A Case Series of Intermittent Theta Burst Stimulation Treatment for Depressive Symptoms in Individuals with Autistic Spectrum Disorder: Real World TMS Study in the Tokyo Metropolitan Area

Abstract

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by deficits in social communication and the presence of restricted interests and repetitive behaviors. While the symptoms of ASD are present from early childhood, there has been an increase in the number of adults with ASD in recent years who visit healthcare professionals to seek the treatment of depression due to maladjustment resulting from the core symptoms and are eventually diagnosed with ASD. Currently, no treatment is available for the core symptoms of ASD, and pharmacotherapy and psychotherapy are often provided mainly for secondary disorders such as depression and anxiety. However, the effectiveness of these therapies is often limited in individuals with ASD compared to those with major depression. In this context, neuromodulation therapies such as transcranial magnetic stimulation (TMS) have gained increasing attention as potential treatments. In this case series, we retrospectively analyzed 18 cases with ASD from the TMS registry data who had failed to improve depressive symptoms with pharmacotherapy and were treated with intermittent theta burst stimulation (iTBS) therapy to the left dorsolateral prefrontal cortex (DLPFC). We also explored the relationship between treatment efficacy and clinical epidemiological profile. Our results indicated that, despite the limitations of an open-label preliminary case series, TMS therapy in the form of iTBS may have some beneficial therapeutic effects on depressive symptoms in individuals with ASD. The present findings warrant further validation through randomized, sham-controlled trials with larger sample sizes.

A systematic review of transcranial magnetic stimulation treatment for autism spectrum disorder

“…The total duration of interventions varied widely, spanning from 1 to 18 weeks across different studies. Notably, one study failed to report both the number of treatments per week and the overall intervention duration [ 25 ].…”

“…Additionally, only one of the 17 studies provides the theoretical consideration for selecting the TMS mode [ 21 ] based on evidence of an animal research, in which low frequency rTMS (inhibitory protocol) has been shown to ameliorate autistic-like behaviors in rats by restoring E/I imbalance through enhancing local cortical inhibition [ 47 ]. Majority of studies apply the TMS mode according to treatment efficiency on clinical and behavior outcomes from depression [ 25 ] and other neuropsychological disease [ 14 , 23 ]. Thus, the intervention effects of inhibition or excitation of different TMS mode and different parameters on various brain regions are far from clear.…”

Diverse Advanced Approaches of Transcranial Magnetic Stimulation in Obsessive-Compulsive Disorder

“…Recently, a case series by Noda et al reported promising results when using bilateral SMA-targeted cTBS administered twice daily in six patients with OCD. This approach achieved a response rate of 67% (4/6) without apparent adverse events, suggesting that bilateral cTBS could serve as a viable alternative for OCD treatment [84].…”