Effectiveness of deep brain stimulation in refractory and drug-resistant aggressiveness in autism spectrum disorder

Benedetti-Isaac, Juan Carlos; Camargo, Loida; Cárdenas, Fernando P.; López, Norman

doi:10.1016/j.rasd.2023.102131

Cited by 8 publications

(16 citation statements)

References 67 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The most frequent comorbidities were medication-resistant abnormal movements (32), psychiatric disorders (28,30,(32)(33)(34), neurodevelopmental syndromes and diseases (6, 25-27, 31, 35) and drug abuse (34). Although in 4 registries, no comorbidities were reported (22)(23)(24)33). The main clinical reason for subjecting patients to DBS was to reduce uncontrolled aggression.…”

Section: Results Of the Bibliographic Searchmentioning

confidence: 99%

“…In contrast, a signi cant number of publications were identi ed in South America, with a concentration of interventions performed in Colombia. In this country, there are several experiences of DBS application in pHypN in intractable aggressiveness in children and adolescents with epilepsy (21,25,27), ASD and ID (22)(23)(24)26). Europe is the second continent where DBS has been used the most.…”

Section: Discussionmentioning

confidence: 99%

“…This is due to the severity of symptoms. Regarding aggressiveness, only 5 records used a specialized scale (OAS) (12,(21)(22)(23)(24), and 6 groups used a modi ed version (MOAS) (5, 25-27, 30, 34). One of these studies did not show test scores (27), and another record assessed the risk of aggression (BPAQ) (30).…”

Section: Neurosurgical Parametersmentioning

confidence: 99%

“…In this regard, it is necessary to highlight that 44/48 DBS implantations with optimal results have been performed in Colombia. 37/48 patients intervened in the same clinical center on the northern coast of Colombia (21)(22)(23)(24). This working group has been re ning the neurosurgical technique and perfecting the methodological aspects to reduce adverse effects and increase the evidence and safety of DBS in children and adolescents.…”

Section: Clinical Follow-up Effectiveness and Complicationsmentioning

confidence: 99%

See 3 more Smart Citations

Effectiveness of deep brain stimulation on refractory aggression in pediatric patients with autism and severe intellectual disability: meta-analytic review

Herrera-Pino,

Benedetti-Isaac,

Ripoll-Córdoba

et al. 2023

Preprint

Self Cite

View full text Add to dashboard Cite

Some patients with autism and severe intellectual disability may experience uncontrolled aggression, causing serious injury or harm to others, and the therapeutic ineffectiveness of traditional pharmacological and behavioral treatment may aggravate symptoms. Deep brain stimulation (DBS) has been tested in patients with little evidence in children and adolescents. Therefore, we analyzed the efficacy and safety of DBS in refractory aggression in pediatric subjects with autism (ASD) and severe intelligence deficit (ID). Methods: A meta-analytic review of Web of Science (WOS) and Scopus articles, following Prisma criteria. A total of 555 articles were identified, but after applying the inclusion criteria, only 18 were analyzed. The review of the registries and the extraction of information was performed by 2 independent groups, to reduce the evaluator's bias. For the description of the results, pediatric patients with ASD or ID present in each registry, with an application of specialized scales (Overt aggression scale, OAS, and THE modified version of the OAS, MOAS) pre and post-DBS, with a clinical follow-up of at least 12 months, were considered valid. Clinical improvement was calculated using tests of aggressiveness. In each registry with available data and then pooling the means of all patients in the OAS and MOAS, the effect size of DBS (overall and per study) was estimated. Finally, the adapted NOS scale was applied to rate the studies' quality and level of bias. Results: In the studies analyzed, 65/100 were pediatric patients, with a mean age of 16.8 years. Most of the studies were conducted in South America and Europe. In all teams, aggressive behavior was intractable, but only 9 groups (53/65) applied specialized scales to measure aggressiveness, and of these, only 51 subjects had a follow-up of at least 12 months. Thus, in 48/51 a clinical improvement of patients was estimated (94.2%), with a considerable overall effect size (OAS: d=4.32; MOAS: d=1.46). However, adverse effects and complications were found in 13/65 subjects undergoing DBS. The brain target with the most evidence and the fewest side effects was the posteromedial hypothalamic nuclei (pHypN). Finally, applying the adapted NOS scale, quality, and bias, only 9 studies show the best indicators. Conclusion: An optimal level of efficacy was found in only half of the publications. This is mainly due to design errors and irrelevant information in the reports. We believe that DBS in intractable aggressiveness in children and adolescents with ASD and severe ID can be safe and effective if working groups apply rigorous criteria for patient selection, interdisciplinary assessments, objective scales for aggressiveness, and known surgical targets.

show abstract

Section: Results Of the Bibliographic Searchmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Neurosurgical Parametersmentioning

confidence: 99%

Section: Clinical Follow-up Effectiveness and Complicationsmentioning

confidence: 99%

See 2 more Smart Citations

Effectiveness of deep brain stimulation on refractory aggression in pediatric patients with autism and severe intellectual disability: meta-analytic review

Herrera-Pino,

Benedetti-Isaac,

Ripoll-Córdoba

et al. 2023

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…As well, the role of motivation in memory of the children with ASD has been discussed in many studies (Dovis et al, 2012;Gabig, 2008;Hilton et al, 2014;Joseph et al, 2005;Stahmer et al, 2022). This is in the case that, resistant to pharmacological treatment, is observed in many cases of autism (Benedetti-Isaac et al, 2023). Since motivation has an underlying role in memory, determining the impact of any cognitive programs to increase performance in memory can also determine its impact on other behaviors and performance (Ozonoff & Strayer, 2001;Sigelman & Rider, 2014).…”

Section: Introductionmentioning

confidence: 99%

The Effect of Family-Oriented Organized Motivational Program on Working Memory in the Children with Autism Spectrum Disorder

Afshari,

Afshari

2023

Preprint

View full text Add to dashboard Cite

Working memory plays an important role in learning. In this study, we are looking for motivational ways to stimulate memory. The participants (8 girls and 10 boys) were divided into experimental and control groups. They are selected from among 28 subjects after primary tests to be matched. The design of the study is semi-experimental including an independent variable, a pretest and a posttest. After considering the research hypotheses, using descriptive statistics and one-way Analysis of Covariance (ANCOVA), the results suggested a significant difference in posttest scores of experimental and control groups after independent variable being applied. The results show that a motivational program including math assignments and naming shapes assignments that it has coincided with children's motivations can has a positive effect on working memory in children with autism spectrum disorders. Due to increase in brain cognitive functions which control motivation and memory, memory experienced a high level of performance which can lead to more learning.

show abstract

Estimulación cerebral profunda como tratamiento de la agresividad refractaria: una revisión bibliográfica

Bravo,

Cantos,

Campos

et al. 2023

Revista Médica Clínica Las Condes

View full text Add to dashboard Cite

Effectiveness of deep brain stimulation in refractory and drug-resistant aggressiveness in autism spectrum disorder

Cited by 8 publications

References 67 publications

Effectiveness of deep brain stimulation on refractory aggression in pediatric patients with autism and severe intellectual disability: meta-analytic review

Effectiveness of deep brain stimulation on refractory aggression in pediatric patients with autism and severe intellectual disability: meta-analytic review

The Effect of Family-Oriented Organized Motivational Program on Working Memory in the Children with Autism Spectrum Disorder

Estimulación cerebral profunda como tratamiento de la agresividad refractaria: una revisión bibliográfica

Contact Info

Product

Resources

About