{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T21:46:38Z","timestamp":1792014398191,"version":"4.4.0"},"reference-count":87,"publisher":"Springer Science and Business Media LLC","issue":"11","license":[{"start":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T00:00:00Z","timestamp":1782086400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"},{"start":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T00:00:00Z","timestamp":1782086400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Mol Psychiatry"],"published-print":{"date-parts":[[2026,11]]},"DOI":"10.1038\/s41380-026-03710-4","type":"journal-article","created":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T13:20:18Z","timestamp":1782134418000},"page":"6413-6421","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Deep brain stimulation of the nucleus accumbens for severe self-injurious behaviour in children: long-term outcomes from a first-in-human pilot trial"],"prefix":"10.1038","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8094-3070","authenticated-orcid":false,"given":"Karim","family":"Mithani","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Breitbart","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7009-9099","authenticated-orcid":false,"given":"Thiemo","family":"Dinger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hrishikesh","family":"Suresh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"LeBlanc-Millar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joelene","family":"Huber","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth N.","family":"Kerr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margot J.","family":"Taylor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfonso","family":"Fasano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Savannah","family":"Sauter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louis","family":"Hagopian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0007-9591","authenticated-orcid":false,"given":"Carolina","family":"Gorodetsky","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9068-8184","authenticated-orcid":false,"given":"George M.","family":"Ibrahim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,22]]},"reference":[{"key":"3710_CR1","doi-asserted-by":"crossref","unstructured":"Shawler LA, Becraft JL, Hagopian LP. Self-injurious behavior. In: Matson JL, editor. Handbook of clinical child psychology: integrating theory and research into practice, Cham: Springer International Publishing; 2023. p. 811-28.","DOI":"10.1007\/978-3-031-24926-6_37"},{"key":"3710_CR2","doi-asserted-by":"crossref","first-page":"1266","DOI":"10.1016\/j.neubiorev.2011.01.002","volume":"35","author":"FJ Symons","year":"2011","unstructured":"Symons FJ. Self-injurious behavior in neurodevelopmental disorders: relevance of nociceptive and immune mechanisms. Neurosci Biobehav Rev. 2011;35:1266\u201374.","journal-title":"Neurosci Biobehav Rev"},{"key":"3710_CR3","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1002\/jaba.664","volume":"53","author":"GW Rooker","year":"2020","unstructured":"Rooker GW, Hagopian LP, Becraft JL, Javed N, Fisher AB, Finney KS. Injury characteristics across functional classes of self-injurious behavior. J Appl Behav Anal. 2020;53:1042\u201357.","journal-title":"J Appl Behav Anal"},{"key":"3710_CR4","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/S0140-6736(21)01541-5","volume":"399","author":"C Lord","year":"2022","unstructured":"Lord C, Charman T, Havdahl A, Carbone P, Anagnostou E, Boyd B, et al. The lancet commission on the future of care and clinical research in autism. Lancet. 2022;399:271\u2013334.","journal-title":"Lancet"},{"key":"3710_CR5","doi-asserted-by":"crossref","first-page":"125","DOI":"10.2147\/PRBM.S44635","volume":"7","author":"NF Minshawi","year":"2014","unstructured":"Minshawi NF, Hurwitz S, Fodstad JC, Biebl S, Morriss DH, McDougle CJ. The association between self-injurious behaviors and autism spectrum disorders. Psychol Res Behav Manag. 2014;7:125\u201336.","journal-title":"Psychol Res Behav Manag"},{"key":"3710_CR6","doi-asserted-by":"crossref","first-page":"3857","DOI":"10.1007\/s10803-020-04443-1","volume":"50","author":"C Steenfeldt-Kristensen","year":"2020","unstructured":"Steenfeldt-Kristensen C, Jones CA, Richards C. The prevalence of self-injurious behaviour in autism: a meta-analytic study. J Autism Developmental Disord. 2020;50:3857.","journal-title":"J Autism Developmental Disord"},{"key":"3710_CR7","first-page":"6278501","volume":"2018","author":"JP Lucchelli","year":"2018","unstructured":"Lucchelli JP, Bertschy G. Low-dose fluoxetine in four children with autistic spectrum disorder improves self-injurious behavior, ADHD-like symptoms, and irritability. Case Rep Psychiatry. 