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Hensel L, Lüdtke J, Brouzou KO, Eickhoff SB, Kamp D, Schilbach L. Noninvasive brain stimulation in autism: review and outlook for personalized interventions in adult patients. Cereb Cortex 2024; 34:8-18. [PMID: 38696602 DOI: 10.1093/cercor/bhae096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/13/2024] [Accepted: 02/21/2024] [Indexed: 05/04/2024] Open
Abstract
Noninvasive brain stimulation (NIBS) has been increasingly investigated during the last decade as a treatment option for persons with autism spectrum disorder (ASD). Yet, previous studies did not reach a consensus on a superior treatment protocol or stimulation target. Persons with ASD often suffer from social isolation and high rates of unemployment, arising from difficulties in social interaction. ASD involves multiple neural systems involved in perception, language, and cognition, and the underlying brain networks of these functional domains have been well documented. Aiming to provide an overview of NIBS effects when targeting these neural systems in late adolescent and adult ASD, we conducted a systematic search of the literature starting at 631 non-duplicate publications, leading to six studies corresponding with inclusion and exclusion criteria. We discuss these studies regarding their treatment rationale and the accordingly chosen methodological setup. The results of these studies vary, while methodological advances may allow to explain some of the variability. Based on these insights, we discuss strategies for future clinical trials to personalize the selection of brain stimulation targets taking into account intersubject variability of brain anatomy as well as function.
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Affiliation(s)
- Lukas Hensel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
- Department of General Psychiatry 2, LVR-Klinikum Düsseldorf, Bergische Landstraße 2, 40629 Düsseldorf, Germany
| | - Jana Lüdtke
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
- Department of General Psychiatry 2, LVR-Klinikum Düsseldorf, Bergische Landstraße 2, 40629 Düsseldorf, Germany
| | - Katia O Brouzou
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
- Department of General Psychiatry 2, LVR-Klinikum Düsseldorf, Bergische Landstraße 2, 40629 Düsseldorf, Germany
- Institute of Systems Neuroscience, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Simon B Eickhoff
- Institute of Systems Neuroscience, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
- Institute of Neuroscience and Medicine, Brain and Behaviour (INM-7), Research Centre Jülich, Wilhelm-Johnen-Straße 1, 52428 Jülich, Germany
| | - Daniel Kamp
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
- Department of General Psychiatry 2, LVR-Klinikum Düsseldorf, Bergische Landstraße 2, 40629 Düsseldorf, Germany
| | - Leonhard Schilbach
- Department of General Psychiatry 2, LVR-Klinikum Düsseldorf, Bergische Landstraße 2, 40629 Düsseldorf, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilians University Munich, Nußbaumstraße 7, 80336 Munich, Germany
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2
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Afshari M, Gharibzadeh S, Pouretemad H, Roghani M. Reversing valproic acid-induced autism-like behaviors through a combination of low-frequency repeated transcranial magnetic stimulation and superparamagnetic iron oxide nanoparticles. Sci Rep 2024; 14:8082. [PMID: 38582936 PMCID: PMC10998842 DOI: 10.1038/s41598-024-58871-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 04/03/2024] [Indexed: 04/08/2024] Open
Abstract
Transcranial magnetic stimulation (TMS) is a neurostimulation device used to modulate brain cortex activity. Our objective was to enhance the therapeutic effectiveness of low-frequency repeated TMS (LF-rTMS) in a rat model of autism spectrum disorder (ASD) induced by prenatal valproic acid (VPA) exposure through the injection of superparamagnetic iron oxide nanoparticles (SPIONs). For the induction of ASD, we administered prenatal VPA (600 mg/kg, I.P.) on the 12.5th day of pregnancy. At postnatal day 30, SPIONs were injected directly into the lateral ventricle of the brain. Subsequently, LF-rTMS treatment was applied for 14 consecutive days. Following the treatment period, behavioral analyses were conducted. At postnatal day 60, brain tissue was extracted, and both biochemical and histological analyses were performed. Our data revealed that prenatal VPA exposure led to behavioral alterations, including changes in social interactions, increased anxiety, and repetitive behavior, along with dysfunction in stress coping strategies. Additionally, we observed reduced levels of SYN, MAP2, and BDNF. These changes were accompanied by a decrease in dendritic spine density in the hippocampal CA1 area. However, LF-rTMS treatment combined with SPIONs successfully reversed these dysfunctions at the behavioral, biochemical, and histological levels, introducing a successful approach for the treatment of ASD.
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Affiliation(s)
- Masoud Afshari
- Department of Cognitive Psychology, Institute for Cognitive and Brain Sciences, Shahid Beheshti University, Tehran, Iran
| | - Shahriar Gharibzadeh
- Department of Cognitive Psychology, Institute for Cognitive and Brain Sciences, Shahid Beheshti University, Tehran, Iran.
| | - Hamidreza Pouretemad
- Department of Cognitive Psychology, Institute for Cognitive and Brain Sciences, Shahid Beheshti University, Tehran, Iran
| | - Mehrdad Roghani
- Neurophysiology Research Center, Shahed University, Tehran, Iran.
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3
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Farzan F. Transcranial Magnetic Stimulation-Electroencephalography for Biomarker Discovery in Psychiatry. Biol Psychiatry 2024; 95:564-580. [PMID: 38142721 DOI: 10.1016/j.biopsych.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 12/08/2023] [Accepted: 12/15/2023] [Indexed: 12/26/2023]
Abstract
Current diagnosis and treatment of psychiatric illnesses are still based on behavioral observations and self-reports, commonly leading to prolonged untreated illness. Biological markers (biomarkers) may offer an opportunity to revolutionize clinical psychiatry practice by helping provide faster and potentially more effective therapies. Transcranial magnetic stimulation concurrent with electroencephalography (TMS-EEG) is a noninvasive brain mapping methodology that can assess the functions and dynamics of specific brain circuitries in awake humans and aid in biomarker discovery. This article provides an overview of TMS-EEG-based biomarkers that may hold potential in psychiatry. The methodological readiness of the TMS-EEG approach and steps in the validation of TMS-EEG biomarkers for clinical utility are discussed. Biomarker discovery with TMS-EEG is in the early stages, and several validation steps are still required before clinical implementations are realized. Thus far, TMS-EEG predictors of response to magnetic brain stimulation treatments in particular have shown promise for translation to clinical practice. Larger-scale studies can confirm validation followed by biomarker-informed trials to assess added value compared to existing practice.
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Affiliation(s)
- Faranak Farzan
- eBrain Lab, School of Mechatronic Systems Engineering, Simon Fraser University, Surrey, British Columbia, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
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4
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Vaishnavi S. Transcranial Magnetic Stimulation for Developmental Neuropsychiatric Disorders with Inflammation. Dev Neurosci 2023; 45:342-348. [PMID: 37944502 PMCID: PMC10664335 DOI: 10.1159/000535103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 11/07/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Transcranial magnetic stimulation (TMS) is a noninvasive brain stimulation technique that may potentially be helpful for neuropsychiatric symptoms of developmental disorders with inflammatory aspects. TMS utilizes a varying magnetic field to induce electrical changes in the brain. Repetitive use of TMS modulates plasticity at multiple levels, particularly at the synapse and network level. SUMMARY As inflammation can affect synaptic plasticity negatively, TMS may theoretically be a tool to address this inflammation-induced dysfunction. There are also data to suggest that TMS can directly downregulate inflammation. Neuropsychiatric consequences of multiple disorders with inflammatory aspects, particularly neurodevelopmental disorders like autism, Tourette syndrome, and obsessive-compulsive disorder (OCD), maybe treated effectively with TMS. Treatment of OCD, treatment-resistant major depression, and nicotine cessation (all in adults) are currently FDA-cleared indications, while migraine is cleared for ages 12 and above. KEY MESSAGES TMS will likely continue to grow in terms of indications as research continues to assess what brain networks are dysfunctional in various disorders and it becomes clearer how to modulate these networks. TMS may thus be best understood as a technology platform that can be utilized to modulate different brain networks affected in neuropsychiatric disorders. TMS is likely to become an increasingly important tool in targeting brain networks that could become dysfunctional in part due to inflammation in the developing brain and addressing consequent neuropsychiatric symptoms.
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Affiliation(s)
- Sandeep Vaishnavi
- Duke Institute for Brain Sciences, Duke University, Durham, NC, USA
- Center for Neuropsychiatry and Brain Stimulation, ARC Health, Cary, NC, USA
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Han YM, Chan MM, Shea CK, Mo FY, Yiu KW, Chung RC, Cheung MC, Chan AS. Effects of prefrontal transcranial direct current stimulation on social functioning in autism spectrum disorder: A randomized clinical trial. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:2465-2482. [PMID: 37151094 DOI: 10.1177/13623613231169547] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
LAY ABSTRACT Currently available pharmacological and behavioral interventions for adolescents and young adults with autism spectrum disorder (ASD) yield only modest effect in alleviating their core behavioral and cognitive symptoms, and some of these treatment options are associated with undesirable side effects. Hence, developing effective treatment protocols is urgently needed. Given emerging evidence shows that the abnormal connections of the frontal brain regions contribute to the manifestations of ASD behavioral and cognitive impairments, noninvasive treatment modalities that are capable in modulating brain connections, such as transcranial direct current stimulation (tDCS), have been postulated to be potentially promising for alleviating core symptoms in ASD. However, whether tDCS can reduce behavioral symptoms and enhance cognitive performance in ASD remains unclear. This randomized controlled trial involving 105 adolescents and young adults with ASD showed that multiple sessions of a tDCS protocol, which was paired up with computerized cognitive training, was effective in improving social functioning in adolescents and young adults with ASD. No prolonged and serious side effects were observed. With more future studies conducted in different clinical settings that recruit participants from a wider age range, this tDCS protocol may be potentially beneficial to a broad spectrum of individuals with autism.
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Affiliation(s)
| | - Melody My Chan
- The Hong Kong Polytechnic University, Hong Kong
- The University of Queensland, Australia
| | - Caroline Ks Shea
- Hospital Authority, Hong Kong
- The Chinese University of Hong Kong, Hong Kong
| | - Flora Ym Mo
- Hospital Authority, Hong Kong
- The Chinese University of Hong Kong, Hong Kong
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Zheng Y, Tang S, Zheng H, Wang X, Liu L, Yang Y, Zhen Y, Zheng Z. Noise improves the association between effects of local stimulation and structural degree of brain networks. PLoS Comput Biol 2023; 19:e1010866. [PMID: 37167331 PMCID: PMC10205011 DOI: 10.1371/journal.pcbi.1010866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 05/23/2023] [Accepted: 04/20/2023] [Indexed: 05/13/2023] Open
Abstract
Stimulation to local areas remarkably affects brain activity patterns, which can be exploited to investigate neural bases of cognitive function and modify pathological brain statuses. There has been growing interest in exploring the fundamental action mechanisms of local stimulation. Nevertheless, how noise amplitude, an essential element in neural dynamics, influences stimulation-induced brain states remains unknown. Here, we systematically examine the effects of local stimulation by using a large-scale biophysical model under different combinations of noise amplitudes and stimulation sites. We demonstrate that noise amplitude nonlinearly and heterogeneously tunes the stimulation effects from both regional and network perspectives. Furthermore, by incorporating the role of the anatomical network, we show that the peak frequencies of unstimulated areas at different stimulation sites averaged across noise amplitudes are highly positively related to structural connectivity. Crucially, the association between the overall changes in functional connectivity as well as the alterations in the constraints imposed by structural connectivity with the structural degree of stimulation sites is nonmonotonically influenced by the noise amplitude, with the association increasing in specific noise amplitude ranges. Moreover, the impacts of local stimulation of cognitive systems depend on the complex interplay between the noise amplitude and average structural degree. Overall, this work provides theoretical insights into how noise amplitude and network structure jointly modulate brain dynamics during stimulation and introduces possibilities for better predicting and controlling stimulation outcomes.
