From Confinement to Autonomy: Improvement of Extreme Aggressiveness in ASD After Deep Brain Stimulation
P. Barcelo, C. Hernandez, C. Velasquez, K. Oyola, M. Pinedo, L. Gutierrez, S. PernethIntroduction
Severe aggressiveness in autism spectrum disorder (ASD) with intellectual disability represents a complex therapeutic challenge. In refractory cases, deep brain stimulation (DBS) emerges as a functional psychosurgical alternative capable of modulating circuits involved in impulsivity and aggressive behavior, offering an opportunity to improve quality of life.
Objectives
To describe the clinical evolution, impact on quality of life, and recovery of dignity in a patient with ASD and extreme aggressiveness, before and after the implementation of deep brain stimulation (DBS).
Methods
A 17-year-old male with ASD level 3, intellectual disability, and severe behavioral disorder characterized by auto- and hetero-aggressiveness, and global insomnia. Since the age of 4, he had received multiple psychopharmacological treatments without sustained response, remaining under preventive restraint due to the risk of aggression toward caregivers. He experienced multiple psychiatric hospitalizations; during his prolonged stay, violent and agitated episodes persisted despite pharmacological adjustments. DBS was performed using a stereotactic system with quadripolar electrodes and an implantable pulse generator targeting the posteromedial hypothalamic region. The KidsLife Scale was applied before and one year after the intervention to assess changes in functionality and quality of life.
Results
As shown in Figure 1, KidsLife results demonstrated domain-specific variations. The patient exhibited a significant reduction in aggressive crises, greater emotional stability, and a marked decrease in the need for physical restraint, achieving participation in supervised activities and showing enhanced affective interaction with his environment.
Image 1: Long description.