2018;2018:6278501.","journal-title":"Case Rep Psychiatry"},{"key":"3710_CR8","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1002\/phar.2238","volume":"39","author":"A Sabus","year":"2019","unstructured":"Sabus A, Feinstein J, Romani P, Goldson E, Blackmer A. Management of self-injurious behaviors in children with neurodevelopmental disorders\u2014a pharmacotherapy overview. Pharmacotherapy. 2019;39:645.","journal-title":"Pharmacotherapy"},{"key":"3710_CR9","doi-asserted-by":"publisher","first-page":"535","DOI":"10.2165\/00003495-200969050-00003","volume":"69","author":"RP Malone","year":"2009","unstructured":"Malone RP, Waheed A. The role of antipsychotics in the management of behavioural symptoms in children and adolescents with autism. Drugs. 2009;69:535\u201348.","journal-title":"Drugs"},{"key":"3710_CR10","doi-asserted-by":"publisher","unstructured":"Gorodetsky C, Mithani K, Breitbart S, Yan H, Zhang K, Gouveia FV, et al. Deep brain stimulation of the nucleus accumbens for severe self-injurious behaviour in children: a phase I pilot trial. Biological Psychiatry. 2024. https:\/\/doi.org\/10.1016\/j.biopsych.2024.12.001.","DOI":"10.1016\/j.biopsych.2024.12.001"},{"key":"3710_CR11","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1002\/jaba.236","volume":"48","author":"LP Hagopian","year":"2015","unstructured":"Hagopian LP, Rooker GW, Zarcone JR. Delineating subtypes of self-injurious behavior maintained by automatic reinforcement. J Appl Behav Anal. 2015;48:523\u201343.","journal-title":"J Appl Behav Anal"},{"key":"3710_CR12","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1901\/jaba.1994.27-197","volume":"27","author":"BA Iwata","year":"1994","unstructured":"Iwata BA, Dorsey MF, Slifer KJ, Bauman KE, Richman GS. Toward a functional analysis of self-injury. J Appl Behav Anal. 1994;27:197\u2013209.","journal-title":"J Appl Behav Anal"},{"key":"3710_CR13","doi-asserted-by":"crossref","first-page":"1108","DOI":"10.1111\/jir.12430","volume":"62","author":"LP Hagopian","year":"2018","unstructured":"Hagopian LP, Frank-Crawford MA. Classification of self-injurious behaviour across the continuum of relative environmental\u2013biological influence. J Intellect Disability Res. 2018;62:1108\u201313.","journal-title":"J Intellect Disability Res"},{"key":"3710_CR14","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1111\/j.1468-3156.2009.00598.x","volume":"38","author":"SJ Prangnell","year":"2010","unstructured":"Prangnell SJ. Behavioural interventions for self injurious behaviour: a review of recent evidence (1998\u20132008). Br J Learn Disabilities. 2010;38:259\u201370.","journal-title":"Br J Learn Disabilities"},{"key":"3710_CR15","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1016\/j.neubiorev.2017.02.027","volume":"84","author":"S Huisman","year":"2018","unstructured":"Huisman S, Mulder P, Kuijk J, Kerstholt M, van Eeghen A, Leenders A, et al. Self-injurious behavior. Neurosci Biobehav Rev. 2018;84:483\u201391.","journal-title":"Neurosci Biobehav Rev"},{"key":"3710_CR16","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1097\/YCO.0b013e32833cfb80","volume":"23","author":"C Oliver","year":"2010","unstructured":"Oliver C, Richards C. Self-injurious behaviour in people with intellectual disability. Curr Opin Psychiatry. 2010;23:412.","journal-title":"Curr Opin Psychiatry"},{"key":"3710_CR17","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1002\/jaba.477","volume":"51","author":"LP Hagopian","year":"2018","unstructured":"Hagopian LP, Rooker GW, Yenokyan G. Identifying predictive behavioral markers: a demonstration using automatically reinforced self-injurious behavior. J Appl Behav Anal. 2018;51:443\u201365.","journal-title":"J Appl Behav Anal"},{"key":"3710_CR18","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1177\/01454455231218742","volume":"48","author":"TR Moore","year":"2024","unstructured":"Moore TR, Lee S, Freeman R, Mahmoundi M, Dimian A, Riegelman A, et al. A meta-analysis of treatment for self-injurious behavior in children and adolescents with intellectual and developmental disabilities. Behav Modif. 2024;48:216\u201356.","journal-title":"Behav Modif"},{"key":"3710_CR19","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1016\/S0165-0173(98)00019-8","volume":"28","author":"KC Berridge","year":"1998","unstructured":"Berridge KC, Robinson TE. What is the role of dopamine in reward: hedonic impact, reward learning, or incentive salience? Brain Res Brain Res Rev. 1998;28:309\u201369.","journal-title":"Brain Res Brain Res Rev"},{"key":"3710_CR20","doi-asserted-by":"publisher","first-page":"483","DOI":"10.1038\/nrn1406","volume":"5","author":"RA Wise","year":"2004","unstructured":"Wise RA. Dopamine, learning and motivation. Nat Rev Neurosci. 