;29
(2
):178
–90
.40.
Jakobs
M
, Fomenko
A
, Lozano
AM
, Kiening
KL
. Cellular, molecular, and clinical mechanisms of action of deep brain stimulation-a systematic review on established indications and outlook on future developments
. EMBO Mol Med
. 2019 Apr 12
;11
(4
):e9575
.41.
Yin
D
, Zhang
C
, Lv
Q
, Chen
X
, Zeljic
K
, Gong
H
, . Dissociable frontostriatal connectivity: mechanism and predictor of the clinical efficacy of capsulotomy in obsessive-compulsive disorder
. Biol Psychiatry
. 2018 Dec
;84
(12
):926
–36
.42.
Stoner
R
, Chow
ML
, Boyle
MP
, Sunkin
SM
, Mouton
PR
, Roy
S
, . Patches of disorganization in the neocortex of children with autism
. N Engl J Med
. 2014 Mar 27
;370
(13
):1209
–19
.43.
Lozano
AJ
. A historical perspective of casuistry and its application to contemporary biomedical ethics
. Linacre Q
. 2003 Feb 1
;70
(1
):37
–45
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