A double-blind, randomized trial of deep repetitive transcranial magnetic stimulation (rTMS) for autism spectrum disorder

Peter G Enticott; Bernadette M Fitzgibbon; Hayley A Kennedy; Sara L Arnold; David Elliot; Amy Peachey; Abraham Zangen; Paul B Fitzgerald

doi:10.1016/j.brs.2013.10.004

A double-blind, randomized trial of deep repetitive transcranial magnetic stimulation (rTMS) for autism spectrum disorder

Brain Stimul. 2014 Mar-Apr;7(2):206-11. doi: 10.1016/j.brs.2013.10.004. Epub 2013 Oct 27.

Authors

Peter G Enticott¹, Bernadette M Fitzgibbon², Hayley A Kennedy², Sara L Arnold², David Elliot², Amy Peachey², Abraham Zangen³, Paul B Fitzgerald²

Affiliations

¹ Monash Alfred Psychiatry Research Centre, The Alfred and Central Clinical School, Monash University, Level 4, 607 St Kilda Road, Melbourne, Victoria 3004, Australia. Electronic address: peter.enticott@deakin.edu.au.
² Monash Alfred Psychiatry Research Centre, The Alfred and Central Clinical School, Monash University, Level 4, 607 St Kilda Road, Melbourne, Victoria 3004, Australia.
³ Ben Gurion University, Beer-Sheva, Israel.

PMID: 24280031
DOI: 10.1016/j.brs.2013.10.004

Abstract

Background: Biomedical treatment options for autism spectrum disorder (ASD) are extremely limited. Repetitive transcranial magnetic stimulation (rTMS) is a safe and efficacious technique when targeting specific areas of cortical dysfunction in major depressive disorder, and a similar approach could yield therapeutic benefits in ASD, if applied to relevant cortical regions.

Objective: The aim of this study was to examine whether deep rTMS to bilateral dorsomedial prefrontal cortex improves social relating in ASD.

Methods: 28 adults diagnosed with either autistic disorder (high-functioning) or Asperger's disorder completed a prospective, double-blind, randomized, placebo-controlled design with 2 weeks of daily weekday treatment. This involved deep rTMS to bilateral dorsomedial prefrontal cortex (5 Hz, 10-s train duration, 20-s inter-train interval) for 15 min (1500 pulses per session) using a HAUT-Coil. The sham rTMS coil was encased in the same helmet of the active deep rTMS coil, but no effective field was delivered into the brain. Assessments were conducted before, after, and one month following treatment.

Results: Participants in the active condition showed a near significant reduction in self-reported social relating symptoms from pre-treatment to one month follow-up, and a significant reduction in social relating symptoms (relative to sham participants) for both post-treatment assessments. Those in the active condition also showed a reduction in self-oriented anxiety during difficult and emotional social situations from pre-treatment to one month follow-up. There were no changes for those in the sham condition.

Conclusion: Deep rTMS to bilateral dorsomedial prefrontal cortex yielded a reduction in social relating impairment and socially-related anxiety. Further research in this area should employ extended rTMS protocols that approximate those used in depression in an attempt to replicate and amplify the clinical response.

Keywords: Autism spectrum disorder; Deep rTMS; Medial prefrontal cortex; Mentalizing; Social relating.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Asperger Syndrome / physiopathology
Asperger Syndrome / psychology
Asperger Syndrome / therapy*
Autistic Disorder / physiopathology
Autistic Disorder / psychology
Autistic Disorder / therapy*
Double-Blind Method
Female
Humans
Male
Middle Aged
Prefrontal Cortex / physiopathology*
Prospective Studies
Social Adjustment*
Transcranial Magnetic Stimulation / methods*
Treatment Outcome
Young Adult