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Affiliation(s)
- Yi Zheng
- School of Mathematical Sciences, Beihang University, Beijing, China
- Key laboratory of Mathematics, Informatics and Behavioral Semantics (LMIB), Beihang University, Beijing, China
| | - Shaoting Tang
- Institute of Artificial Intelligence, Beihang University, Beijing, China
- Key laboratory of Mathematics, Informatics and Behavioral Semantics (LMIB), Beihang University, Beijing, China
- State Key Lab of Software Development Environment (NLSDE), Beihang University, Beijing, China
- Zhongguancun Laboratory, Beijing, P.R. China
- Beijing Advanced Innovation Center for Future Blockchain and Privacy Computing, Beihang University, Beijing, China
- PengCheng Laboratory, Shenzhen, China
- Institute of Medical Artificial Intelligence, Binzhou Medical University, Yantai, China
- School of Mathematical Sciences, Dalian University of Technology, Dalian, China
| | - Hongwei Zheng
- Beijing Academy of Blockchain and Edge Computing (BABEC), Beijing, China
| | - Xin Wang
- Institute of Artificial Intelligence, Beihang University, Beijing, China
- Key laboratory of Mathematics, Informatics and Behavioral Semantics (LMIB), Beihang University, Beijing, China
- State Key Lab of Software Development Environment (NLSDE), Beihang University, Beijing, China
- Zhongguancun Laboratory, Beijing, P.R. China
- Beijing Advanced Innovation Center for Future Blockchain and Privacy Computing, Beihang University, Beijing, China
- PengCheng Laboratory, Shenzhen, China
| | - Longzhao Liu
- Institute of Artificial Intelligence, Beihang University, Beijing, China
- Key laboratory of Mathematics, Informatics and Behavioral Semantics (LMIB), Beihang University, Beijing, China
- State Key Lab of Software Development Environment (NLSDE), Beihang University, Beijing, China
- Zhongguancun Laboratory, Beijing, P.R. China
- Beijing Advanced Innovation Center for Future Blockchain and Privacy Computing, Beihang University, Beijing, China
- PengCheng Laboratory, Shenzhen, China
| | - Yaqian Yang
- School of Mathematical Sciences, Beihang University, Beijing, China
- Key laboratory of Mathematics, Informatics and Behavioral Semantics (LMIB), Beihang University, Beijing, China
| | - Yi Zhen
- School of Mathematical Sciences, Beihang University, Beijing, China
- Key laboratory of Mathematics, Informatics and Behavioral Semantics (LMIB), Beihang University, Beijing, China
| | - Zhiming Zheng
- Institute of Artificial Intelligence, Beihang University, Beijing, China
- Key laboratory of Mathematics, Informatics and Behavioral Semantics (LMIB), Beihang University, Beijing, China
- State Key Lab of Software Development Environment (NLSDE), Beihang University, Beijing, China
- Zhongguancun Laboratory, Beijing, P.R. China
- Beijing Advanced Innovation Center for Future Blockchain and Privacy Computing, Beihang University, Beijing, China
- PengCheng Laboratory, Shenzhen, China
- Institute of Medical Artificial Intelligence, Binzhou Medical University, Yantai, China
- School of Mathematical Sciences, Dalian University of Technology, Dalian, China
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7
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Shamim S, Khan N, Greene DL, Habiba UE, Umer A. The promise of autologous and allogeneic cellular therapies in the clinical trials of autism spectrum disorder. Regen Med 2023; 18:347-361. [PMID: 36935631 DOI: 10.2217/rme-2022-0176] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023] Open
Abstract
Autism spectrum disorder (ASD) is a consortium of developmental conditions. As scientists have not yet identified the exact underlying cause for these disorders, it is not easy to narrow down a singular therapy to propose a reliable cure. The preponderance of research suggests that stem-cell therapy improves aspects of outcome measure scales in patients with ASD; therefore, future studies should give us more confidence in the results. This overview considers the data that have emerged from the small set of published trials conducted using different approaches in stem-cell therapy for ASD, evaluates their results and proposes additional steps that could be taken if this field of endeavor is to be pursued further.
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Affiliation(s)
- Sabiha Shamim
- Bello Bio Labs & Therapeutics (SMC) Pvt. Ltd, Jahangir Multiplex, Peshawar Road, Sector H-13 Islamabad, 44000, Pakistan
| | - Nasar Khan
- Bello Bio Labs & Therapeutics (SMC) Pvt. Ltd, Jahangir Multiplex, Peshawar Road, Sector H-13 Islamabad, 44000, Pakistan.,R3 Medical Research LLC, 10045 East Dynamite Boulevard Suite 260, Scottsdale, AZ 85262, United States of America
| | - David L Greene
- Bello Bio Labs & Therapeutics (SMC) Pvt. Ltd, Jahangir Multiplex, Peshawar Road, Sector H-13 Islamabad, 44000, Pakistan.,R3 Medical Research LLC, 10045 East Dynamite Boulevard Suite 260, Scottsdale, AZ 85262, United States of America
| | - Umm E Habiba
- Bello Bio Labs & Therapeutics (SMC) Pvt. Ltd, Jahangir Multiplex, Peshawar Road, Sector H-13 Islamabad, 44000, Pakistan
| | - Amna Umer
- Bello Bio Labs & Therapeutics (SMC) Pvt. Ltd, Jahangir Multiplex, Peshawar Road, Sector H-13 Islamabad, 44000, Pakistan
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8
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Huashuang Z, Yang L, Chensheng H, Jing X, Bo C, Dongming Z, Kangfu L, Shi-Bin W. Prevalence of Adverse Effects Associated With Transcranial Magnetic Stimulation for Autism Spectrum Disorder: A Systematic Review and Meta-Analysis. Front Psychiatry 2022; 13:875591. [PMID: 35677871 PMCID: PMC9168239 DOI: 10.3389/fpsyt.2022.875591] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/19/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND A growing number of studies have suggested that transcranial magnetic stimulation (TMS) may represent a novel technique with both investigative and therapeutic potential for autism spectrum disorder (ASD). However, a full spectrum of the adverse effects (AEs) of TMS used in ASD has not been specifically and systematically evaluated. OBJECTIVE This systematic review and meta-analysis was to assess the prevalence of AEs related to TMS in ASD and to further explore the potentially related factors on the AEs. METHODS A systematic literature research of articles published before 31 December 2020 was conducted in the databases of PubMed, Embase, Cochrane Library, Ovid, PsycINFO, Chinese National Knowledge Infrastructure (CNKI), Chongqing VIP, and WANFANG DATA. AEs reported in the studies were carefully examined and synthesized to understand the safety and tolerability of TMS among ASD. Then, subgroup and sensitivity analyses were performed to examine the potentially related factors on the AEs. PROSPERO registration number: CRD42021239827. RESULTS Eleven studies were included in the meta-analysis. The pooled prevalence with 95% confidence interval (CI) of AEs was calculated (overall AEs: 25%, 95% CI 18-33%; headache: 10%, 95% CI 3-19%; facial discomfort: 15%, 95% CI 4-29%; irritability 21%, 95% CI 8-37%; pain at the application site: 6%, 95% CI 0-19%; headedness or dizziness: 8%, 95% CI 0-23%). All reported AEs were mild and transient with relatively few serious AEs and can be resolved after having a rest or medication. In addition, the following variables showed no significant change in overall prevalence of AEs: the purpose of using TMS, mean age of participants, whether the stimulation site was dorsolateral pre-frontal cortex (DLPFC), intensity of TMS, and the number of stimulation sessions. CONCLUSION The overall prevalence of reported AEs of TMS among ASD was 25%. No identified ASD-specific risk factors for TMS-induced AEs were found. Further studies are needed to clarify the variation in the prevalence. SYSTEMATIC REVIEW REGISTRATION www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=239827, PROSPERO, identifier: CRD42021239827.
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Affiliation(s)
- Zhang Huashuang
- Institute for Brain Research and Rehabilitation, South China Normal University, Guangzhou, China.,Department of Ophthalmology, Affiliated Foshan Hospital, Southern Medical University, Foshan, China
| | - Li Yang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Hou Chensheng
- Institute for Brain Research and Rehabilitation, South China Normal University, Guangzhou, China
| | - Xin Jing
- Department of Pediatric Rehabilitation Medicine, Foshan Fosun Chancheng Hospital, Foshan, China
| | - Chen Bo
- Department of Cardiovascular Surgery, The People's Hospital of Gaozhou, Gaozhou, China
| | - Zhang Dongming
- Department of Neurology, Foshan Fosun Chancheng Hospital, Foshan, China
| | - Liang Kangfu
- Department of Ophthalmology, Affiliated Foshan Hospital, Southern Medical University, Foshan, China
| | - Wang Shi-Bin
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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9
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Padrón I, García-Marco E, Moreno I, Birba A, Silvestri V, León I, Álvarez C, López J, de Vega M. Multisession Anodal tDCS on the Right Temporo-Parietal Junction Improves Mentalizing Processes in Adults with Autistic Traits. Brain Sci 2021; 12:brainsci12010030. [PMID: 35053774 PMCID: PMC8773564 DOI: 10.3390/brainsci12010030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/21/2021] [Accepted: 12/25/2021] [Indexed: 11/16/2022] Open
Abstract
Persons with autism spectrum disorder (ASD) have impaired mentalizing skills. In this study, a group of persons with ASD traits (high-AQ scores) initially received sham tDCS before completing a pre-test in two mentalizing tasks: false belief and self-other judgments. Over the next week, on four consecutive days, they received sessions of anodal electrical stimulation (a-tDCS) over the right temporo-parietal junction (rTPJ), a region frequently associated with the theory of mind. On the last day, after the stimulation session, they completed a new set of mentalizing tasks. A control group (with low-AQ scores) matched in age, education and intelligence received just sham stimulation and completed the same pre-test and post-test. The results showed that the high-AQ group improved their performance (faster responses), after a-tDCS, in the false belief and in the self-other judgments of mental features, whereas they did not change performance in the false photographs or the self-other judgments of physical features. These selective improvements cannot be attributed to increased familiarity with the tasks, because the performance of the low-AQ control group remained stable about one week later. Therefore, our study provides initial proof that tDCS could be used to improve mentalizing skills in persons with ASD traits.
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Affiliation(s)
- Iván Padrón
- Instituto Universitario de Neurociencia, Universidad de La Laguna, 38200 La Laguna, Spain; (I.P.); (E.G.-M.); (I.M.); (I.L.); (C.Á.); (J.L.)
| | - Enrique García-Marco
- Instituto Universitario de Neurociencia, Universidad de La Laguna, 38200 La Laguna, Spain; (I.P.); (E.G.-M.); (I.M.); (I.L.); (C.Á.); (J.L.)
- Facultad de Ciencias de la Salud, Universidad Europea de Canarias, 38300 La Orotava, Spain
- Facultad de Psicología, Universidad Nacional de Educación a Distancia (UNED), 28040 Madrid, Spain
| | - Iván Moreno
- Instituto Universitario de Neurociencia, Universidad de La Laguna, 38200 La Laguna, Spain; (I.P.); (E.G.-M.); (I.M.); (I.L.); (C.Á.); (J.L.)
| | - Agustina Birba
- Cognitive Neuroscience Center (CNC), Universidad de San Andrés, Buenos Aires B1644BID, Argentina;
- National Scientific and Technical Research Council (CONICET), Buenos Aires C1033AAJ, Argentina
| | - Valentina Silvestri
- Department of Psychology, University of Milan-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milan, Italy;
| | - Inmaculada León
- Instituto Universitario de Neurociencia, Universidad de La Laguna, 38200 La Laguna, Spain; (I.P.); (E.G.-M.); (I.M.); (I.L.); (C.Á.); (J.L.)
| | - Carlos Álvarez
- Instituto Universitario de Neurociencia, Universidad de La Laguna, 38200 La Laguna, Spain; (I.P.); (E.G.-M.); (I.M.); (I.L.); (C.Á.); (J.L.)
| | - Joana López
- Instituto Universitario de Neurociencia, Universidad de La Laguna, 38200 La Laguna, Spain; (I.P.); (E.G.-M.); (I.M.); (I.L.); (C.Á.); (J.L.)
- Department of Psychology, Faculty of Health Sciences, University of Hull, Hull HU6 7RX, UK
| | - Manuel de Vega
- Instituto Universitario de Neurociencia, Universidad de La Laguna, 38200 La Laguna, Spain; (I.P.); (E.G.-M.); (I.M.); (I.L.); (C.Á.); (J.L.)
- Correspondence: ; Tel.: +34-630027293
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10
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Khodatars M, Shoeibi A, Sadeghi D, Ghaasemi N, Jafari M, Moridian P, Khadem A, Alizadehsani R, Zare A, Kong Y, Khosravi A, Nahavandi S, Hussain S, Acharya UR, Berk M. Deep learning for neuroimaging-based diagnosis and rehabilitation of Autism Spectrum Disorder: A review. Comput Biol Med 2021; 139:104949. [PMID: 34737139 DOI: 10.1016/j.compbiomed.2021.104949] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/02/2021] [Accepted: 10/13/2021] [Indexed: 01/23/2023]
Abstract
Accurate diagnosis of Autism Spectrum Disorder (ASD) followed by effective rehabilitation is essential for the management of this disorder. Artificial intelligence (AI) techniques can aid physicians to apply automatic diagnosis and rehabilitation procedures. AI techniques comprise traditional machine learning (ML) approaches and deep learning (DL) techniques. Conventional ML methods employ various feature extraction and classification techniques, but in DL, the process of feature extraction and classification is accomplished intelligently and integrally. DL methods for diagnosis of ASD have been focused on neuroimaging-based approaches. Neuroimaging techniques are non-invasive disease markers potentially useful for ASD diagnosis. Structural and functional neuroimaging techniques provide physicians substantial information about the structure (anatomy and structural connectivity) and function (activity and functional connectivity) of the brain. Due to the intricate structure and function of the brain, proposing optimum procedures for ASD diagnosis with neuroimaging data without exploiting powerful AI techniques like DL may be challenging. In this paper, studies conducted with the aid of DL networks to distinguish ASD are investigated. Rehabilitation tools provided for supporting ASD patients utilizing DL networks are also assessed. Finally, we will present important challenges in the automated detection and rehabilitation of ASD and propose some future works.
