Dual-target deep brain stimulation for severe pediatric autism: Sustained core symptom reduction in a 12-month case study.

OBJECTIVE: Core autism spectrum disorder (ASD) symptoms lack effective interventions. While single-target DBS helps comorbid conditions, it fails to improve social deficits. Here we aimed to explore the efficacy of bilateral dual-target DBS targeting the anterior limb of the internal capsule (ALIC) and nucleus accumbens (NAcc) in a pediatric severe ASD patient. METHODS: A 9-year-old girl diagnosed with ASD, presenting with severe symptoms and intellectual disability, underwent bilateral NAcc/ALIC DBS implantation. Standardized assessments, including Autism Treatment Evaluation Checklist (ATEC), Repetitive Behavior Scale-Revised (RBS-R), Autism Behavior Checklist (AuBC), and Childhood Autism Rating Scale-2 (CARS-2), were performed pre-operatively and at 3, 6, 9 and 12 months postoperatively. RESULTS: Clinical assessments revealed significant improvement in core ASD symptoms by the 3-month postoperative evaluation. Specifically, ATEC scores decreased by 65.9%, RBS-R by 85.7%, AuBC by 69.4% and CARS-2 by 17.5%. These benefits persisted for the 12 months follow-up period with the last assessment showing ATEC reduced by 81.3%, RBS-R by 96.4%, AuBC by 86.5%, and CARS-2 by 21.3%. No adverse events occurred. CONCLUSIONS: Bilateral dual-target ALIC-NAcc DBS was feasibility and safety, and resulted in sustained improvement in the core features of severe ASD. SIGNIFICANCE: The present results suggest DBS targeting ALIC and NAcc is a promising neurotherapeutic strategy for ASD.