The Impact of Single Session Intermittent Theta-Burst Stimulation over the Dorsolateral Prefrontal Cortex and Posterior Superior Temporal Sulcus on Adults with Autism Spectrum Disorder

Abstract

Intermittent theta burst stimulation (iTBS), a patterned repetitive transcranial magnetic stimulation, was applied over the posterior superior temporal sulcus (pSTS) or dorsolateral prefrontal cortex (DLPFC) to explore its impact in adults with autism spectrum disorder (ASD). Among 25 adults with ASD, 19 (mean age: 20.8 years) completed the randomized, sham-controlled, crossover trial. Every participant received iTBS over the bilateral DLPFC, bilateral pSTS and inion (as a sham control stimulation) in a randomized order with a 1-week interval. Neuropsychological functions were assessed using the Conners' Continuous Performance Test (CCPT) and the Wisconsin Card Sorting Test (WCST). Behavioral outcomes were measured using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Social Responsiveness Scale (SRS). In comparison to that in the sham stimulation, the reaction time in the CCPT significantly decreased following single DLPFC session (p = 0.04, effect size = 0.71) while there were no significant differences in the CCPT and WCST following single pSTS session. Besides, the results in behavioral outcomes were inconsistent and had discrepancy between reports of parents and patients. In conclusion, a single session of iTBS over the bilateral DLPFC may alter the neuropsychological function in adults with ASD. The impacts of multiple-sessions iTBS over the DLPFC or pSTS deserve further investigations.

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

“…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. Three studies recruited exclusively adult subjects to the experimental arm (Fecteau et al, 2011 ; Enticott et al, 2014 ; Ni et al, 2017 ), with the remainder focusing predominantly on children and adolescents.…”

“…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. Three studies recruited exclusively adult subjects to the experimental arm (Fecteau et al, 2011 ; Enticott et al, 2014 ; Ni et al, 2017 ), with the remainder focusing predominantly on children and adolescents. Overall, data were reported from 371 rTMS-treated patients, with a mean age of 15.9 ± 5.2 years, 5 of whom in case-reports (26.4 ± 9.3 years-old) and the remaining 366 from intervention studies (15.8 ± 5.1 years-old).…”

“…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 ).…”

“…Most studies targeted stimulation to the dorsolateral prefrontal cortex (DLPFC), either bilaterally or in the left hemisphere, using low stimulation frequencies (0.5–1 Hz). Ni et al ( 2017 ) additionally stimulated the posterior superior temporal sulcus using iTBS, while Fecteau et al ( 2011 ) used 1 Hz rTMS to stimulate the pars triangularis and pars opercularis of the inferior frontal gyrus, bilaterally. Avirame et al ( 2017 ) and Enticott et al ( 2011 , 2014 ) targeted the dorsal medial prefrontal cortex (DMPFC) with stimulation frequencies of 5 Hz.…”

Exploratory Study of rTMS Neuromodulation Effects on Electrocortical Functional Measures of Performance in an Oddball Test and Behavioral Symptoms in Autism

“…Neuromodulation and, more specifically, non-invasive brain stimulation is an intervention aimed at normalizing the putative cortical inhibitory deficit of autism. Among neuromodulation techniques, transcranial magnetic stimulation (TMS) has provided promising results as a possible therapeutic modality in many psychiatric disorders ( Wassermann and Lisanby, 2001 ; Pascual-Leone et al, 2002 ; George et al, 2003 ; Rossi et al, 2009 ; Enticott et al, 2014 ; Rotenberg et al, 2014 ; Oberman and Enticott, 2015 ; Ni et al, 2017 ). Magnetic pulses generated by a current passing through a coil stimulate targeted cortical regions, usually within 2–3 cm of the skull surface ( Rudiak and Marg, 1994 ; George et al, 1999 ; Hoffman and Cavus, 2002 ).…”