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Affiliation(s)
- Marjane Khodatars
- Dept. of Medical Engineering, Mashhad Branch, Islamic Azad University, Mashhad, Iran
| | - Afshin Shoeibi
- Faculty of Electrical Engineering, FPGA Lab, K. N. Toosi University of Technology, Tehran, Iran; Computer Engineering Department, Ferdowsi University of Mashhad, Mashhad, Iran.
| | - Delaram Sadeghi
- Dept. of Medical Engineering, Mashhad Branch, Islamic Azad University, Mashhad, Iran
| | - Navid Ghaasemi
- Faculty of Electrical Engineering, FPGA Lab, K. N. Toosi University of Technology, Tehran, Iran; Computer Engineering Department, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Mahboobeh Jafari
- Electrical and Computer Engineering Faculty, Semnan University, Semnan, Iran
| | - Parisa Moridian
- Faculty of Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Ali Khadem
- Department of Biomedical Engineering, Faculty of Electrical Engineering, K. N. Toosi University of Technology, Tehran, Iran.
| | - Roohallah Alizadehsani
- Institute for Intelligent Systems Research and Innovation (IISRI), Deakin University, Victoria, 3217, Australia
| | - Assef Zare
- Faculty of Electrical Engineering, Gonabad Branch, Islamic Azad University, Gonabad, Iran
| | - Yinan Kong
- School of Engineering, Macquarie University, Sydney, 2109, Australia
| | - Abbas Khosravi
- Institute for Intelligent Systems Research and Innovation (IISRI), Deakin University, Victoria, 3217, Australia
| | - Saeid Nahavandi
- Institute for Intelligent Systems Research and Innovation (IISRI), Deakin University, Victoria, 3217, Australia
| | | | - U Rajendra Acharya
- Ngee Ann Polytechnic, Singapore, 599489, Singapore; Dept. of Biomedical Informatics and Medical Engineering, Asia University, Taichung, Taiwan; Dept. of Biomedical Engineering, School of Science and Technology, Singapore University of Social Sciences, Singapore
| | - Michael Berk
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, The University of Melbourne, Melbourne, Australia
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11
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Elias GJB, Boutet A, Parmar R, Wong EHY, Germann J, Loh A, Paff M, Pancholi A, Gwun D, Chow CT, Gouveia FV, Harmsen IE, Beyn ME, Santarnecchi E, Fasano A, Blumberger DM, Kennedy SH, Lozano AM, Bhat V. Neuromodulatory treatments for psychiatric disease: A comprehensive survey of the clinical trial landscape. Brain Stimul 2021; 14:1393-1403. [PMID: 34461326 DOI: 10.1016/j.brs.2021.08.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 08/21/2021] [Accepted: 08/24/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Numerous neuromodulatory therapies are currently under investigation or in clinical use for the treatment of psychiatric conditions. OBJECTIVE/HYPOTHESIS We sought to catalogue past and present human research studies on psychiatric neuromodulation and identify relevant trends in this field. METHODS ClinicalTrials.gov (https://www.clinicaltrials.gov/) and the International Clinical Trials Registry Platform (https://www.who.int/ictrp/en/) were queried in March 2020 for trials assessing the outcome of neuromodulation for psychiatric disorders. Relevant trials were categorized by variables such as neuromodulation modality, country, brain target, publication status, design, and funding source. RESULTS From 72,086 initial search results, 1252 unique trials were identified. The number of trials registered annually has consistently increased. Half of all trials were active and a quarter have translated to publications. The largest proportion of trials involved depression (45%), schizophrenia (18%), and substance use disorders (14%). Trials spanned 37 countries; China, the second largest contributor (13%) after the United States (28%), has increased its output substantially in recent years. Over 75% of trials involved non-convulsive non-invasive modalities (e.g., transcranial magnetic stimulation), while convulsive (e.g., electroconvulsive therapy) and invasive modalities (e.g., deep brain stimulation) were less represented. 72% of trials featured approved or cleared interventions. Characteristic inter-modality differences were observed with respect to enrollment size, trial design/phase, and funding. Dorsolateral prefrontal cortex accounted for over half of focal neuromodulation trial targets. The proportion of trials examining biological correlates of neuromodulation has increased. CONCLUSION(S) These results provide a comprehensive overview of the state of psychiatric neuromodulation research, revealing the growing scope and internationalism of this field.
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Affiliation(s)
- Gavin J B Elias
- Division of Neurosurgery, Department of Surgery, University Health Network & University of Toronto, Toronto, Canada; Krembil Research Institute, University of Toronto, Toronto, Canada
| | - Alexandre Boutet
- Division of Neurosurgery, Department of Surgery, University Health Network & University of Toronto, Toronto, Canada; Krembil Research Institute, University of Toronto, Toronto, Canada; Joint Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Roohie Parmar
- Division of Neurosurgery, Department of Surgery, University Health Network & University of Toronto, Toronto, Canada
| | - Emily H Y Wong
- Division of Neurosurgery, Department of Surgery, University Health Network & University of Toronto, Toronto, Canada
| | - Jürgen Germann
- Division of Neurosurgery, Department of Surgery, University Health Network & University of Toronto, Toronto, Canada; Krembil Research Institute, University of Toronto, Toronto, Canada
| | - Aaron Loh
- Division of Neurosurgery, Department of Surgery, University Health Network & University of Toronto, Toronto, Canada; Krembil Research Institute, University of Toronto, Toronto, Canada
| | - Michelle Paff
- Division of Neurosurgery, Department of Surgery, University Health Network & University of Toronto, Toronto, Canada
| | - Aditya Pancholi
- Division of Neurosurgery, Department of Surgery, University Health Network & University of Toronto, Toronto, Canada
| | - Dave Gwun
- Division of Neurosurgery, Department of Surgery, University Health Network & University of Toronto, Toronto, Canada
| | - Clement T Chow
- Division of Neurosurgery, Department of Surgery, University Health Network & University of Toronto, Toronto, Canada
| | - Flavia Venetucci Gouveia
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre & University of Toronto, Toronto, Canada
| | - Irene E Harmsen
- Division of Neurosurgery, Department of Surgery, University Health Network & University of Toronto, Toronto, Canada; Krembil Research Institute, University of Toronto, Toronto, Canada
| | - Michelle E Beyn
- Division of Neurosurgery, Department of Surgery, University Health Network & University of Toronto, Toronto, Canada
| | - Emiliano Santarnecchi
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, United States
| | - Alfonso Fasano
- Krembil Research Institute, University of Toronto, Toronto, Canada; Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, University Health Network, Toronto, Canada; Center for Advancing Neurotechnological Innovation to Application, Toronto, Canada
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University Health Network & University of Toronto, Toronto, Canada
| | - Sidney H Kennedy
- Krembil Research Institute, University of Toronto, Toronto, Canada; Department of Psychiatry, University Health Network & University of Toronto, Toronto, Canada; Centre for Depression & Suicide Studies, St. Michael's Hospital & University of Toronto, Toronto, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, University Health Network & University of Toronto, Toronto, Canada; Krembil Research Institute, University of Toronto, Toronto, Canada
| | - Venkat Bhat
- Krembil Research Institute, University of Toronto, Toronto, Canada; Department of Psychiatry, University Health Network & University of Toronto, Toronto, Canada; Centre for Depression & Suicide Studies, St. Michael's Hospital & University of Toronto, Toronto, Canada.
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12
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García-González S, Lugo-Marín J, Setien-Ramos I, Gisbert-Gustemps L, Arteaga-Henríquez G, Díez-Villoria E, Ramos-Quiroga JA. Transcranial direct current stimulation in Autism Spectrum Disorder: A systematic review and meta-analysis. Eur Neuropsychopharmacol 2021; 48:89-109. [PMID: 33773886 DOI: 10.1016/j.euroneuro.2021.02.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 02/11/2021] [Accepted: 02/24/2021] [Indexed: 02/06/2023]
Abstract
Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that has gained relevance in recent years as an alternative treatment for neuropsychiatric conditions. The aim of this study is to conduct a systematic review of the use of tDCS in Autism Spectrum Disorder (ASD). Both electronic and manual searches were conducted to identify studies published in peer-reviewed scientific journals addressing the use of tDCS in ASD population. A total of 16 studies fulfilled the criteria to be included in the review. Studies were conducted both in child and adult population. Anodal stimulation on the left dorsolateral prefrontal cortex was the most commonly chosen methodology. Outcomes addressed ASD symptoms and neuropsychological functions. Meta-analytic synthesis identified improvements in social, health, and behavioral problem domains of the Autism Treatment Evaluation Checklist. Limitations included high heterogeneity in the methodology and low-efficacy study designs (pre-post and single-case studies). Recent controlled trials shed promising results for the use of tDCS in ASD. A standardized stimulation protocol and a consensus in the measures used in the evaluation of the efficacy are imperative.
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Affiliation(s)
- Sara García-González
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain
| | - Jorge Lugo-Marín
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain
| | - Imanol Setien-Ramos
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain
| | - Laura Gisbert-Gustemps
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Gara Arteaga-Henríquez
- Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain
| | - Emiliano Díez-Villoria
- Centro de Atención Integral al Autismo-InFoAutismo, INICO-Instituto Universitario de Integración en la Comunidad, University of Salamanca, Salamanca, Spain
| | - Josep Antoni Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Psychiatric Genetics Unit, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain.
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13
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McCann H, Beltrachini L. Does participant's age impact on tDCS induced fields? Insights from computational simulations. Biomed Phys Eng Express 2021; 7. [PMID: 34038881 DOI: 10.1088/2057-1976/ac0547] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 05/26/2021] [Indexed: 12/20/2022]
Abstract
Objective: Understanding the induced current flow from transcranial direct current stimulation (tDCS) is essential for determining the optimal dose and treatment. Head tissue conductivities play a key role in the resulting electromagnetic fields. However, there exists a complicated relationship between skull conductivity and participant age, that remains unclear. We explored how variations in skull electrical conductivities, particularly as a suggested function of age, affected tDCS induced electric fields.Approach: Simulations were employed to compare tDCS outcomes for different intensities across head atlases of varying age. Three databases were chosen to demonstrate differing variability in skull conductivity with age and how this may affect induced fields. Differences in tDCS electric fields due to proposed age-dependent skull conductivity variation, as well as deviations in grey matter, white matter and scalp, were compared and the most influential tissues determined.Main results: tDCS induced peak electric fields significantly negatively correlated with age, exacerbated by employing proposed age-appropriate skull conductivity (according to all three datasets). Uncertainty in skull conductivity was the most sensitive to changes in peak fields with increasing age. These results were revealed to be directly due to changing skull conductivity, rather than head geometry alone. There was no correlation between tDCS focality and age.Significance: Accurate and individualised head anatomy andin vivoskull conductivity measurements are essential for modelling tDCS induced fields. In particular, age should be taken into account when considering stimulation dose to precisely predict outcomes.
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Affiliation(s)
- Hannah McCann
- School of Physics and Astronomy, Cardiff University, Cardiff, United Kingdom.,Cardiff University Brain Research Imaging Centre (CUBRIC), Cardiff, United Kingdom
| | - Leandro Beltrachini
- School of Physics and Astronomy, Cardiff University, Cardiff, United Kingdom.,Cardiff University Brain Research Imaging Centre (CUBRIC), Cardiff, United Kingdom
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14
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Chen D, Jia T, Zhang Y, Cao M, Loth E, Lo CYZ, Cheng W, Liu Z, Gong W, Sahakian BJ, Feng J. Neural Biomarkers Distinguish Severe From Mild Autism Spectrum Disorder Among High-Functioning Individuals. Front Hum Neurosci 2021; 15:657857. [PMID: 34025376 PMCID: PMC8134539 DOI: 10.3389/fnhum.2021.657857] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 03/11/2021] [Indexed: 01/01/2023] Open
Abstract
Several previous studies have reported atypicality in resting-state functional connectivity (FC) in autism spectrum disorder (ASD), yet the relatively small effect sizes prevent us from using these characteristics for diagnostic purposes. Here, canonical correlation analysis (CCA) and hierarchical clustering were used to partition the high-functioning ASD group (i.e., the ASD discovery group) into subgroups. A support vector machine (SVM) model was trained through the 10-fold strategy to predict Autism Diagnostic Observation Schedule (ADOS) scores within the ASD discovery group (r = 0.30, P < 0.001, n = 260), which was further validated in an independent sample (i.e., the ASD validation group) (r = 0.35, P = 0.031, n = 29). The neuroimage-based partition derived two subgroups representing severe versus mild autistic patients. We identified FCs that show graded changes in strength from ASD-severe, through ASD-mild, to controls, while the same pattern cannot be observed in partitions based on ADOS score. We also identified FCs that are specific for ASD-mild, similar to a partition based on ADOS score. The current study provided multiple pieces of evidence with replication to show that resting-state functional magnetic resonance imaging (rsfMRI) FCs could serve as neural biomarkers in partitioning high-functioning autistic individuals based on their symptom severity and showing advantages over traditional partition based on ADOS score. Our results also indicate a compensatory role for a frontocortical network in patients with mild ASD, indicating potential targets for future clinical treatments.