2004;5:483\u201394.","journal-title":"Nat Rev Neurosci"},{"key":"3710_CR21","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-024-44836-9","volume":"15","author":"KM Ibrahim","year":"2024","unstructured":"Ibrahim KM, Massaly N, Yoon H-J, Sandoval R, Widman AJ, Heuermann RJ, et al. Dorsal hippocampus to nucleus accumbens projections drive reinforcement via activation of accumbal dynorphin neurons. Nat Commun. 2024;15:750.","journal-title":"Nat Commun"},{"key":"3710_CR22","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.1001\/archgenpsychiatry.2010.122","volume":"67","author":"D Denys","year":"2010","unstructured":"Denys D, Mantione M, Figee M, Van Den Munckhof P, Koerselman F, Westenberg H, et al. Deep brain stimulation of the nucleus accumbens for treatment-refractory obsessive-compulsive disorder. Arch Gen Psychiatry. 2010;67:1061\u20138.","journal-title":"Arch Gen Psychiatry"},{"key":"3710_CR23","doi-asserted-by":"crossref","first-page":"1322","DOI":"10.1093\/brain\/awac425","volume":"146","author":"S Naze","year":"2023","unstructured":"Naze S, Hearne LJ, Roberts JA, Sanz-Leon P, Burgher B, Hall C, et al. Mechanisms of imbalanced frontostriatal functional connectivity in obsessive-compulsive disorder. Brain. 2023;146:1322\u20137.","journal-title":"Brain"},{"key":"3710_CR24","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1037\/abn0000732","volume":"131","author":"K Mar","year":"2022","unstructured":"Mar K, Townes P, Pechlivanoglou P, Arnold P, Schachar R. Obsessive compulsive disorder and response inhibition: meta-analysis of the stop-signal task. J Psychopathol Clin Sci. 2022;131:152\u201361.","journal-title":"J Psychopathol Clin Sci"},{"key":"3710_CR25","doi-asserted-by":"crossref","first-page":"1243","DOI":"10.1126\/science.1232380","volume":"340","author":"E Burgui\u00e8re","year":"2013","unstructured":"Burgui\u00e8re E, Monteiro P, Feng G, Graybiel AM. Optogenetic stimulation of lateral orbitofronto-striatal pathway suppresses compulsive behaviors. Science. 2013;340:1243\u20136.","journal-title":"Science"},{"key":"3710_CR26","doi-asserted-by":"publisher","first-page":"1148","DOI":"10.1038\/s41593-024-01633-3","volume":"27","author":"SL Mondrag\u00f3n-Gonz\u00e1lez","year":"2024","unstructured":"Mondrag\u00f3n-Gonz\u00e1lez SL, Schreiweis C, Burgui\u00e8re E. Closed-loop recruitment of striatal interneurons prevents compulsive-like grooming behaviors. Nat Neurosci. 2024;27:1148\u201356.","journal-title":"Nat Neurosci"},{"key":"3710_CR27","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1038\/s41386-022-01495-y","volume":"48","author":"SE Swinford-Jackson","year":"2023","unstructured":"Swinford-Jackson SE, Huffman PJ, Knouse MC, Thomas AS, Rich MT, Mankame S, et al. High frequency DBS-like optogenetic stimulation of nucleus accumbens dopamine D2 receptor-containing neurons attenuates cocaine reinstatement in male rats. Neuropsychopharmacology. 2023;48:459\u201367.","journal-title":"Neuropsychopharmacology"},{"key":"3710_CR28","volume":"203","author":"MJ Ku","year":"2024","unstructured":"Ku MJ, Kim CY, Park JW, Lee S, Jeong EY, Jeong J-W, et al. Wireless optogenetic stimulation on the prelimbic to the nucleus accumbens core circuit attenuates cocaine-induced behavioral sensitization. Neurobiol Dis. 2024;203:106733.","journal-title":"Neurobiol Dis"},{"key":"3710_CR29","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2202-6-37","volume":"6","author":"RN Cardinal","year":"2005","unstructured":"Cardinal RN, Howes NJ. Effects of lesions of the nucleus accumbens core on choice between small certain rewards and large uncertain rewards in rats. BMC Neurosci. 2005;6:37.","journal-title":"BMC Neurosci"},{"key":"3710_CR30","doi-asserted-by":"crossref","first-page":"2499","DOI":"10.1126\/science.1060818","volume":"292","author":"RN Cardinal","year":"2001","unstructured":"Cardinal RN, Pennicott DR, Sugathapala CL, Robbins TW, Everitt BJ. Impulsive choice induced in rats by lesions of the nucleus accumbens core. Science. 2001;292:2499\u2013501.","journal-title":"Science"},{"key":"3710_CR31","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1016\/j.bbr.2009.04.003","volume":"202","author":"S da Costa Ara\u00fajo","year":"2009","unstructured":"da Costa Ara\u00fajo S, Body S, Hampson CL, Langley RW, Deakin JFW, Anderson IM, et al. Effects of lesions of the nucleus accumbens core on inter-temporal choice: further observations with an adjusting-delay procedure. Behav Brain Res. 2009;202:272\u20137.","journal-title":"Behav Brain Res"},{"key":"3710_CR32","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1007\/s00213-007-0882-0","volume":"195","author":"G Bezzina","year":"2007","unstructured":"Bezzina G, Cheung THC, Asgari K, Hampson CL, Body S, Bradshaw CM, et al. Effects of quinolinic acid-induced lesions of the nucleus accumbens core on inter-temporal choice: a quantitative analysis. Psychopharmacology. 