Nucleus Accumbens (NAc) DBS for obsessive compulsive disorder and aggression in an autistic patient: a case report and hypothesis of the role of NAc in autism and co-morbid symptoms.

Nucleus Accumbens (NAc) DBS for obsessive compulsive disorder and aggression in an autistic patient: a case report and hypothesis of the role of NAc in autism and co-morbid symptoms.

World Neurosurg. 2019 Feb 21;:

Authors: Doshi PK, Hegde A, Desai A

Abstract
BACKGROUND: Autism spectrum disorder (ASD) is a set of developmental disorders characterized by lack of social interaction, verbal and non-verbal communication in the first 3 years of life. It is also associated with several co-morbidities, including epilepsy, aggression, self-mutilating behaviour and obsessive-compulsive behaviour. In some cases this can turn in to obsessive compulsive disorder (OCD). Nucleus accumbens (NAc) plays a key role in reward circuitry and is also involved in the control of OCD and aggression.
CASE DESCRIPTION: A 42 years old Autistic lady suffering from OCD and aggression was offered NAc DBS for her comorbidities of OCD and aggression. NAc was targeted using standard stereotactic methods and the postoperative scans confirmed the position of the active electrode to be within the NAc. The patient had a significant relief of her symptoms. At one-year follow-up the Yale-Brown obsessive-compulsive scale (YBOCS) score for OCD, excluding the item 1-5 of YBOCS, improved from 19 to 5. Her Hamilton depression and anxiety scores similarly improved from 20 to 15 and from 30 to 18. Social communication questionnaire - current for autism score improved from 26 to16, the subscores for reciprocal social interaction improved from 13 to 8, for the communication from 5 to 4 and for the restricted, repetitive and stereotyped patterns of behaviour 6 to 3.
CONCLUSION: This case reports illustrates the role of NAc in OCD and aggression in an autistic patient. We have discussed the role of NAc as a target to explain the above outcome in this paper.

PMID: 30797934 [PubMed - as supplied by publisher]

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