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Affiliation(s)
- Di Chen
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China.,Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Ministry of Education, Shanghai, China
| | - Tianye Jia
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China.,Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Ministry of Education, Shanghai, China.,Centre for Population Neuroscience and Precision Medicine, MRC SGDP Centre, IoPPN, King's College London, London, United Kingdom
| | - Yuning Zhang
- Centre for Population Neuroscience and Precision Medicine, MRC SGDP Centre, IoPPN, King's College London, London, United Kingdom.,State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China.,School of Psychology, University of Southampton, Southampton, United Kingdom
| | - Miao Cao
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China.,Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Ministry of Education, Shanghai, China
| | - Eva Loth
- Sackler Institute for Translational Neurodevelopment, Department of Forensic and Neurodevelopmental Sciences, IoPPN, King's College London, London, United Kingdom
| | - Chun-Yi Zac Lo
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China.,Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Ministry of Education, Shanghai, China
| | - Wei Cheng
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China.,Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Ministry of Education, Shanghai, China
| | - Zhaowen Liu
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Weikang Gong
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Barbara Jacquelyn Sahakian
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Jianfeng Feng
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China.,Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Ministry of Education, Shanghai, China.,School of Mathematical Sciences and Centre for Computational Systems Biology, Fudan University, Shanghai, China.,Department of Computer Science, University of Warwick, Coventry, United Kingdom
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15
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Desarkar P, Rajji TK, Ameis SH, Blumberger DM, Lai MC, Lunsky Y, Daskalakis ZJ. Assessing and stabilizing atypical plasticity in autism spectrum disorder using rTMS: Results from a proof-of-principle study. Clin Neurophysiol 2021; 141:109-118. [PMID: 34011467 DOI: 10.1016/j.clinph.2021.03.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/08/2021] [Accepted: 03/05/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Emerging evidence implicates atypical plasticity in the neurophysiology of autism spectrum disorder (ASD). Specifically, autistic people demonstrated hyperplasticity in response to theta-burst stimulation (TBS). We hypothesized that autistic adults would display hyperplasticity to TBS and that repetitive transcranial magnetic stimulation (rTMS) - which potentiates brain inhibitory mechanisms - would 'stabilize' hyperplasticity. METHODS Using a randomized, cross-over design, plasticity was assessed using TBS in the left motor cortex (M1) in 31 autistic adults and 30 sex-, intelligence quotient-, and age-matched controls. Autistic adults (n = 29) were further randomized (1:1) to receive a single session of active (n = 14) or sham (n = 15) rTMS (6000 pulses at 20 Hz) over left M1 and plasticity was reassessed on the next day following rTMS. RESULTS Both long-term potentiation (LTP) and long-term depression (LTD) were significantly increased in the ASD group, indicating hyperplasticity. Active, but not sham rTMS, attenuated LTD in autistic adults. CONCLUSIONS We provided further evidence for the presence of brain hyperplasticity in ASD. To our knowledge, this is the first study to show preliminary evidence that an excessive LTD in ASD can be 'stabilized' using rTMS. Such 'stabilizing' effect of rTMS on LTP was not observed, likely due to small sample size or a more specific 'attenuating' effect of rTMS on LTD, compared to LTP. SIGNIFICANCE These findings indicate atypical brain inhibitory mechanisms behind hyperplasticity in ASD. Utilizing a larger sample, future replication studies could investigate therapeutic opportunities of 'mechanism-driven' rTMS.
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Affiliation(s)
- Pushpal Desarkar
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.
| | - Tarek K Rajji
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Stephanie H Ameis
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada; The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Daniel M Blumberger
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Meng-Chuan Lai
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Yona Lunsky
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Zafiris J Daskalakis
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of California San Diego, San Diego, CA, USA
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16
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Nagappan A, Kalokairinou L, Wexler A. Ethical and Legal Considerations of Alternative Neurotherapies. AJOB Neurosci 2021; 12:257-269. [PMID: 33759705 DOI: 10.1080/21507740.2021.1896601] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Neurotherapies for diagnostics and treatment-such as electroencephalography (EEG) neurofeedback, single-photon emission computerized tomography (SPECT) imaging for neuropsychiatric evaluation, and off-label/experimental uses of brain stimulation-are continuously being offered to the public outside mainstream healthcare settings. Because these neurotherapies share many key features of complementary and alternative medicine (CAM) techniques-and meet the definition of CAM as set out in Kaptchuk and Eisenberg-here we refer to them as "alternative neurotherapies." By explicitly linking these alternative neurotherapy practices under a common conceptual framework, this paper draws attention to, and critically considers, the cross-cutting ethical and legal issues related to the provision of these services. The first section of this paper provides an updated empirical overview of uses of SPECT neuropsychiatric evaluations, EEG neurofeedback, and experimental/off-label forms of brain stimulation. Next, drawing on CAM bioethics scholarship, we highlight the pertinent ethical issues in the alternative neurotherapy context, including the truthful representation of evidence base, marketing to vulnerable populations, potential harms, provider competency, and conflicts of interest. Finally, we consider the principal legal issues at stake for the provision of alternative neurotherapies in the U.S., namely those related to licensing and scope-of-practice considerations. We conclude with recommendations for future research in this domain.
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17
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Neklyudova AK, Portnova GV, Rebreikina AB, Voinova VY, Vorsanova SG, Iourov IY, Sysoeva OV. 40-Hz Auditory Steady-State Response (ASSR) as a Biomarker of Genetic Defects in the SHANK3 Gene: A Case Report of 15-Year-Old Girl with a Rare Partial SHANK3 Duplication. Int J Mol Sci 2021; 22:ijms22041898. [PMID: 33673024 PMCID: PMC7917917 DOI: 10.3390/ijms22041898] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 01/26/2021] [Accepted: 02/09/2021] [Indexed: 12/02/2022] Open
Abstract
SHANK3 encodes a scaffold protein involved in postsynaptic receptor density in glutamatergic synapses, including those in the parvalbumin (PV)+ inhibitory neurons—the key players in the generation of sensory gamma oscillations, such as 40-Hz auditory steady-state response (ASSR). However, 40-Hz ASSR was not studied in relation to SHANK3 functioning. Here, we present a 15-year-old girl (SH01) with previously unreported duplication of the first seven exons of the SHANK3 gene (22q13.33). SH01’s electroencephalogram (EEG) during 40-Hz click trains of 500 ms duration binaurally presented with inter-trial intervals of 500–800 ms were compared with those from typically developing children (n = 32). SH01 was diagnosed with mild mental retardation and learning disabilities (F70.88), dysgraphia, dyslexia, and smaller vocabulary than typically developing (TD) peers. Her clinical phenotype resembled the phenotype of previously described patients with 22q13.33 microduplications (≈30 reported so far). SH01 had mild autistic symptoms but below the threshold for ASD diagnosis and microcephaly. No seizures or MRI abnormalities were reported. While SH01 had relatively preserved auditory event-related potential (ERP) with slightly attenuated P1, her 40-Hz ASSR was totally absent significantly deviating from TD’s ASSR. The absence of 40-Hz ASSR in patients with microduplication, which affected the SHANK3 gene, indicates deficient temporal resolution of the auditory system, which might underlie language problems and represent a neurophysiological biomarker of SHANK3 abnormalities.
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Affiliation(s)
- Anastasia K. Neklyudova
- Laboratory of Human Higher Nervous Activity, Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Science, 117485 Moscow, Russia; (A.K.N.); (G.V.P.); (A.B.R.)
| | - Galina V. Portnova
- Laboratory of Human Higher Nervous Activity, Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Science, 117485 Moscow, Russia; (A.K.N.); (G.V.P.); (A.B.R.)
| | - Anna B. Rebreikina
- Laboratory of Human Higher Nervous Activity, Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Science, 117485 Moscow, Russia; (A.K.N.); (G.V.P.); (A.B.R.)
| | - Victoria Yu Voinova
- Veltischev Research and Clinical Institute for Pediatrics of the Pirogov, Russian National Research Medical University, Ministry of Health of Russian Federation, 125412 Moscow, Russia; (V.Y.V.); (S.G.V.); (I.Y.I.)
- Mental Health Research Center, 117152 Moscow, Russia
| | - Svetlana G. Vorsanova
- Veltischev Research and Clinical Institute for Pediatrics of the Pirogov, Russian National Research Medical University, Ministry of Health of Russian Federation, 125412 Moscow, Russia; (V.Y.V.); (S.G.V.); (I.Y.I.)
- Mental Health Research Center, 117152 Moscow, Russia
| | - Ivan Y. Iourov
- Veltischev Research and Clinical Institute for Pediatrics of the Pirogov, Russian National Research Medical University, Ministry of Health of Russian Federation, 125412 Moscow, Russia; (V.Y.V.); (S.G.V.); (I.Y.I.)
- Mental Health Research Center, 117152 Moscow, Russia
| | - Olga V. Sysoeva
- Laboratory of Human Higher Nervous Activity, Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Science, 117485 Moscow, Russia; (A.K.N.); (G.V.P.); (A.B.R.)
- Correspondence:
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18
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Penton T, Catmur C, Banissy MJ, Bird G, Walsh V. Non-invasive stimulation in the social brain: the methodological challenges. Soc Cogn Affect Neurosci 2020; 17:15-25. [PMID: 32734295 PMCID: PMC9083106 DOI: 10.1093/scan/nsaa102] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 06/09/2020] [Accepted: 07/15/2020] [Indexed: 11/15/2022] Open
Abstract
Use of non-invasive brain stimulation methods (NIBS) has become a common approach to study social processing in addition to behavioural, imaging and lesion studies. However, research using NIBS to investigate social processing faces challenges. Overcoming these is important to allow valid and reliable interpretation of findings in neurotypical cohorts, but also to allow us to tailor NIBS protocols to atypical groups with social difficulties. In this review, we consider the utility of brain stimulation as a technique to study and modulate social processing. We also discuss challenges that face researchers using NIBS to study social processing in neurotypical adults with a view to highlighting potential solutions. Finally, we discuss additional challenges that face researchers using NIBS to study and modulate social processing in atypical groups. These are important to consider given that NIBS protocols are rarely tailored to atypical groups before use. Instead, many rely on protocols designed for neurotypical adults despite differences in brain function that are likely to impact response to NIBS.
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Affiliation(s)
- Tegan Penton
- Department of Psychology, Goldsmiths, University of London, London, SE14 6NW, UK.,MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, London, SE5 8AF, UK
| | - Caroline Catmur
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, London, SE5 8AF, UK
| | - Michael J Banissy
- Department of Psychology, Goldsmiths, University of London, London, SE14 6NW, UK
| | - Geoffrey Bird
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, London, SE5 8AF, UK.,Department of Experimental Psychology, University of Oxford, Oxford, OX1 3PH
| | - Vincent Walsh
- Institute of Cognitive Neuroscience, University College London, London WC1N 3AR, UK
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19
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Rothärmel M, Moulier V, Vasse M, Isaac C, Faerber M, Bendib B, Mirea-Grivel I, Opolczynski G, Rosier A, Guillin O. A Prospective Open-Label Pilot Study of Transcranial Direct Current Stimulation in High-Functioning Autistic Patients with a Dysexecutive Syndrome. Neuropsychobiology 2020; 78:189-199. [PMID: 31266030 DOI: 10.1159/000501025] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 05/18/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Executive functions (EF) are often impaired in autism spectrum disorder (ASD). Such dysfunctions are associated with anxiety, depression, and a lack of autonomy. Transcranial direct current stimulation (tDCS) has been shown to enhance EF in healthy adults and clinical populations and to improve working memory - a component of the EF - in adults with high-functioning ASD (HF-ASD). We hypothesized that tDCS could improve the EF of HF-ASD patients. Such enhancement could improve their adaptive behaviors. METHOD Eight patients with HF-ASD received 10 consecutive cathodal tDCS sessions (2 mA) over the left dorsolateral prefrontal cortex (F3) for 15 min each in an open trial. EF (with the Stroop test, Trail Making Test [TMT] A and B, Modified Wisconsin Card Sorting Test [mWCST], and Verbal Fluency Test) and behavioral dysexecutive syndrome (with the Behavioral Dysexecutive Syndrome Inventory and the Repetitive and Restricted Behaviour scale) were assessed before and 10 days after treatment. RESULTS This study showed significant improvement in initiation (TMT-A time: p = 0.018) and cognitive flexibility (TMT-B time: p = 0.009; letter Verbal Fluency Test: p = 0.017; mWCST total errors: p = 0.028) after tDCS. Regarding behavior, the hypoactivity of the patients improved, as well as their repetitive and restrictive behaviors. In addition, this noninvasive neurostimulation technique was well tolerated. CONCLUSIONS Flexibility and initiation are the most impaired EF in autism. These are promising results which justify a randomized and placebo-controlled study in a wider population. If these results were confirmed by a randomized controlled trial, tDCS could be an easy and well-tolerated adjunctive treatment aiming to improve the quality of life and the autonomy of ASD patients.
