Intermittent theta-burst transcranial magnetic stimulation for autism spectrum disorder: an open-label pilot study

Abstract

Objective Theta-burst stimulation (TBS) modulates synaptic plasticity more efficiently than standard repetitive transcranial magnetic stimulation delivery and may be a promising modality for neuropsychiatric disorders such as autism spectrum disorder (ASD). At present there are few effective interventions for prefrontal cortex dysfunction in ASD. We report on an open-label, pilot study of intermittent TBS (iTBS) to target executive function deficits and restricted, repetitive behaviors in male children and adolescents with ASD. Methods Ten right-handed, male participants, aged 9–17 years with ASD were enrolled in an open-label trial of iTBS treatment. Fifteen sessions of neuronavigated iTBS at 100% motor threshold targeting the right dorsolateral prefrontal cortex were delivered over 3 weeks. Results Parent report scores on the Repetitive Behavior Scale Revised and the Yale-Brown Obsessive Compulsive Scale demonstrated improvements with iTBS treatment. Participants demonstrated improvements in perseverative errors on the Wisconsin Card Sorting Test and total time for the Stroop test. The iTBS treatments were well tolerated with no serious adverse effects. Conclusion These preliminary results suggest that further controlled interventional studies of iTBS for ASD are warranted.

Repetitive Transcranial Magnetic Stimulation for Treatment of Autism Spectrum Disorder: A Systematic Review and Meta-Analysis

“…Figure 1 shows a flow diagram of the process leading to the identification of 23 eligible papers, using rTMS for therapeutic purposes in subjects with ASD (refer to Tables 1 – 3 for individual study details). Four of these papers were case-reports (Enticott et al, 2011 ; Niederhofer, 2012 ; Cristancho et al, 2014 ; Avirame et al, 2017 ), 7 were non-controlled trials (Sokhadze et al, 2010 , 2016 , 2017 ; Casanova et al, 2014 ; Wang et al, 2016 ; Abujadi et al, 2017 ; Gómez et al, 2017 ) and the remaining 12 were controlled trials (Sokhadze et al, 2009 , 2012 , 2014a , b ; Baruth et al, 2010 ; Fecteau et al, 2011 ; Casanova et al, 2012 ; Enticott et al, 2012 , 2014 ; Panerai et al, 2014 ; Anninos et al, 2016 ; Ni et al, 2017 ). Six of the controlled studies used sham rTMS as the control intervention (Fecteau et al, 2011 ; Enticott et al, 2012 , 2014 ; Panerai et al, 2014 ; Anninos et al, 2016 ; Ni et al, 2017 ) while the remaining 6 compared rTMS-treated patients with wait-list controls.…”

“…The overwhelming majority of studies recruited patients with an IQ higher than 80. The 4 trials reported in the paper by Panerai et al ( 2014 ) were all performed on subjects with severe cognitive impairment, while Abujadi et al ( 2017 ), Baruth et al ( 2010 ), and Wang et al ( 2016 ) included patients both with and without cognitive impairment.…”

“…One study used a pico-Tesla TMS protocol (Anninos et al, 2016 ) while two others used TBS protocols (Abujadi et al, 2017 ; Ni et al, 2017 ). Pico-Tesla TMS is a technology invented and used by a specific research group (Anninos and Tsagas, 1995 ).…”

“…Sixteen studies assessed the effects of rTMS on ASD symptoms or ASD associated behavioral problems. Seven of these studies were prospective and non-controlled (Sokhadze et al, 2010 , 2016 , 2017 ; Casanova et al, 2014 ; Wang et al, 2016 ; Abujadi et al, 2017 ; Gómez et al, 2017 ). Data from the study by Gómez et al ( 2017 ), who used both rTMS and transcranial direct current stimulation in their sample, could not be used as authors did not provide separate outcome data for the rTMS intervention.…”

“…All of the eight studies incurred in risk of bias, as none was subject- or rater blinded, and none used an intent-to-treat approach regarding dropouts. All but Abujadi et al ( 2017 ), that used iTBS, applied low-frequency rTMS with stimulus frequencies between 0.5 and 1 Hz. Sokhadze et al ( 2010 ) and Sokhadze et al ( 2009 ) targeted the left DLPFC, while Abujadi et al ( 2017 ) stimulated the right DLPFC.…”