CHANGE IN REPORTED RESILIENCE AFTER REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (rTMS) FOR MAJOR DEPRESSIVE DISORDER AT A SUBURBAN TERTIARY CLINIC

Abstract

Background:Autism is a heterogeneous neurodevelopmental disorder with social and executive deficits. Symptoms do not isolate to a specific brain network, and there is atypical cortical plasticity with a reduction in cortical inhibition. Autistic patients have a high degree of comorbidity, disability and disease burden with a 2025 forecasted annual cost of care of $461billion (exceeding ADHD, diabetes and stroke). 40% of autistic patients manifest anxiety including obsessive compulsive disorder (OCD). TMS is indicated for several adult neuro-psychiatric conditions and has a superior safety profile in the paediatric literature. Here we present the treatment course of a 10-year-old male verbal autistic patient with severe anxiety and OCD resistant to psychotherapy and pharmacotherapy. Methods: Treatments were administered over four months using the H7 coil. Symptoms were assessed with the Screen-for-Child-Anxiety-Related-Disorder (SCARED) and Child-Yale-Brown-Obsessive-Compulsive-Scale (CYBOCS). Anxiety being prominent, TMS was initiated with twenty right PFC sessions over 4weeks at 1HZ/120hand. After COVID exacerbated his OCD three sessions of 20Hz/100MTfoot over medial PFC/ACC were administered. After further worsening, switched to 1HZ/100MTfoot for 20sessions/4weeks. Results:After the initial 20 LF sessions over PFC, SCARED score decreased from 52 to 28 with sustained benefit for two months. Following the 3 HF sessions over PFC/ACC, CYBOCS worsened dramatically (25/37). Finally, after switching to LF for another 20 sessions, CYBOCS score improved from 37 to 15. Noticeable were decreased stereotypies, improved eye contact, interpersonal and spontaneous interactions and coping abilities. Conclusions:This case demonstrates safe and successful use of the H7 deep-TMS device in a treatment-resistant 10-year-old with autism, severe anxiety and OCD. Further controlled studies in this age group are warranted. Funding: None. Disclosures: AM OM AJ have a financial interest in commercial TMS. AT has a financial interest in commercial TMS and in BrainsWay, the manufacturer of the H7 coil.