{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T16:49:42Z","timestamp":1791823782537,"version":"4.3.4"},"reference-count":41,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T00:00:00Z","timestamp":1791763200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T00:00:00Z","timestamp":1791763200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100001454","name":"American Epilepsy Society","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100001454","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"publisher","award":["T32NS096050"],"award-info":[{"award-number":["T32NS096050"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The current study examined the occurrence, clinical predictors, and neuroanatomical correlates of self\u2010 or other\u2010directed harmful ideation or behavior (HIB) following deep brain stimulation of the anterior nucleus of the thalamus (ANT\u2010DBS) for drug\u2010resistant epilepsy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed 90 ANT\u2010DBS 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\u2010DBS to compare patients with and without HIB. Stimulation parameters associated with symptom emergence and resolution were examined within patients longitudinally.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Eleven of the 90 patients (12.2%) developed new or worsening HIB following ANT\u2010DBS. Preoperative HIB predicted postoperative HIB (odds ratio\u2009=\u20098.07,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.003). 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                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200911), eight patients' symptoms were resolved by changing from high\u2010 to low\u2010frequency stimulation, and three were resolved via contact and amplitude changes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance<\/jats:title>\n                    <jats:p>HIB following ANT\u2010DBS 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\u2010DBS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/epi.70540","type":"journal-article","created":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T16:06:08Z","timestamp":1791821168000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Self\u2010 and other\u2010directed harmful behavior following deep brain stimulation of the anterior nucleus of the thalamus for drug\u2010resistant epilepsy"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8620-3946","authenticated-orcid":false,"given":"Rebecca W.","family":"Roth","sequence":"first","affiliation":[{"name":"Department of Neurology Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob","family":"Sloan","sequence":"additional","affiliation":[{"name":"Department of Neurology Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Yun","sequence":"additional","affiliation":[{"name":"Department of Neurology Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor","family":"Karpychev","sequence":"additional","affiliation":[{"name":"Department of Neurology Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Villarreal","sequence":"additional","affiliation":[{"name":"Department of Neurology Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diane","family":"Teagarden","sequence":"additional","affiliation":[{"name":"Department of Neurology Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle","family":"Carns","sequence":"additional","affiliation":[{"name":"Department of Neurology Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carl","family":"Hacker","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9603-9169","authenticated-orcid":false,"given":"Nealen","family":"Laxpati","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Emory University  Atlanta Georgia USA"},{"name":"Department of Pediatric Neurosurgery Children's Healthcare of Atlanta  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4212-4146","authenticated-orcid":false,"given":"Ezequiel","family":"Gleichgerrcht","sequence":"additional","affiliation":[{"name":"Department of Neurology Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,12]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"crossref","first-page":"2179","DOI":"10.1111\/epi.14596","article-title":"The epidemiology of drug\u2010resistant epilepsy: a systematic review and meta\u2010analysis","volume":"59","author":"Kalilani L","year":"2018","journal-title":"Epilepsia"},{"key":"e_1_2_13_3_1","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1016\/S1474-4422(23)00151-5","article-title":"Drug resistance in epilepsy","volume":"22","author":"Perucca E","year":"2023","journal-title":"The Lancet 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