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Affiliation(s)
- Maud Rothärmel
- University Department of Psychiatry, Centre Hospitalier du Rouvray, Sotteville-lès-Rouen, France,
| | - Virginie Moulier
- University Department of Psychiatry, Centre Hospitalier du Rouvray, Sotteville-lès-Rouen, France.,EPS Ville Evrard, Unité de Recherche Clinique, Neuilly-sur-Marne, France
| | - Marianne Vasse
- University Department of Psychiatry, Centre Hospitalier du Rouvray, Sotteville-lès-Rouen, France
| | - Clémence Isaac
- EPS Ville Evrard, Unité de Recherche Clinique, Neuilly-sur-Marne, France
| | - Mathieu Faerber
- Centre Ressource Autisme Normandie Seine Eure, Centre Hospitalier du Rouvray, Sotteville-lès-Rouen, France
| | - Bilal Bendib
- University Department of Psychiatry, Centre Hospitalier du Rouvray, Sotteville-lès-Rouen, France
| | - Iris Mirea-Grivel
- University Department of Psychiatry, Centre Hospitalier du Rouvray, Sotteville-lès-Rouen, France
| | - Gaëlle Opolczynski
- University Department of Psychiatry, Centre Hospitalier du Rouvray, Sotteville-lès-Rouen, France
| | - Antoine Rosier
- Centre Ressource Autisme Normandie Seine Eure, Centre Hospitalier du Rouvray, Sotteville-lès-Rouen, France
| | - Olivier Guillin
- University Department of Psychiatry, Centre Hospitalier du Rouvray, Sotteville-lès-Rouen, France.,Centre Ressource Autisme Normandie Seine Eure, Centre Hospitalier du Rouvray, Sotteville-lès-Rouen, France.,CHU de Rouen, Rouen, France.,Faculté de Médecine, Normandy University, Rouen, France
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20
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Gwynette MF, Lowe DW, Henneberry EA, Sahlem GL, Wiley MG, Alsarraf H, Russo SB, Joseph JE, Summers PM, Lohnes L, George MS. Treatment of Adults with Autism and Major Depressive Disorder Using Transcranial Magnetic Stimulation: An Open Label Pilot Study. Autism Res 2020; 13:346-351. [PMID: 31944611 PMCID: PMC10150802 DOI: 10.1002/aur.2266] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 11/25/2019] [Accepted: 12/23/2019] [Indexed: 12/31/2022]
Abstract
Patients with autism spectrum disorder (ASD) are at high risk for comorbid major depressive disorder (MDD), which can severely impair functioning and quality of life. Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive brain stimulation technique, which is Food and Drug Administration (FDA) cleared for the treatment of MDD in adults. Despite demonstrated efficacy in the treatment of depression, there are limited data on the use of rTMS in patients with ASD and comorbid MDD. We hypothesized that a standard rTMS protocol for MDD would reduce depressive symptoms for adults with ASD and MDD. Secondarily, we investigated whether this treatment would also reduce core ASD symptoms. Participants of 18-65 years old with ASD and MDD without any medication changes in the last month were eligible for this open-label trial. Participants underwent 25 sessions of rTMS (figure-of-eight coil, 100-120% resting motor threshold, 10 Hz, 3,000 pulses per session) applied to the left dorsolateral prefrontal cortex. Thirteen participants enrolled in the study, with two withdrawing due to tolerability, and one excluded from analysis. Overall, side effects were mild and rTMS was well tolerated. The Hamilton rating scale for depression (HAM-D17 ) improved 13.5 points (IQR 5-15), and 40% of participants achieved remission (HAM-D17 ≤ 7) after rTMS treatment. Informant clinical scales of core symptoms of autism also suggested improvement with rTMS, though no change was observed by the participants themselves. Thus, this open-label trial suggests that high-frequency rTMS is well tolerated by adults with autism and MDD, with improvement in depressive symptoms and possible effects on core autism symptoms. Autism Res 2020, 13: 346-351. © 2020 International Society for Autism Research,Wiley Periodicals, Inc. LAY SUMMARY: This study evaluated the safety and effects of repetitive transcranial magnetic stimulation (rTMS) on depression and autism symptoms in individuals with both major depressive disorder and autism spectrum disorder. rTMS was well tolerated by the participants, depression improved with treatment, and family members' assessment of autism symptoms improved as well. This study supports the need for further work to evaluate rTMS in individuals who have both autism and depression.
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Affiliation(s)
- McLeod Frampton Gwynette
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Danielle W Lowe
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Erin A Henneberry
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Gregory L Sahlem
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Melanie Gail Wiley
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Hussam Alsarraf
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Sarah Brice Russo
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Jane E Joseph
- Department of Neuroscience, Medical University of South Carolina, Charleston, South Carolina
| | - Philipp M Summers
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Laura Lohnes
- Department of Neuroscience, Medical University of South Carolina, Charleston, South Carolina
| | - Mark S George
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina.,Ralph H. Johnson VA Medical Center, Charleston, South Carolina
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21
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Kang JN, Song JJ, Casanova MF, Sokhadze EM, Li XL. Effects of repetitive transcranial magnetic stimulation on children with low-function autism. CNS Neurosci Ther 2019; 25:1254-1261. [PMID: 31228356 PMCID: PMC6834922 DOI: 10.1111/cns.13150] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 04/17/2019] [Accepted: 04/25/2019] [Indexed: 01/09/2023] Open
Abstract
Background Autism spectrum disorder (ASD) is a very complex neurodevelopmental disorder, characterized by social difficulties and stereotypical or repetitive behavior. Some previous studies using low‐frequency repetitive transcranial magnetic stimulation (rTMS) have proven of benefit in ASD children. Methods In this study, 32 children (26 males and six females) with low‐function autism were enrolled, 16 children (three females and 13 males; mean ± SD age: 7.8 ± 2.1 years) received rTMS treatment twice every week, while the remaining 16 children (three females and 13 males; mean ± SD age: 7.2 ± 1.6 years) served as waitlist group. This study investigated the effects of rTMS on brain activity and behavioral response in the autistic children. Results Peak alpha frequency (PAF) is an electroencephalographic measure of cognitive preparedness and might be a neural marker of cognitive function for the autism. Coherence is one way to assess the brain functional connectivity of ASD children, which has proven abnormal in previous studies. The results showed significant increases in the PAF at the frontal region, the left temporal region, the right temporal region and the occipital region and a significant increase of alpha coherence between the central region and the right temporal region. Autism Behavior Checklist (ABC) scores were also compared before and after receiving rTMS with positive effects shown on behavior. Conclusion These findings supported our hypothesis by demonstration of positive effects of combined rTMS neurotherapy in active treatment group as compared to the waitlist group, as the rTMS group showed significant improvements in behavioral and functional outcomes as compared to the waitlist group.
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Affiliation(s)
- Jian-Nan Kang
- College of Electronic & Information Engineering, Hebei University, Baoding, China
| | - Jia-Jia Song
- College of Electronic & Information Engineering, Hebei University, Baoding, China
| | - Manuel F Casanova
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville Campus, Greenville Health System, Greenville, South Carolina
| | - Estate M Sokhadze
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville Campus, Greenville Health System, Greenville, South Carolina
| | - Xiao-Li Li
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
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22
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Functional and structural asymmetry in primary motor cortex in Asperger syndrome: a navigated TMS and imaging study. Brain Topogr 2019; 32:504-518. [PMID: 30949863 PMCID: PMC6477009 DOI: 10.1007/s10548-019-00704-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 03/25/2019] [Indexed: 12/27/2022]
Abstract
Motor functions are frequently impaired in Asperger syndrome (AS). In this study, we examined the motor cortex structure and function using navigated transcranial magnetic stimulation (nTMS) and voxel-based morphometry (VBM) and correlated the results with the box and block test (BBT) of manual dexterity and physical activity in eight boys with AS, aged 8–11 years, and their matched controls. With nTMS, we found less focused cortical representation areas of distinct hand muscles in AS. There was hemispheric asymmetry in the motor maps, silent period duration and active MEP latency in the AS group, but not in controls. Exploratory VBM analysis revealed less gray matter in the left postcentral gyrus, especially in the face area, and less white matter in the precentral area in AS as compared to controls. On the contrary, in the right leg area, subjects with AS displayed an increased density of gray matter. The structural findings of the left hemisphere correlated negatively with BBT score in controls, whereas the structure of the right hemisphere in the AS group correlated positively with motor function as assessed by BBT. These preliminary functional (neurophysiological and behavioral) findings are indicative of asymmetry, and co-existing structural alterations may reflect the motor impairments causing the deteriorations in manual dexterity and other motor functions commonly encountered in children with AS.
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23
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Sathappan AV, Luber BM, Lisanby SH. The Dynamic Duo: Combining noninvasive brain stimulation with cognitive interventions. Prog Neuropsychopharmacol Biol Psychiatry 2019; 89:347-360. [PMID: 30312634 DOI: 10.1016/j.pnpbp.2018.10.006] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 10/03/2018] [Accepted: 10/04/2018] [Indexed: 12/21/2022]
Abstract
Pharmacotherapy, psychotherapy, and non-invasive brain stimulation (NIBS)1 each show efficacy in the treatment of psychiatric disorders; however, more efficacious interventions are needed as reflected by an overall unmet need in mental health care. While each modality has typically been studied and developed as a monotherapy, in practice they are typically used in combination. Research has begun to emerge studying the potential synergistic actions of multi-modal, combination therapies. For example, NIBS combined with rehabilitation strategies have demonstrated some success for speech and motor rehabilitation in stroke patients. In this review we present evidence suggesting that combining NIBS with targeted, cognitive interventions offers a potentially powerful new approach to treating neuropsychiatric disorders. Here we focus on NIBS studies using transcranial direct current stimulation (tDCS)2 and transcranial magnetic stimulation (TMS)3 given that these modalities are relatively safe, noninvasive, and can be performed simultaneously with neurocognitive interventions. We review the concept of "state dependent" effects of NIBS and highlight how simultaneous or sequential cognitive interventions could help optimize NIBS therapy by providing further control of ongoing neural activity in targeted neural networks. This review spans a range of neuropsychiatric disorders including major depressive disorder, schizophrenia, generalized anxiety, and autism. For each disorder, we emphasize neuroanatomical circuitry that could be engaged with combination therapy and critically discuss the literature that has begun to emerge. Finally, we present possible underlying mechanisms and propose future research strategies that may further refine the potential of combination therapies.
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Affiliation(s)
- Aakash V Sathappan
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Bruce M Luber
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA.
| | - Sarah H Lisanby
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
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24
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Donaldson PH, Kirkovski M, Rinehart NJ, Enticott PG. A double-blind HD-tDCS/EEG study examining right temporoparietal junction involvement in facial emotion processing. Soc Neurosci 2019; 14:681-696. [PMID: 30668274 DOI: 10.1080/17470919.2019.1572648] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Prior studies have demonstrated that aspects of social cognition can be modulated via temporoparietal junction (TPJ) transcranial direct current stimulation (tDCS). However, this technique lacks focality and electrophysiological effects or correlates are rarely examined. The present study investigated whether anodal and/or cathodal high-definition tDCS (HD-tDCS) would influence facial emotion processing performance relative to sham stimulation, and whether task performance changes were related to neurophysiological changes. Participants completed a facial emotion attribution tasks before and after rTPJ HD-tDCS, with event-related potentials (ERP) recorded during task performance. Anodal rTPJ HD-tDCS improved facial emotion processing performance for static depictions of fear (but not surprise). Stimulation condition influenced P300 latency, and also influenced the relationship between behavioural and electrophysiological (ERP) outcomes in several circumstances, findings which both support and challenge anodal-excitation/cathodal-inhibition accounts of tDCS effects. Results suggest that rTPJ anodal HD-tDCS can influence facial emotion recognition (i.e., affective mentalizing), and elucidate the nature and distribution of underlying neurophysiological processes. Stimulation effects, however, might depend on the intensity and salience/valence (negativity/threat) of the emotion, and these behavioural effects may not relate directly or simply to the ERPs assessed here.
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Affiliation(s)
- Peter H Donaldson
- Deakin Child Study Centre, School of Psychology, Deakin University , Geelong , Australia.,Cognitive Neuroscience Unit, School of Psychology, Deakin University , Geelong , Australia
| | - Melissa Kirkovski
- Deakin Child Study Centre, School of Psychology, Deakin University , Geelong , Australia.,Cognitive Neuroscience Unit, School of Psychology, Deakin University , Geelong , Australia
| | - Nicole J Rinehart
- Deakin Child Study Centre, School of Psychology, Deakin University , Geelong , Australia
| | - Peter G Enticott
- Deakin Child Study Centre, School of Psychology, Deakin University , Geelong , Australia.,Cognitive Neuroscience Unit, School of Psychology, Deakin University , Geelong , Australia
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25
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Siniscalco D, Kannan S, Semprún-Hernández N, Eshraghi AA, Brigida AL, Antonucci N. Stem cell therapy in autism: recent insights. STEM CELLS AND CLONING-ADVANCES AND APPLICATIONS 2018; 11:55-67. [PMID: 30425534 PMCID: PMC6204871 DOI: 10.2147/sccaa.s155410] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Autism spectrum disorders (ASDs) are characterized by core domains: persistent deficits in social communication and interaction; restricted, repetitive patterns of behavior, interests, or activities. ASDs comprise heterogeneous and complex neurodevelopmental pathologies with well-defined inflammatory conditions and immune system dysfunction. Due to neurobiologic changes underlying ASD development, cell-based therapies have been proposed and applied to ASDs. Indeed, stem cells show specific immunologic properties, which make them promising candidates in ASD treatment. This comprehensive up-to-date review focuses on ASD cellular/molecular abnormalities, potentially useful stem cell types, animal models, and current clinical trials on the use of stem cells in treating autism. Limitations are also discussed.