2007;195:71\u201384.","journal-title":"Psychopharmacology"},{"key":"3710_CR33","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1016\/j.biopsych.2013.08.013","volume":"76","author":"M Langen","year":"2014","unstructured":"Langen M, Bos D, Noordermeer SDS, Nederveen H, Engeland HV, Durston S. Changes in the development of striatum are involved in repetitive behavior in Autism. Biol Psychiatry. 2014;76:405\u201311.","journal-title":"Biol Psychiatry"},{"key":"3710_CR34","doi-asserted-by":"crossref","unstructured":"Rojahn J, Tass\u00e9 MJ, Morin D Self-injurious behavior and stereotypies. In: Ollendick TH, Hersen M, editors. Handbook of child psychopathology, Boston, MA: Springer US; 1998. p. 307-36.","DOI":"10.1007\/978-1-4615-5905-4_12"},{"key":"3710_CR35","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1111\/j.1365-2788.2012.01534.x","volume":"56","author":"F Furniss","year":"2012","unstructured":"Furniss F, Biswas AB. Recent research on aetiology, development and phenomenology of self-injurious behaviour in people with intellectual disabilities: a systematic review and implications for treatment. J Intellect Disability Res. 2012;56:453\u201375.","journal-title":"J Intellect Disability Res"},{"key":"3710_CR36","doi-asserted-by":"crossref","first-page":"1938","DOI":"10.3390\/ijms26051938","volume":"26","author":"K Zhang","year":"2025","unstructured":"Zhang K, Ibrahim GM, Venetucci Gouveia F. Molecular pathways, neural circuits and emerging therapies for self-injurious behaviour. Int J Mol Sci. 2025;26:1938.","journal-title":"Int J Mol Sci"},{"key":"3710_CR37","first-page":"387","volume":"9","author":"EJ Choi","year":"2024","unstructured":"Choi EJ, Vandewouw MM, Taylor MJ, Stevenson RA, Arnold PD, Brian J, et al. Dorsal striatal functional connectivity and repetitive behavior dimensions in children and youths with neurodevelopmental disorders. Biol Psychiatry: Cognit Neurosci Neuroimaging. 2024;9:387\u201397.","journal-title":"Biol Psychiatry: Cognit Neurosci Neuroimaging"},{"key":"3710_CR38","doi-asserted-by":"crossref","unstructured":"Furniss F, Biswas AB Neurobiology of self-injurious behavior. In: Furniss F, Biswas AB, editors. Self-injurious behavior in individuals with neurodevelopmental conditions, Cham: Springer International Publishing; 2020. p. 51\u2013110.","DOI":"10.1007\/978-3-030-36016-0_3"},{"key":"3710_CR39","doi-asserted-by":"crossref","first-page":"1676","DOI":"10.1177\/1362361320918763","volume":"24","author":"MA Cascio","year":"2020","unstructured":"Cascio MA, Weiss JA, Racine E. Person-oriented ethics for autism research: Creating best practices through engagement with autism and autistic communities. Autism: Int J Res Pract. 2020;24:1676\u201390.","journal-title":"Autism: Int J Res Pract"},{"key":"3710_CR40","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1111\/dmcn.16185","volume":"67","author":"S Breitbart","year":"2025","unstructured":"Breitbart S, Yan H, Mithani K, Gorodetsky C, Ibrahim GM. Experiences of caregivers of children with severe self-injurious behavior: an interpretive, descriptive study. Dev Med Child Neurol. 2025;67:779\u201387.","journal-title":"Dev Med Child Neurol"},{"key":"3710_CR41","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s40814-022-00988-3","volume":"8","author":"H Yan","year":"2022","unstructured":"Yan H, Siegel L, Breitbart S, Gorodetsky C, Fasano A, Rahim A, et al. An open-label prospective pilot trial of nucleus accumbens deep brain stimulation for children with autism spectrum disorder and severe, refractory self-injurious behavior: study protocol. Pilot Feasibility Stud. 2022;8:1\u201310.","journal-title":"Pilot Feasibility Stud"},{"key":"3710_CR42","first-page":"607","volume":"37","author":"H Yan","year":"2021","unstructured":"Yan H, Siegel L, Breitbart S, Gorodetsky C, Gonorazky HD, Yau I, et al. The Child & Youth CompreHensIve Longitudinal Database for Deep Brain Stimulation (CHILD-DBS). Child\u2019s nervous system: ChNS. Off J Int Soc Pediatric Neurosurg. 2021;37:607\u201315.","journal-title":"Off J Int Soc Pediatric Neurosurg"},{"key":"3710_CR43","doi-asserted-by":"crossref","unstructured":"World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310:2191-4.","DOI":"10.1001\/jama.2013.281053"},{"key":"3710_CR44","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-025-64416-9","volume":"16","author":"A Balachandar","year":"2025","unstructured":"Balachandar A, Vogt LM, Mithani K, Coleman SC, Ebden M, Leblanc-Miller A, et al. Status dystonicus is a distinct state characterized by pallidal beta-band activity. Nat Commun. 