Evidence map›Paper›PMID 42332026›Full record

ArticleMolecular psychiatry2026

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, Hrishikesh Suresh, Andrea LeBlanc-Millar, Joelene Huber, Elizabeth N Kerr, Margot J Taylor, Alfonso Fasano, Savannah Sauter and 3 more

Registry-linked trialAbstract read
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In one paragraph

Article in Molecular psychiatry, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03982888 (Deep Brain Stimulation for the Treatment of Refractory Repetitive Self-Injurious Behaviour in Children With Autism Spectrum Disorder), which is not on this map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03982888 nacompletednot on this map

Deep Brain Stimulation for the Treatment of Refractory Repetitive Self-Injurious Behaviour in Children With Autism Spectrum Disorder: A Pilot Project

TypeinterventionalSponsorThe Hospital for Sick ChildrenRan2019 to 2024Enrolled6ConditionsAutism Spectrum Disorder, Self-Injurious BehaviorArmsDeep Brain Stimulation, DBS
3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Karim MithaniDivision of Neurosurgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, ON, Toronto, Canada.ORCID http://orcid.org/0000-0002-8094-3070
Sara BreitbartDivision of Neurosurgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, ON, Toronto, Canada.
Thiemo DingerDivision of Neurosurgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, ON, Toronto, Canada.ORCID http://orcid.org/0000-0002-7009-9099
Hrishikesh SureshDivision of Neurosurgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, ON, Toronto, Canada.
Andrea LeBlanc-MillarDivision of Neurosurgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, ON, Toronto, Canada.
Joelene HuberDivision of Pediatric Medicine and Developmental Pediatrics, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
Elizabeth N KerrDepartment of Psychology, The Hospital for Sick Children, Toronto, ON, Canada.
Margot J TaylorDepartment of Psychology, The Hospital for Sick Children, Toronto, ON, Canada.
Alfonso FasanoDivision of Neurology, The Hospital for Sick Children, Toronto, ON, Canada.
Savannah SauterNeurobehavioural Unit, Department of Behavioural Psychology, Kennedy Krieger Institute, Baltimore, MD, USA.
Louis HagopianNeurobehavioural Unit, Department of Behavioural Psychology, Kennedy Krieger Institute, Baltimore, MD, USA.
Carolina GorodetskyDivision of Neurology, The Hospital for Sick Children, Toronto, ON, Canada.ORCID http://orcid.org/0000-0003-0007-9591
George M IbrahimDivision of Neurosurgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, ON, Toronto, Canada. george.ibrahim@sickkids.ca.ORCID http://orcid.org/0000-0001-9068-8184

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Children with severe self-injurious behaviour (SIB) are at risk of permanent injury and lack effective treatment options. Neuromodulation of the nucleus accumbens (NAc), a key node in reward and behavioural regulation circuits, may directly modulate the drivers of SIB. We report long-term outcomes from a first-in-human, single-centre trial of deep brain stimulation (DBS) targeting the NAc in children and adolescents with profound autism and treatment-refractory SIB (NCT03982888). Six participants (ages 7-14 years; mean 11.7) underwent bilateral implantation and were followed prospectively for at least 24 months (mean 32.5 months, range 25.8-56.0). One serious adverse event occurred: a device-related infection requiring hardware explantation, followed by relapse to baseline levels of self-injury. Subsequent re-implantation in this participant yielded rapid improvement in SIB, providing single-subject, causal withdrawal-rechallenge evidence of treatment-specific benefit. Across the cohort, NAc-DBS produced sustained reductions in SIB frequency and severity, repetitive and obsessive-compulsive behaviours, and clinically meaningful improvements in quality of life. The durability of these effects over multi-year follow-up suggests that circuit-targeted neuromodulation may modify the developmental course of severe behavioural pathology. These findings provide the first long-term evidence that modulation of reward circuitry can durably alter maladaptive behaviour in childhood neurodevelopmental disorders.

Identifiers

PMID42332026

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