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Affiliation(s)
- Dario Siniscalco
- Department of Experimental Medicine, University of Campania, Napoli, Italy,
| | - Suresh Kannan
- Department of Biomedical Sciences, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Neomar Semprún-Hernández
- Research Division, Autism Immunology Unit of Maracaibo, Catedra libre de Autismo, Universidad del Zulia, Maracaibo, Venezuela
| | - Adrien A Eshraghi
- Department of Otolaryngology, Hearing Research and Cochlear Implant Laboratory, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Nicola Antonucci
- Biomedical Centre for Autism Research and Treatment, Bari, Italy
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26
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Meta-analysis of GABRB3 Gene Polymorphisms and Susceptibility to Autism Spectrum Disorder. J Mol Neurosci 2018; 65:432-437. [PMID: 30074174 DOI: 10.1007/s12031-018-1114-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 07/06/2018] [Indexed: 12/17/2022]
Abstract
Several lines of evidence have suggested that the GABA receptor subunit β3 (GABRB3) gene is a genetic contributor in the autism spectrum disorder (ASD). The aberrant expression of GABRB3 is reported in ASD patients which may be a consequence of the presence of certain genetic variants in the promoter region of the gene. The associations between single-nucleotide polymorphisms (SNPs) within this gene and ASD have been analyzed in previous studies. However, the results are conflicting. In the present study, we performed a meta-analysis on association between two SNPs located in the promoter region of GABRB3 gene (rs4906902 and rs20317) and ASD. The literature search was performed based on criteria provided by the meta-analysis of observational studies in epidemiology (MOOSE). The association between mentioned SNPs and ASD was calculated using pooled odd ratios (ORs) and 95% confidence intervals. The result of the present meta-analysis indicates that neither rs4906902 nor rs20317 are significantly associated with the risk of ASD. The underlying mechanism of the aberrant expression of GABRB3 gene in ASD patients should be investigated in other biological levels.
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27
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Sokhadze EM, Lamina EV, Casanova EL, Kelly DP, Opris I, Tasman A, Casanova MF. Exploratory Study of rTMS Neuromodulation Effects on Electrocortical Functional Measures of Performance in an Oddball Test and Behavioral Symptoms in Autism. Front Syst Neurosci 2018; 12:20. [PMID: 29892214 PMCID: PMC5985329 DOI: 10.3389/fnsys.2018.00020] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 05/02/2018] [Indexed: 12/17/2022] Open
Abstract
There is no accepted pathology to autism spectrum disorders (ASD) but research suggests the presence of an altered excitatory/inhibitory (E/I) bias in the cerebral cortex. Repetitive transcranial magnetic stimulation (rTMS) offers a non-invasive means of modulating the E/I cortical bias with little in terms of side effects. In this study, 124 high functioning ASD children (IQ > 80, <18 years of age) were recruited and assigned using randomization to either a waitlist group or one of three different number of weekly rTMS sessions (i.e., 6, 12, and 18). TMS consisted of trains of 1.0 Hz frequency pulses applied over the dorsolateral prefrontal cortex (DLPFC). The experimental task was a visual oddball with illusory Kanizsa figures. Behavioral response variables included reaction time and error rate along with such neurophysiological indices such as stimulus and response-locked event-related potentials (ERP). One hundred and twelve patients completed the assigned number of TMS sessions. Results showed significant changes from baseline to posttest period in the following measures: motor responses accuracy [lower percentage of committed errors, slower latency of commission errors and restored normative post-error reaction time slowing in both early and later-stage ERP indices, enhanced magnitude of error-related negativity (ERN), improved error monitoring and post-error correction functions]. In addition, screening surveys showed significant reductions in aberrant behavior ratings and in both repetitive and stereotypic behaviors. These differences increased with the total number of treatment sessions. Our results suggest that rTMS, particularly after 18 sessions, facilitates cognitive control, attention and target stimuli recognition by improving discrimination between task-relevant and task-irrelevant illusory figures in an oddball test. The noted improvement in executive functions of behavioral performance monitoring further suggests that TMS has the potential to target core features of ASD.
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Affiliation(s)
- Estate M. Sokhadze
- Department of Biomedical Sciences, School of Medicine Greenville, University of South Carolina, Greenville, SC, United States
- Department of Psychiatry and Behavioral Sciences, University of Louisville, Louisville, KY, United States
| | - Eva V. Lamina
- Department of Biomedical Sciences, School of Medicine Greenville, University of South Carolina, Greenville, SC, United States
| | - Emily L. Casanova
- Department of Biomedical Sciences, School of Medicine Greenville, University of South Carolina, Greenville, SC, United States
| | - Desmond P. Kelly
- Department of Biomedical Sciences, School of Medicine Greenville, University of South Carolina, Greenville, SC, United States
- Department of Pediatrics, Greenville Health System, Greenville, SC, United States
| | - Ioan Opris
- Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Allan Tasman
- Department of Psychiatry and Behavioral Sciences, University of Louisville, Louisville, KY, United States
| | - Manuel F. Casanova
- Department of Biomedical Sciences, School of Medicine Greenville, University of South Carolina, Greenville, SC, United States
- Department of Psychiatry and Behavioral Sciences, University of Louisville, Louisville, KY, United States
- Department of Pediatrics, Greenville Health System, Greenville, SC, United States
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28
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Sun D, Shao R, Wang Z, Lee TMC. Perceived Gaze Direction Modulates Neural Processing of Prosocial Decision Making. Front Hum Neurosci 2018; 12:52. [PMID: 29487516 PMCID: PMC5816754 DOI: 10.3389/fnhum.2018.00052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 01/31/2018] [Indexed: 11/13/2022] Open
Abstract
Gaze direction is a common social cue implying potential interpersonal interaction. However, little is known about the neural processing of social decision making influenced by perceived gaze direction. Here, we employed functional magnetic resonance imaging (fMRI) method to investigate 27 females when they were engaging in an economic exchange game task during which photos of direct or averted eye gaze were shown. We found that, when averted but not direct gaze was presented, prosocial vs. selfish choices were associated with stronger activations in the right superior temporal gyrus (STG) as well as larger functional couplings between right STG and the posterior cingulate cortex (PCC). Moreover, stronger activations in right STG was associated with quicker actions for making prosocial choice accompanied with averted gaze. The findings suggest that, when the cue implying social contact is absent, the processing of understanding others’ intention and the relationship between self and others is more involved for making prosocial than selfish decisions. These findings could advance our understanding of the roles of subtle cues in influencing prosocial decision making, as well as shedding lights on deficient social cue processing and functioning among individuals with autism spectrum disorder (ASD).
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Affiliation(s)
- Delin Sun
- Laboratory of Neuropsychology, The University of Hong Kong, Pokfulam, Hong Kong.,Laboratory of Cognitive Affective Neuroscience, The University of Hong Kong, Pokfulam, Hong Kong.,Duke-UNC Brain Imaging and Analysis Center, Duke University, Durham, NC, United States.,VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC, United States
| | - Robin Shao
- Laboratory of Neuropsychology, The University of Hong Kong, Pokfulam, Hong Kong.,Laboratory of Cognitive Affective Neuroscience, The University of Hong Kong, Pokfulam, Hong Kong
| | - Zhaoxin Wang
- Shanghai Key Laboratory of Brain Functional Genomics, Key Laboratory of Brain Functional Genomics, Ministry of Education, Institute of Cognitive Neuroscience, School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Tatia M C Lee
- Laboratory of Neuropsychology, The University of Hong Kong, Pokfulam, Hong Kong.,Laboratory of Cognitive Affective Neuroscience, The University of Hong Kong, Pokfulam, Hong Kong.,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong.,Institute of Clinical Neuropsychology, The University of Hong Kong, Pokfulam, Hong Kong
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29
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Donaldson PH, Kirkovski M, Rinehart NJ, Enticott PG. Autism-relevant traits interact with temporoparietal junction stimulation effects on social cognition: a high-definition transcranial direct current stimulation and electroencephalography study. Eur J Neurosci 2017; 47:669-681. [DOI: 10.1111/ejn.13675] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 08/17/2017] [Accepted: 08/23/2017] [Indexed: 01/14/2023]
Affiliation(s)
- Peter H. Donaldson
- Deakin Child Study Centre; School of Psychology; Deakin University; Locked Bag 20000; Geelong Victoria 3220 Australia
| | - Melissa Kirkovski
- Deakin Child Study Centre; School of Psychology; Deakin University; Locked Bag 20000; Geelong Victoria 3220 Australia
| | - Nicole J. Rinehart
- Deakin Child Study Centre; School of Psychology; Deakin University; Locked Bag 20000; Geelong Victoria 3220 Australia
| | - Peter G. Enticott
- Deakin Child Study Centre; School of Psychology; Deakin University; Locked Bag 20000; Geelong Victoria 3220 Australia
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30
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Ameis SH, Daskalakis ZJ, Blumberger DM, Desarkar P, Drmic I, Mabbott DJ, Lai MC, Croarkin PE, Szatmari P. Repetitive Transcranial Magnetic Stimulation for the Treatment of Executive Function Deficits in Autism Spectrum Disorder: Clinical Trial Approach. J Child Adolesc Psychopharmacol 2017; 27:413-421. [PMID: 28346865 PMCID: PMC5510034 DOI: 10.1089/cap.2016.0146] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Executive function (EF) deficits in patients with autism spectrum disorder (ASD) are ubiquitous and understudied. Further, there are no effective, neuroscience-based treatments to address this impairing feature of ASD. Repetitive transcranial magnetic stimulation (rTMS) has demonstrated promise in addressing EF deficits in adult neuropsychiatric disorders. This article will outline the design of a novel randomized-controlled trial of bilateral, 20 Hz, rTMS applied to the dorsolateral prefrontal cortex (DLPFC) for treatment of EF deficits in ASD that is currently ongoing. We describe prior therapeutic rTMS research for ASD and prior rTMS trials targeting EFs in adult neuropsychiatric disorders. A neurophysiological rationale for rTMS treatment of EF deficits in ASD is presented. METHODS An ongoing protocol will enroll participants aged 16-35 with ASD and no intellectual disability. Psychotropic medications will be continued during the 4-week trial of active 20 Hz versus sham rTMS applied to the DLPFC. Twenty, active treatment sessions consisting of 25 stimulation trains at a 90% motor threshold will be administered. The primary outcome measure is the Cambridge Neuropsychological Test Automated Battery (CANTAB) spatial working memory task. At present, recruitment, enrollment, and treatment within the described clinical trial are ongoing. CONCLUSIONS EF deficits are common and impairing symptoms of ASD. There are no evidence-based treatments for EF deficits in ASD. The protocol described here will provide important preliminary data on the feasibility and efficacy of 20 Hz rTMS to DLPFC for EF deficits in ASD.
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Affiliation(s)
- Stephanie H. Ameis
- Centre for Brain and Mental Health, The Hospital for Sick Children, Toronto, Canada.,The Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Campbell Family Mental Health Research Institute, The Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Zafiris J. Daskalakis
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada.,Temerty Centre for Therapeutic Brain Intervention, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Daniel M. Blumberger
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada.,Temerty Centre for Therapeutic Brain Intervention, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Pushpal Desarkar
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada.,Temerty Centre for Therapeutic Brain Intervention, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Irene Drmic
- Genetics and Genome Biology and Autism Research Unit, The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, Canada
| | - Donald J. Mabbott
- Program in Neurosciences and Mental Health, Research Institute, The Hospital for Sick Children, Toronto, Canada.,Department of Psychology, Faculty of Graduate Studies, University of Toronto, Toronto, Canada
| | - Meng-Chuan Lai
- Centre for Brain and Mental Health, The Hospital for Sick Children, Toronto, Canada.,The Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Campbell Family Mental Health Research Institute, The Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Paul E. Croarkin
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Peter Szatmari
- Centre for Brain and Mental Health, The Hospital for Sick Children, Toronto, Canada.,The Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Campbell Family Mental Health Research Institute, The Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
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Avirame K, Stehberg J, Todder D. Enhanced cognition and emotional recognition, and reduced obsessive compulsive symptoms in two adults with high-functioning autism as a result of deep Transcranial Magnetic Stimulation (dTMS): a case report. Neurocase 2017; 23:187-192. [PMID: 28786315 DOI: 10.1080/13554794.2017.1361451] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
We report reduced repetitive behaviors similar to obsessive compulsive disorder and improved emotional recognition and cognitive abilities in two young patients diagnosed with high-functioning Autism as a result of deep transcranial magnetic stimulation (dTMS). The patients received daily high-frequency (5 Hz) dTMS with HAUT-coil over the medial prefrontal cortex for a period of 5-6 weeks. A computerized cognitive battery, tasks for testing emotional recognition, and clinical questionnaires were used to measure the effects of treatment. TMS might have modulated networks related to metalizing abilities and self-referential processes since both patients reported improved sociability and communication skills.