2025;16:9352.","journal-title":"Nat Commun"},{"key":"3710_CR45","doi-asserted-by":"publisher","unstructured":"Mithani K, Niazi F, Suresh H, Alrumayyan Y, Rayco ER, Ochi A, et al. Deep brain stimulation of the centromedian nucleus for drug-resistant epilepsy in children: quality-of-life and functional outcomes from the CHILD-DBS registry. Epilepsia. 2025. https:\/\/doi.org\/10.1111\/epi.18393.","DOI":"10.1111\/epi.18393"},{"key":"3710_CR46","unstructured":"National Cancer Institute. Common Terminology Criteria for Adverse Events (CTCAE) v6.0. U.S. Department of Health and Human Services; 2025. Available from: National Cancer Institute CTCAE and Adverse Event Reporting website."},{"key":"3710_CR47","doi-asserted-by":"publisher","first-page":"577","DOI":"10.1023\/A:1013299028321","volume":"31","author":"J Rojahn","year":"2001","unstructured":"Rojahn J, Matson JL, Lott D, Esbensen AJ, Smalls Y. The behavior problems inventory: an instrument for the assessment of self-injury, stereotyped behavior, and aggression\/destruction in individuals with developmental disabilities. J Autism Dev Disord. 2001;31:577\u201388.","journal-title":"J Autism Dev Disord"},{"key":"3710_CR48","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1007\/s10862-008-9107-z","volume":"31","author":"ED Klonsky","year":"2009","unstructured":"Klonsky ED, Glenn CR. Assessing the functions of non-suicidal self-injury: psychometric properties of the Inventory of Statements About Self-injury (ISAS). J Psychopathol Behav Assess. 2009;31:215\u20139.","journal-title":"J Psychopathol Behav Assess"},{"key":"3710_CR49","doi-asserted-by":"publisher","unstructured":"Bodfish JW, Symons FJ, Parker DE, Lewis MH. Repetitive behavior scale\u2013revised. Journal of Autism and Developmental Disorders. 1999;1999. https:\/\/doi.org\/10.1037\/t17338-000.","DOI":"10.1037\/t17338-000"},{"key":"3710_CR50","first-page":"485","volume":"89","author":"M Aman","year":"1985","unstructured":"Aman M, Singh N, Stewart A, Field C. The aberrant behavior checklist: a behavior rating scale for the assessment of treatment effects. Am J Ment Defic. 1985;89:485\u201391.","journal-title":"Am J Ment Defic"},{"key":"3710_CR51","doi-asserted-by":"crossref","first-page":"844","DOI":"10.1097\/00004583-199706000-00023","volume":"36","author":"L Scahill","year":"1997","unstructured":"Scahill L, Riddle MA, McSwiggin-Hardin M, Ort SI, King RA, Goodman WK, et al. Children\u2019s yale-brown obsessive compulsive scale: reliability and validity. J Am Acad Child Adolesc Psychiatry. 1997;36:844\u201352.","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"key":"3710_CR52","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1367\/1539-4409(2003)003<0329:TPAAPP>2.0.CO;2","volume":"3","author":"JW Varni","year":"2003","unstructured":"Varni JW, Burwinkle TM, Seid M, Skarr D. The PedsQL 4.0 as a pediatric population health measure: feasibility, reliability, and validity. Ambul Pediatr. 2003;3:329\u201341.","journal-title":"Ambul Pediatr"},{"key":"3710_CR53","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1001\/jamaoncol.2018.6205","volume":"5","author":"JK Roydhouse","year":"2019","unstructured":"Roydhouse JK, Fiero MH, Kluetz PG. Investigating potential bias in patient-reported outcomes in open-label cancer trials. JAMA Oncol. 2019;5:457\u20138.","journal-title":"JAMA Oncol"},{"key":"3710_CR54","doi-asserted-by":"crossref","first-page":"1327","DOI":"10.1097\/00004583-200010000-00023","volume":"39","author":"JA Gliner","year":"2000","unstructured":"Gliner JA, Morgan GA, Harmon RJ. Single-subject designs. J Am Acad Child Adolesc Psychiatry. 2000;39:1327\u20139.","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"key":"3710_CR55","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1055\/s-0041-1741019","volume":"43","author":"JP Lynch","year":"2022","unstructured":"Lynch JP, Clark NM, Zhanel GG. Infections due to acinetobacter baumannii-calcoaceticus complex: escalation of antimicrobial resistance and evolving treatment options. Semin Respir Crit Care Med. 2022;43:97\u2013124.","journal-title":"Semin Respir Crit Care Med"},{"key":"3710_CR56","doi-asserted-by":"crossref","first-page":"e105288","DOI":"10.1371\/journal.pone.0105288","volume":"9","author":"S Bjerknes","year":"2014","unstructured":"Bjerknes S, Skogseid IM, S\u00e6hle T, Dietrichs E, Toft M. Surgical site infections after deep brain stimulation surgery: frequency, characteristics and management in a 10-year period. PLOS ONE. 2014;9:e105288.","journal-title":"PLOS ONE"},{"key":"3710_CR57","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.jns.2017.10.031","volume":"383","author":"MS Kim","year":"2017","unstructured":"Kim MS, Jeong JS, Ryu H-S, Choi S-H, Chung SJ. Infection related to deep brain stimulation in patients with Parkinson disease: clinical characteristics and risk factors. J Neurological Sci. 2017;383:135\u201341.","journal-title":"J Neurological Sci"},{"key":"3710_CR58","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1159\/000362934","volume":"92","author":"C Tolleson","year":"2014","unstructured":"Tolleson C, Stroh J, Ehrenfeld J, Neimat J, Konrad P, Phibbs F. The factors involved in deep brain stimulation infection: a large case series. Stereotact Funct Neurosurg. 