Epilepsia · 2026
Self- and other-directed harmful behavior following deep brain stimulation of the anterior nucleus of the thalamus for drug-resistant epilepsy.
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Roth Rebecca W, Sloan Jacob, Yun William, Karpychev Victor, Villarreal Hannah, Teagarden Diane, Carns Danielle, Hacker Carl, Laxpati Nealen, Gleichgerrcht Ezequiel
Аннотация
OBJECTIVE: The current study examined the occurrence, clinical predictors, and neuroanatomical correlates of self- or other-directed harmful ideation or behavior (HIB) following deep brain stimulation of the anterior nucleus of the thalamus (ANT-DBS) for drug-resistant epilepsy.
METHODS: We retrospectively analyzed 90 ANT-DBS patients followed longitudinally, tracking stimulation parameters, seizure outcomes, and psychiatric status. HIB was defined as documented suicidal ideation, suicide attempt, homicidal ideation, threats, or physical aggression requiring clinical intervention. Preoperative predictors were identified using Firth penalized logistic regression. Lead reconstructions, volumes of tissue activated, sweet spot analysis, and normative structural and functional connectivity mapping were performed in Lead-DBS to compare patients with and without HIB. Stimulation parameters associated with symptom emergence and resolution were examined within patients longitudinally.
RESULTS: Eleven of the 90 patients (12.2%) developed new or worsening HIB following ANT-DBS. Preoperative HIB predicted postoperative HIB (odds ratio = 8.07, p = .003). Neither the volume of tissue activated by stimulation nor the structural or functional connectivity of the stimulated tissue differed between patients who developed HIB and those who did not. Within patient analyses (n = 11), eight patients' symptoms were resolved by changing from high- to low-frequency stimulation, and three were resolved via contact and amplitude changes.
SIGNIFICANCE: HIB following ANT-DBS occurs in a clinically meaningful minority of patients and is strongly associated with preoperative psychiatric vulnerability rather than differences in lead location or network engagement. Most cases were resolved through stimulation parameter adjustments, particularly frequency reduction, suggesting these complications are often reversible through routine DBS reprogramming. Careful preoperative psychiatric evaluation and close postoperative monitoring are recommended for patients undergoing ANT-DBS.
METHODS: We retrospectively analyzed 90 ANT-DBS patients followed longitudinally, tracking stimulation parameters, seizure outcomes, and psychiatric status. HIB was defined as documented suicidal ideation, suicide attempt, homicidal ideation, threats, or physical aggression requiring clinical intervention. Preoperative predictors were identified using Firth penalized logistic regression. Lead reconstructions, volumes of tissue activated, sweet spot analysis, and normative structural and functional connectivity mapping were performed in Lead-DBS to compare patients with and without HIB. Stimulation parameters associated with symptom emergence and resolution were examined within patients longitudinally.
RESULTS: Eleven of the 90 patients (12.2%) developed new or worsening HIB following ANT-DBS. Preoperative HIB predicted postoperative HIB (odds ratio = 8.07, p = .003). Neither the volume of tissue activated by stimulation nor the structural or functional connectivity of the stimulated tissue differed between patients who developed HIB and those who did not. Within patient analyses (n = 11), eight patients' symptoms were resolved by changing from high- to low-frequency stimulation, and three were resolved via contact and amplitude changes.
SIGNIFICANCE: HIB following ANT-DBS occurs in a clinically meaningful minority of patients and is strongly associated with preoperative psychiatric vulnerability rather than differences in lead location or network engagement. Most cases were resolved through stimulation parameter adjustments, particularly frequency reduction, suggesting these complications are often reversible through routine DBS reprogramming. Careful preoperative psychiatric evaluation and close postoperative monitoring are recommended for patients undergoing ANT-DBS.