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Affiliation(s)
| | - Jimmy Stehberg
- b Laboratorio de Neurobiología, Centro de Investigaciones Biomédicas , Universidad Andres Bello , Santiago , Chile
| | - Doron Todder
- a Neuroclinic Health center , Ramat Gan , Israel.,c Beersheva Mental Health Center , Beersheva , Israel.,d Zlotovsky Center for Neuroscience , Ben-Gurion University , Beersheva , Israel
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Abstract
An increasing number of case reports and series document the safe and effective use of electroconvulsive therapy (ECT) in children, adolescents, and young adults with autism spectrum disorder who engage in severe, intractable, repetitive self-injurious behavior (SIB) without environmental or operant function. Although the treatment is very effective for such patients, they typically remain highly dependent on frequent maintenance ECT (M-ECT) to maintain suppression of the SIB achieved during the acute course. Some patients receive M-ECT as frequently as once every 5 days. Such a regimen is quite burdensome for the patient and the patient's family, and the long-term effects of such regimens, starting as early as childhood, are unknown. In this review, we explore the expanding literature supporting the use of ECT for suppressing severe SIB associated with autism spectrum disorder. We also focus on the possible development of alternate nonconvulsive focal forms of brain stimulation, which might replace frequent M-ECT or reduce how frequently a patient needs to receive it. Although there are scarce clinical data currently available supporting these latter treatments, future studies are clearly indicated.
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Pedapati EV, Gilbert DL, Erickson CA, Horn PS, Shaffer RC, Wink LK, Laue CS, Wu SW. Abnormal Cortical Plasticity in Youth with Autism Spectrum Disorder: A Transcranial Magnetic Stimulation Case-Control Pilot Study. J Child Adolesc Psychopharmacol 2016; 26:625-31. [PMID: 27007257 PMCID: PMC5035833 DOI: 10.1089/cap.2015.0183] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE This case-control study investigated the use of a low-intensity repetitive transcranial magnetic stimulation (rTMS) protocol to measure motor cortex (M1) plasticity in youth with autism spectrum disorder (ASD) compared with typically developing children (TDC). We hypothesized that impairments in long-term potentiation-like properties represent a neurophysiological biomarker of abnormal cortical function in ASD. METHODS We studied youth with ASD aged 11-18 years and matched controls (TDC). Intermittent theta burst stimulation (iTBS) was delivered to the dominant M1 at an intensity of 70% of resting motor threshold. Suprathreshold single-pulse TMS was performed to compare amplitudes of motor-evoked potentials (MEP) measured from surface electromyography electrodes on a target muscle before (20 pulses) and after (10 pulses/time point) iTBS at predefined timepoints (up to 30 minutes) to measure any potentiation effects. A linear mixed model was used to examine group differences in MEP amplitudes over time following iTBS. RESULTS Nine youth with ASD (mean age 15.6; 7 males; 6 right-hand dominant) and 9 TDC (mean age 14.5; 5 males; 9 right-hand dominant) participated. All subjects tolerated the procedure well. Both groups had a mean increase in excitability after iTBS for 30 minutes; however, the time course of excitability changes differed (F9,144 = 2.05; p = 0.038). Post-hoc testing identified a significant decrease in amplitude of the ASD group at 20 minutes following iTBS compared with the TDC after correcting for multiple comparisons. CONCLUSION In this study, we demonstrate early evidence for a potential physiological biomarker of cortical plasticity in youth with ASD using a rapid low-intensity rTMS protocol with a discriminate measure at 20 minutes following stimulation. The procedure was well tolerated by all 18 participants. Future work will include modification of the protocol to improve the ability to distinguish subtypes of ASD based on behavioral and cognitive testing.
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Affiliation(s)
- Ernest V. Pedapati
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Donald L. Gilbert
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Craig A. Erickson
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Paul S. Horn
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Rebecca C. Shaffer
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Logan K. Wink
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Cameron S. Laue
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Steve W. Wu
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Integrative Approaches to Caring for Children with Autism. Curr Probl Pediatr Adolesc Health Care 2016; 46:195-201. [PMID: 26776326 DOI: 10.1016/j.cppeds.2015.12.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 12/04/2015] [Indexed: 01/20/2023]
Abstract
Parents commonly integrate complementary and alternative medical (CAM) treatments for autism spectrum disorder (ASD) with conventional care. The aims of this article are to (1) describe the most commonly used treatments, (2) assess their efficacy and safety, and (3) organize the information in practical format for practitioners. We organized treatment modalities into four categories: recommended, monitored, tolerated, and therapies that should be avoided. These four categories are based on a two by two table weighing a therapy׳s effectiveness and safety. To meet the threshold for "recommended," its effectiveness needed to be supported by two or more randomized, controlled trials. In addition to promoting an overall healthy lifestyle via nutrition, exercise, sleep, stress management, social support, and avoiding neurotoxins (healthy habits in a healthy habitat), the most promising therapies recommend are applied behavior analysis, parent-implemented training, melatonin supplements to improve sleep, supplements to correct deficiencies, and music therapy. Medications and restrictive diets may be helpful for some children, but use should be monitored given the risk of side effects. Most complementary therapies are safe, so they can be tolerated, but additional research is needed before they should be recommended. Given their risks, costs, and limited evidence of efficacy, chelation, secretin, and hyperbaric oxygen should be avoided.
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Uzunova G, Pallanti S, Hollander E. Excitatory/inhibitory imbalance in autism spectrum disorders: Implications for interventions and therapeutics. World J Biol Psychiatry 2016; 17:174-86. [PMID: 26469219 DOI: 10.3109/15622975.2015.1085597] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Imbalance between excitation and inhibition and increased excitatory-inhibitory (E-I) ratio is a common mechanism in autism spectrum disorders (ASD) that is responsible for the learning and memory, cognitive, sensory, motor deficits, and seizures occurring in these disorders. ASD are very heterogeneous and better understanding of E-I imbalance in brain will lead to better diagnosis and treatments. METHODS We perform a critical literature review of the causes and presentations of E-I imbalance in ASD. RESULTS E-I imbalance in ASD is due primarily to abnormal glutamatergic and GABAergic neurotransmission in key brain regions such as neocortex, hippocampus, amygdala, and cerebellum. Other causes are due to dysfunction of neuropeptides (oxytocin), synaptic proteins (neuroligins), and immune system molecules (cytokines). At the neuropathological level E-I imbalance in ASD is presented as a "minicolumnopathy". E-I imbalance alters the manner by which the brain processes information and regulates behaviour. New developments for investigating E-I imbalance such as optogenetics and transcranial magnetic stimulation (TMS) are presented. Non-invasive brain stimulation methods such as TMS for treatment of the core symptoms of ASD are discussed. CONCLUSIONS Understanding E-I imbalance has important implications for developing better pharmacological and behavioural treatments for ASD, including TMS, new drugs, biomarkers and patient stratification.
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Affiliation(s)
- Genoveva Uzunova
- a Albert Einstein College of Medicine and Montefiore Medical Center , Bronx , NY , USA
| | - Stefano Pallanti
- a Albert Einstein College of Medicine and Montefiore Medical Center , Bronx , NY , USA.,b Psychiatry and Behavioural Sciences, UC Davis Health System , CA , USA.,c Department Psychiatry , University of Florence , Florence , Italy.,d Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - Eric Hollander
- a Albert Einstein College of Medicine and Montefiore Medical Center , Bronx , NY , USA
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Oberman LM, Enticott PG, Casanova MF, Rotenberg A, Pascual-Leone A, McCracken JT. Transcranial magnetic stimulation in autism spectrum disorder: Challenges, promise, and roadmap for future research. Autism Res 2015; 9:184-203. [PMID: 26536383 DOI: 10.1002/aur.1567] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 08/25/2015] [Accepted: 09/01/2015] [Indexed: 12/26/2022]
Abstract
Autism Spectrum Disorder (ASD) is a behaviorally defined complex neurodevelopmental syndrome characterized by impairments in social communication, by the presence of restricted and repetitive behaviors, interests and activities, and by abnormalities in sensory reactivity. Transcranial magnetic stimulation (TMS) is a promising, emerging tool for the study and potential treatment of ASD. Recent studies suggest that TMS measures provide rapid and noninvasive pathophysiological ASD biomarkers. Furthermore, repetitive TMS (rTMS) may represent a novel treatment strategy for reducing some of the core and associated ASD symptoms. However, the available literature on the TMS use in ASD is preliminary, composed of studies with methodological limitations. Thus, off-label clinical rTMS use for therapeutic interventions in ASD without an investigational device exemption and outside of an IRB approved research trial is premature pending further, adequately powered and controlled trials. Leaders in this field have gathered annually for a two-day conference (prior to the 2014 and 2015 International Meeting for Autism Research, IMFAR) to share recent progress, promote collaboration across laboratories, and establish consensus on protocols. Here we review the literature in the use of TMS in ASD in the context of the unique challenges required for the study and exploration of treatment strategies in this population. We also suggest future directions for this field of investigations. While its true potential in ASD has yet to be delineated, TMS represents an innovative research tool and a novel, possibly transformative approach to the treatment of neurodevelopmental disorders.
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Affiliation(s)
- Lindsay M Oberman
- Neuroplasticity and Autism Spectrum Disorder Program and Department of Psychiatry and Human Behavior, E.P. Bradley Hospital and Warren Alpert Medical School, Brown University, Providence, Rhode, Island
| | - Peter G Enticott
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Burwood, Victoria, Australia
| | - Manuel F Casanova
- Department of Psychiatry and Behavioral Science, University of Louisville, Louisville, Kentucky
| | - Alexander Rotenberg
- Neuromodulation Program, Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Alvaro Pascual-Leone
- Neuromodulation Program, Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.,Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - James T McCracken
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California
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Casanova MF, Sokhadze E, Opris I, Wang Y, Li X. Autism spectrum disorders: linking neuropathological findings to treatment with transcranial magnetic stimulation. Acta Paediatr 2015; 104:346-55. [PMID: 25626149 DOI: 10.1111/apa.12943] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 01/15/2015] [Accepted: 01/20/2015] [Indexed: 01/09/2023]
Abstract
UNLABELLED Postmortem studies in autism spectrum disorder (ASD) individuals indicate the presence of abnormalities within the peripheral neuropil space (PNS) of cortical minicolumns. The geometrical orientation of inhibitory elements within the PNS suggests using repetitive transcranial magnetic stimulation (rTMS) to up-regulate their activity. Several rTMS trials in ASD have shown marked improvements in motor symptomatology, attention and perceptual binding. CONCLUSION rTMS is the first therapeutic attempt at ASD aimed at correcting some of its core pathology.
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Affiliation(s)
| | - Estate Sokhadze
- Department of Psychiatry; University of Louisville; Louisville KA USA
| | - Ioan Opris
- Department of Physiology and Pharmacology; Wake Forest University School of Medicine; Winston-Salem NA USA
| | - Yao Wang
- Department of Psychiatry; University of Louisville; Louisville KA USA
- State Key Laboratory of Cognitive Neuroscience and Learning; Beijing Normal University; Beijing China
| | - Xiaoli Li
- State Key Laboratory of Cognitive Neuroscience and Learning; Beijing Normal University; Beijing China
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38
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Oberman LM, Enticott PG, Casanova MF, Rotenberg A, Pascual-Leone A, McCracken JT. Transcranial magnetic stimulation (TMS) therapy for autism: an international consensus conference held in conjunction with the international meeting for autism research on May 13th and 14th, 2014. Front Hum Neurosci 2015; 8:1034. [PMID: 25642178 PMCID: PMC4295436 DOI: 10.3389/fnhum.2014.01034] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 12/09/2014] [Indexed: 11/13/2022] Open
Affiliation(s)
- Lindsay M Oberman
- Neuroplasticity and Autism Spectrum Disorder Program, Department of Psychiatry and Human Behavior, E.P. Bradley Hospital and Warren Alpert Medical School, Brown University Providence, RI, USA
| | - Peter G Enticott
- Cognitive Neuroscience Unit, School of Psychology, Deakin University Burwood, VIC, Australia
| | - Manuel F Casanova
- Department of Psychiatry and Behavioral Science, University of Louisville Louisville, KY, USA
| | - Alexander Rotenberg
- Neuromodulation Program, Department of Neurology, Boston Children's Hospital and Harvard Medical School Boston, MA, USA ; Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School Boston, MA, USA
| | - Alvaro Pascual-Leone
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School Boston, MA, USA
| | - James T McCracken
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles Los Angeles, CA, USA
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Abstract
Psychiatric disorders disturb higher cognitive functions and severely compromise human health. However, the pathophysiological mechanisms underlying psychiatric disorders are very complex, and understanding these mechanisms remains a great challenge. Currently, many psychiatric disorders are hypothesized to reflect "faulty wiring" or aberrant connectivity in the brains. Imaging connectomics is arising as a promising methodological framework for describing the structural and functional connectivity patterns of the human brain. Recently, alterations of brain networks in the connectome have been reported in various psychiatric disorders, and these alterations may provide biomarkers for disease diagnosis and prognosis for the evaluation of treatment efficacy. Here, we summarize the current achievements in both the structural and functional connectomes in several major psychiatric disorders (eg, schizophrenia, attention-deficit/hyperactivity disorder, and autism) based on multi-modal neuroimaging data. We highlight the current progress in the identification of these alterations and the hypotheses concerning the aberrant brain networks in individuals with psychiatric disorders and discuss the research questions that might contribute to a further mechanistic understanding of these disorders from a connectomic perspective.