2014;92:227\u201333.","journal-title":"Stereotact Funct Neurosurg"},{"key":"3710_CR59","volume":"10","author":"H Tabaja","year":"2023","unstructured":"Tabaja H, Yuen J, Tai DBG, Campioli CC, Chesdachai S, DeSimone DC, et al. Deep brain stimulator device infection: the mayo clinic rochester experience. Open Forum Infect Dis. 2023;10:ofac631.","journal-title":"Open Forum Infect Dis"},{"key":"3710_CR60","doi-asserted-by":"crossref","DOI":"10.1212\/WNL.0000000000214201","volume":"105","author":"A Balachandar","year":"2025","unstructured":"Balachandar A, Verhey LH, Mithani K, Suresh H, Kerr EN, Breitbart SC, et al. Surgical complications of deep brain stimulation in children across targets and indications. Neurology. 2025;105:e214201.","journal-title":"Neurology"},{"key":"3710_CR61","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1159\/000365576","volume":"92","author":"JF Thrane","year":"2014","unstructured":"Thrane JF, Sunde NA, Bergholt B, Rosendal F. Increasing infection rate in multiple implanted pulse generator changes in movement disorder patients treated with deep brain stimulation. Stereotact Funct Neurosurg. 2014;92:360\u20134.","journal-title":"Stereotact Funct Neurosurg"},{"key":"3710_CR62","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1159\/000343202","volume":"91","author":"J Pepper","year":"2012","unstructured":"Pepper J, Zrinzo L, Mirza B, Foltynie T, Limousin P, Hariz M. The risk of hardware infection in deep brain stimulation surgery is greater at impulse generator replacement than at the primary procedure. Stereotact Funct Neurosurg. 2012;91:56\u201365.","journal-title":"Stereotact Funct Neurosurg"},{"key":"3710_CR63","doi-asserted-by":"crossref","first-page":"100335","DOI":"10.1016\/j.prdoa.2025.100335","volume":"12","author":"RA Ricciuti","year":"2025","unstructured":"Ricciuti RA, Ottaviani MM, Mancini F, Liverotti V, Marruzzo D, Marano M, et al. Long-term infective complications of deep brain stimulation in Parkinson\u2019s disease: a 22-year follow-up. Clin Parkinsonism Relat Disord. 2025;12:100335.","journal-title":"Clin Parkinsonism Relat Disord"},{"key":"3710_CR64","unstructured":"Medtronic. Medtronic DBS: Adapting to you. Deep brain stimulation (DBS) therapy [brochure]. Minneapolis, MN: Medtronic; 2024. Available from: https:\/\/www.medtronic.com\/content\/dam\/medtronic-wide\/public\/united-states\/products\/neurological\/dbs-percept-rc-patient-brochure.pdf. Accessed 20 June 2026"},{"key":"3710_CR65","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1159\/000500993","volume":"97","author":"KT Mitchell","year":"2019","unstructured":"Mitchell KT, Volz M, Lee A, San Luciano M, Wang S, Starr PA, et al. Patient experience with rechargeable implantable pulse generator deep brain stimulation for movement disorders. Stereotact Funct Neurosurg. 2019;97:113\u20139.","journal-title":"Stereotact Funct Neurosurg"},{"key":"3710_CR66","doi-asserted-by":"publisher","first-page":"799","DOI":"10.3171\/2018.4.JNS172995","volume":"131","author":"FL Hitti","year":"2018","unstructured":"Hitti FL, Vaughan KA, Ramayya AG, McShane BJ, Baltuch GH. Reduced long-term cost and increased patient satisfaction with rechargeable implantable pulse generators for deep brain stimulation. J Neurosurg. 2018;131:799\u2013806. https:\/\/doi.org\/10.3171\/2018.4.JNS172995","journal-title":"J Neurosurg"},{"key":"3710_CR67","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1159\/000323340","volume":"89","author":"B Waldau","year":"2011","unstructured":"Waldau B, Clayton DA, Gasperson LB, Turner DA. Analysis of the time course of the effect of subthalamic nucleus stimulation upon hand function in Parkinson\u2019s patients. Stereotact Funct Neurosurg. 2011;89:48\u201355.","journal-title":"Stereotact Funct Neurosurg"},{"key":"3710_CR68","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1002\/mds.22291","volume":"24","author":"J Levin","year":"2009","unstructured":"Levin J, Krafczyk S, Valkovic P, Eggert T, Claassen J, B\u00f6tzel K. Objective measurement of muscle rigidity in Parkinsonian patients treated with subthalamic stimulation. Mov Disord. 2009;24:57\u201363.","journal-title":"Mov Disord"},{"key":"3710_CR69","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1159\/000338683","volume":"90","author":"TH de Oliveira","year":"2012","unstructured":"de Oliveira TH, Ginsberg MR, Cooper S, Nowacki A, Rezai A, Deogaonkar M, et al. Long-term effects of deep brain stimulation for essential tremor with subjective and objective quantification via mailed-in questionnaires. Stereotact Funct Neurosurg. 2012;90:394\u2013400.","journal-title":"Stereotact Funct Neurosurg"},{"key":"3710_CR70","doi-asserted-by":"publisher","first-page":"234","DOI":"10.1038\/s41582-019-0145-9","volume":"15","author":"P Limousin","year":"2019","unstructured":"Limousin P, Foltynie T. Long-term outcomes of deep brain stimulation in Parkinson disease. Nat Rev Neurol. 2019;15:234\u201342.","journal-title":"Nat Rev Neurol"},{"key":"3710_CR71","doi-asserted-by":"crossref","DOI":"10.1016\/j.eplepsyres.2025.107607","volume":"216","author":"JK Dhaliwal","year":"2025","unstructured":"Dhaliwal JK, Ruiz-Perez M, Chari A, Piper RJ, Tisdall MM, Hart M. Deep brain stimulation for epilepsy: a systematic review and meta-analysis of randomized and non-randomized studies of thalamic targeting. Epilepsy Res. 2025;216:107607.","journal-title":"Epilepsy Res"},{"key":"3710_CR72","doi-asserted-by":"publisher","first-page":"1075","DOI":"10.1038\/s41380-023-02394-4","volume":"29","author":"KA Johnson","year":"2024","unstructured":"Johnson KA, Okun MS, Scangos KW, Mayberg HS, de Hemptinne C. Deep brain stimulation for refractory major depressive disorder: a comprehensive review. Mol Psychiatry. 2024;29:1075\u201387.","journal-title":"Mol Psychiatry"},{"key":"3710_CR73","doi-asserted-by":"crossref","first-page":"2384","DOI":"10.1038\/sj.npp.1301165","volume":"31","author":"BD Greenberg","year":"2006","unstructured":"Greenberg BD, Malone DA, Friehs GM, Rezai AR, Kubu CS, Malloy PF, et al. Three-year outcomes in deep brain stimulation for highly resistant obsessive-compulsive disorder. Neuropsychopharmacology: Off Publ Am Coll Neuropsychopharmacology. 2006;31:2384\u201393.","journal-title":"Neuropsychopharmacology: Off Publ Am Coll Neuropsychopharmacology"},{"key":"3710_CR74","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1177\/0883073811415853","volume":"27","author":"LL Deon","year":"2012","unstructured":"Deon LL, Kalichman MA, Booth CL, Slavin KV, Gaebler-Spira DJ. Pallidal deep-brain stimulation associated with complete remission of self-injurious behaviors in a patient with Lesch-Nyhan syndrome: a case report. J Child Neurol. 2012;27:117\u201320.","journal-title":"J Child Neurol"},{"key":"3710_CR75","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1111\/ner.12261","volume":"18","author":"F Piedimonte","year":"2015","unstructured":"Piedimonte F, Andreani JC, Piedimonte L, Micheli F, Graff P, Bacaro V. Remarkable clinical improvement with bilateral globus pallidus internus deep brain stimulation in a case of Lesch\u2013Nyhan disease: five-year follow-up. Neuromodulation: Technol Neural Interface. 2015;18:118\u201322.","journal-title":"Neuromodulation: Technol Neural Interface"},{"key":"3710_CR76","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1111\/ner.13217","volume":"24","author":"K Tambirajoo","year":"2021","unstructured":"Tambirajoo K, Furlanetti L, Hasegawa H, Raslan A, Gimeno H, Lin JP, et al. Deep brain stimulation of the internal pallidum in Lesch-Nyhan syndrome: clinical outcomes and connectivity analysis. Neuromodulation: J Int Neuromodulation Soc. 2021;24:380\u201391.","journal-title":"Neuromodulation: J Int Neuromodulation Soc"},{"key":"3710_CR77","doi-asserted-by":"crossref","first-page":"594","DOI":"10.3171\/2014.8.PEDS1451","volume":"14","author":"TJ Abel","year":"2014","unstructured":"Abel TJ, Dalm BD, Grossbach AJ, Jackson AW, Thomsen T, Greenlee JDW. Lateralized effect of pallidal stimulation on self-mutilation in Lesch-Nyhan disease. J Neurosurg Pediatrics. 2014;14:594\u20137.","journal-title":"J Neurosurg Pediatrics"},{"key":"3710_CR78","doi-asserted-by":"crossref","first-page":"2126","DOI":"10.1002\/mds.21723","volume":"22","author":"L Cif","year":"2007","unstructured":"Cif L, Biolsi B, Gavarini S, Saux A, Robles SG, Tancu C, et al. Antero-ventral internal pallidum stimulation improves behavioral disorders in Lesch-Nyhan disease. Mov Disorders: Off J Mov Disord Soc. 2007;22:2126\u20139.","journal-title":"Mov Disorders: Off J Mov Disord Soc"},{"key":"3710_CR79","doi-asserted-by":"crossref","first-page":"414","DOI":"10.3171\/jns.2003.98.2.0414","volume":"98","author":"T Taira","year":"2003","unstructured":"Taira T, Kobayashi T, Hori T. Disappearance of self-mutilation in a patient with Lesch\u2014Nyhan syndrome after bilateral chronic stimulation of the globus pallidus internus: case report. J Neurosurg. 2003;98:414\u20136.","journal-title":"J Neurosurg"},{"key":"3710_CR80","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/j.neurom.2024.07.009","volume":"28","author":"K Mithani","year":"2025","unstructured":"Mithani K, Zhang K, Yan H, Elkaim L, Gariscsak PJ, Suresh H, et al. Effect of deep brain stimulation on comorbid self-injurious behavior: a systematic review and meta-analysis of individual patient data. Neuromodulation. 2025;28:373\u20139.","journal-title":"Neuromodulation"},{"key":"3710_CR81","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1136\/jnnp-2019-322569","volume":"91","author":"JF Fischer","year":"2020","unstructured":"Fischer JF, Mainka T, Mainka T, Worbe Y, Pringsheim T, Bhatia K, et al. Self-injurious behaviour in movement disorders: systematic review. J Neurology, Neurosurgery, Psychiatry. 2020;91:712\u20139.","journal-title":"J Neurology, Neurosurgery, Psychiatry"},{"key":"3710_CR82","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1159\/000485385","volume":"53","author":"S Peeters","year":"2018","unstructured":"Peeters S, Skoch J, Holt H, Mubita L, Choudhary EA, Vadivelu KP, et al. Functional neuroanatomy of secondary self-injurious behavior. Pediatr Neurosurg. 2018;53:71\u201380.","journal-title":"Pediatr Neurosurg"},{"key":"3710_CR83","doi-asserted-by":"crossref","unstructured":"Mithani K, Ibrahim GM. Normalization of deviance in neuromodulation for epilepsy. Epilepsia. 2026;67:582\u2013587.","DOI":"10.1111\/epi.18679"},{"key":"3710_CR84","doi-asserted-by":"publisher","first-page":"E11","DOI":"10.3171\/2018.7.FOCUS18219","volume":"45","author":"B Davidson","year":"2018","unstructured":"Davidson B, Elkaim LM, Lipsman N, Ibrahim GM. Editorial. An ethical framework for deep brain stimulation in children. Neurosurg Focus. 2018;45:E11 https:\/\/doi.org\/10.3171\/2018.7.FOCUS18219","journal-title":"Neurosurg Focus"},{"key":"3710_CR85","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/S2352-4642(25)00336-0","volume":"10","author":"K Mithani","year":"2026","unstructured":"Mithani K, Ibrahim GM. The case for action in paediatric neuromodulation. Lancet Child Adolesc Health. 2026;10:e1.","journal-title":"Lancet Child Adolesc Health"},{"key":"3710_CR86","doi-asserted-by":"crossref","first-page":"s17","DOI":"10.1017\/cjn.2023.18","volume":"50","author":"L Harding","year":"2023","unstructured":"Harding L, McFarlane J, Honey CR, McDonald PJ, Illes J. Mapping the landscape of equitable access to advanced neurotechnologies in Canada. Can J Neurol Sci. 2023;50:s17\u2013s25.","journal-title":"Can J Neurol Sci"},{"key":"3710_CR87","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1016\/j.yebeh.2018.10.040","volume":"90","author":"H Yan","year":"2019","unstructured":"Yan H, Snead C, Ibrahim GM. Epilepsy surgery for children with severe developmental delay: an ethical double jeopardy. Epilepsy Behav. 2019;90:287\u201390.","journal-title":"Epilepsy Behav"}],"container-title":["Molecular Psychiatry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41380-026-03710-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41380-026-03710-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41380-026-03710-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T20:57:32Z","timestamp":1792011452000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41380-026-03710-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,22]]},"references-count":87,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2026,11]]}},"alternative-id":["3710"],"URL":"https:\/\/doi.org\/10.1038\/s41380-026-03710-4","relation":{},"ISSN":["1359-4184","1476-5578"],"issn-type":[{"value":"1359-4184","type":"print"},{"value":"1476-5578","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,22]]},"assertion":[{"value":"3 November 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 May 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 June 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 June 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Karim Mithani, Sara Breitbart, Thiemo Dinger, Hrishikesh Suresh, Andrea LeBlanc-Millar, Joelene Huber, Elizabeth Kerr, Margot Taylor, Savannah Tate, and Louis Hagopian have no competing interests to disclose. Carolina Gorodetsky, Alfonso Fasano and George Ibrahim receive consulting or advisory fees from Medtronic Inc. Alfonso Fasano also receives consulting and speaking fees from Boston Scientific and Abbott. George Ibrahim also reports a relationship with Synergia Inc and LivaNova Inc that includes consulting and advisory fees and investigator-initiated funding. These organizations played no role in any part of this study, including its design, conduct, analysis, or writing.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Ethics"}}]}}