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Affiliation(s)
- Miao Cao
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, People's Republic of China
| | - Zhijiang Wang
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, People's Republic of China
| | - Yong He
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, People's Republic of China
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40
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Desarkar P, Rajji TK, Ameis SH, Daskalakis ZJ. Assessing and Stabilizing Aberrant Neuroplasticity in Autism Spectrum Disorder: The Potential Role of Transcranial Magnetic Stimulation. Front Psychiatry 2015; 6:124. [PMID: 26441685 PMCID: PMC4563147 DOI: 10.3389/fpsyt.2015.00124] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 08/25/2015] [Indexed: 11/13/2022] Open
Abstract
Exciting developments have taken place in the neuroscience research in autism spectrum disorder (ASD), and results from these studies indicate that brain in ASD is associated with aberrant neuroplasticity. Transcranial magnetic stimulation (TMS) has rapidly evolved to become a widely used, safe, and non-invasive neuroscientific tool to investigate a variety of neurophysiological processes, including neuroplasticity. The diagnostic and therapeutic potential of TMS in ASD is beginning to be realized. In this article, we briefly reviewed evidence of aberrant neuroplasticity in ASD, suggested future directions in assessing neuroplasticity using repetitive TMS (rTMS), and discussed the potential of rTMS in rectifying aberrant neuroplasticity in ASD.
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Affiliation(s)
- Pushpal Desarkar
- Department of Psychiatry, Centre for Addiction and Mental Health, University of Toronto , Toronto, ON , Canada ; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health , Toronto, ON , Canada
| | - Tarek K Rajji
- Department of Psychiatry, Centre for Addiction and Mental Health, University of Toronto , Toronto, ON , Canada ; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health , Toronto, ON , Canada
| | - Stephanie H Ameis
- Department of Psychiatry, Centre for Addiction and Mental Health, University of Toronto , Toronto, ON , Canada ; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health , Toronto, ON , Canada ; Department of Psychiatry, The Hospital for Sick Children, University of Toronto , Toronto, ON , Canada ; Research Imaging Centre, Campbell Family Mental Health Research Institute, The Centre for Addiction and Mental Health (CAMH) , Toronto, ON , Canada
| | - Zafiris Jeff Daskalakis
- Department of Psychiatry, Centre for Addiction and Mental Health, University of Toronto , Toronto, ON , Canada ; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health , Toronto, ON , Canada
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41
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Levy SE, Hyman SL. Complementary and alternative medicine treatments for children with autism spectrum disorders. Child Adolesc Psychiatr Clin N Am 2015; 24:117-43. [PMID: 25455579 DOI: 10.1016/j.chc.2014.09.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
There are many treatments in current use for core and associated symptoms of autism spectrum disorders (ASD). This review discusses the complementary and alternative medical (CAM) treatments commonly added to conventional interventions for children with ASD, including natural products, mind and body practices, and other biomedical treatments. The article focuses on factors associated with use of CAM, the empirical evidence for the most frequently used treatments, and how clinicians work with families who choose CAM treatments. Some treatments have been ineffective, some have unacceptable potential side effects, and others require more study in depth.
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Affiliation(s)
- Susan E Levy
- Division of Developmental & Behavioral Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3550 Market Street, 3rd Floor, Philadelphia, PA 19104, USA.
| | - Susan L Hyman
- Neurodevelopmental and Behavioral Pediatrics, Golisano Children's Hospital, School of Medicine and Dentistry, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
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42
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Sokhadze EM, El-Baz AS, Tasman A, Sears LL, Wang Y, Lamina EV, Casanova MF. Neuromodulation integrating rTMS and neurofeedback for the treatment of autism spectrum disorder: an exploratory study. Appl Psychophysiol Biofeedback 2014; 39:237-57. [PMID: 25267414 PMCID: PMC4221494 DOI: 10.1007/s10484-014-9264-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Autism spectrum disorder (ASD) is a pervasive developmental disorder characterized by deficits in social interaction, language, stereotyped behaviors, and restricted range of interests. In previous studies low frequency repetitive transcranial magnetic stimulation (rTMS) has been used, with positive behavioral and electrophysiological results, for the experimental treatment in ASD. In this study we combined prefrontal rTMS sessions with electroencephalographic (EEG) neurofeedback (NFB) to prolong and reinforce TMS-induced EEG changes. The pilot trial recruited 42 children with ASD (~14.5 years). Outcome measures included behavioral evaluations and reaction time test with event-related potential (ERP) recording. For the main goal of this exploratory study we used rTMS-neurofeedback combination (TMS-NFB, N = 20) and waitlist (WTL, N = 22) groups to examine effects of 18 sessions of integrated rTMS-NFB treatment or wait period) on behavioral responses, stimulus and response-locked ERPs, and other functional and clinical outcomes. The underlying hypothesis was that combined TMS-NFB will improve executive functions in autistic patients as compared to the WTL group. Behavioral and ERP outcomes were collected in pre- and post-treatment tests in both groups. Results of the study supported our hypothesis by demonstration of positive effects of combined TMS-NFB neurotherapy in active treatment group as compared to control WTL group, as the TMS-NFB group showed significant improvements in behavioral and functional outcomes as compared to the WTL group.
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Affiliation(s)
- Estate M Sokhadze
- University of Louisville, 401 E Chestnut Street, Suite 600, Louisville, KY, 40202, USA,
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43
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Curatolo P, Ben-Ari Y, Bozzi Y, Catania MV, D'Angelo E, Mapelli L, Oberman LM, Rosenmund C, Cherubini E. Synapses as therapeutic targets for autism spectrum disorders: an international symposium held in pavia on july 4th, 2014. Front Cell Neurosci 2014; 8:309. [PMID: 25324723 PMCID: PMC4179609 DOI: 10.3389/fncel.2014.00309] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 09/12/2014] [Indexed: 11/13/2022] Open
Abstract
New progresses into the molecular and cellular mechanisms of autism spectrum disorders (ASDs) have been discussed in 1 day international symposium held in Pavia (Italy) on July 4th, 2014 entitled "synapses as therapeutic targets for autism spectrum disorders" (satellite of the FENS Forum for Neuroscience, Milan, 2014). In particular, world experts in the field have highlighted how animal models of ASDs have greatly advanced our understanding of the molecular pathways involved in synaptic dysfunction leading sometimes to "synaptic clinical trials" in children.
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Affiliation(s)
- Paolo Curatolo
- Pediatric Neurology Unit, Department of Neurosciences, Tor Vergata University , Rome , Italy
| | - Yehezkel Ben-Ari
- Institut National de la Santé et de la Recherche Médicale, Mediterranean Institute of Neurobiology (INMED) , Marseille , France
| | - Yuri Bozzi
- CNR Neuroscience Institute and Laboratory of Molecular Neuropathology, Centre for Integrative Biology (CIBIO), University of Trento , Trento , Italy
| | - Maria Vincenza Catania
- CNR, Institute of Neurological Sciences (ISN) , Catania , Italy ; Laboratory of Neurobiology, Istituto di Ricovero e Cura a Carattere Scientifico Oasi Maria SS , Troina , Italy
| | - Egidio D'Angelo
- Department of Brain and Behavioral Sciences, University of Pavia , Pavia , Italy ; Brain Connectivity Center, Neurological Institute Istituto di Ricovero e Cura a Carattere Scientifico Mondino , Pavia , Italy
| | - Lisa Mapelli
- Department of Brain and Behavioral Sciences, University of Pavia , Pavia , Italy
| | - Lindsay M Oberman
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University , Providence, RI , USA
| | - Christian Rosenmund
- Neuroscience Research Center and NeuroCure Cluster of Excellence, Charité-Universitätsmedizin Berlin , Berlin , Germany
| | - Enrico Cherubini
- International School for Advanced Studies (SISSA) , Trieste , Italy ; European Brain Research Institute (EBRI) , Rome , Italy
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Croarkin PE, Nakonezny PA, Lewis CP, Zaccariello MJ, Huxsahl JE, Husain MM, Kennard BD, Emslie GJ, Daskalakis ZJ. Developmental aspects of cortical excitability and inhibition in depressed and healthy youth: an exploratory study. Front Hum Neurosci 2014; 8:669. [PMID: 25228870 PMCID: PMC4151107 DOI: 10.3389/fnhum.2014.00669] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 08/11/2014] [Indexed: 02/05/2023] Open
Abstract
Objectives: The objective of this post-hoc exploratory analysis was to examine the relationship between age and measures of cortical excitability and inhibition. Methods: Forty-six participants (24 with major depressive disorder and 22 healthy controls) completed MT, SICI, ICF, and CSP testing in a cross-sectional protocol. Of these 46 participants, 33 completed LICI testing. Multiple linear robust regression and Spearman partial correlation coefficient were used to examine the relationship between age and the TMS measures. Results: In the overall sample of 46 participants, age had a significant negative relationship with motor threshold (MT) in both the right (rs = −0.49, adjusted p = 0.007; β = −0.08, adjusted p = 0.001) and left (rs = −0.42, adjusted p = 0.029; β = −0.05, adjusted p = 0.004) hemispheres. This significant negative relationship of age with MT was also observed in the sample of depressed youth in both the right (rs = −0.70, adjusted p = 0.002; β = −0.09, adjusted p = 0.001) and left (rs = −0.54, adjusted p = 0.034; β = −0.05, adjusted p = 0.017) hemispheres, but not in healthy controls. In the sample of the 33 participants who completed LICI testing, age had a significant negative relationship with LICI (200 ms interval) in both the right (rs = −0.48, adjusted p = 0.05; β = −0.24, adjusted p = 0.007) and left (rs = −0.64, adjusted p = 0.002; β = −0.23, adjusted p = 0.001) hemispheres. This negative relationship between age and LICI (200 ms interval) was also observed in depressed youth in both the right (rs = −0.76, adjusted p = 0.034; β = −0.35, adjusted p = 0.004) and left (rs = −0.92, adjusted p = 0.002; β = −0.25, adjusted p = 0.001) hemispheres. Conclusion: These findings suggest that younger children have higher MTs. This is more pronounced in depressed youth than healthy controls. LICI inhibition may also increase with age in youth.
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Affiliation(s)
- Paul E Croarkin
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Psychology, Mayo Clinic Rochester, MN, USA
| | - Paul A Nakonezny
- Division of Biostatistics, Department of Clinical Sciences, UT Southwestern Medical Center Dallas, TX, USA ; Department of Psychiatry, UT Southwestern Medical Center Dallas, TX, USA
| | - Charles P Lewis
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Psychology, Mayo Clinic Rochester, MN, USA
| | - Michael J Zaccariello
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Psychology, Mayo Clinic Rochester, MN, USA
| | - John E Huxsahl
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Psychology, Mayo Clinic Rochester, MN, USA
| | - Mustafa M Husain
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine Durham, NC, USA
| | - Betsy D Kennard
- Department of Psychiatry, UT Southwestern Medical Center Dallas, TX, USA
| | - Graham J Emslie
- Department of Psychiatry, UT Southwestern Medical Center Dallas, TX, USA
| | - Zafiris J Daskalakis
- Department of Psychiatry, Centre for Addiction and Mental Health, University of Toronto Toronto, ON, Canada
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Oberman LM, Pascual-Leone A, Rotenberg A. Modulation of corticospinal excitability by transcranial magnetic stimulation in children and adolescents with autism spectrum disorder. Front Hum Neurosci 2014; 8:627. [PMID: 25165441 PMCID: PMC4131188 DOI: 10.3389/fnhum.2014.00627] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 07/28/2014] [Indexed: 11/22/2022] Open
Abstract
The developmental pathophysiology of autism spectrum disorders (ASD) is currently not fully understood. However, multiple lines of evidence suggest that the behavioral phenotype may result from dysfunctional inhibitory control over excitatory synaptic plasticity. Consistent with this claim, previous studies indicate that adults with Asperger’s Syndrome show an abnormally extended modulation of corticospinal excitability following a train of repetitive transcranial magnetic stimulation (rTMS). As ASD is a developmental disorder, the current study aimed to explore the effect of development on the duration of modulation of corticospinal excitability in children and adolescents with ASD. Additionally, as the application of rTMS to the understanding and treatment of pediatric neurological and psychiatric disorders is an emerging field, this study further sought to provide evidence for the safety and tolerability of rTMS in children and adolescents with ASD. Corticospinal excitability was measured by applying single pulses of TMS to the primary motor cortex both before and following a 40 s train of continuous theta burst stimulation. 19 high-functioning males ages 9–18 with ASD participated in this study. Results from this study reveal a positive linear relationship between age and duration of modulation of rTMS after-effects. Specifically we found that the older participants had a longer lasting response. Furthermore, though the specific protocol employed typically suppresses corticospinal excitability in adults, more than one third of our sample had a paradoxical facilitatory response to the stimulation. Results support the safety and tolerability of rTMS in pediatric clinical populations. Data also support published theories implicating aberrant plasticity and GABAergic dysfunction in this population.
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Affiliation(s)
- Lindsay M Oberman
- Department of Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center - Harvard Medical School Boston, MA, USA ; Neuromodulation Program and Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital - Harvard Medical School Boston, MA, USA ; Neuroplasticity and Autism Spectrum Disorder Program, E. P. Bradley Hospital, East Providence, RI USA ; Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, East Providence, RI USA
| | - Alvaro Pascual-Leone
- Department of Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center - Harvard Medical School Boston, MA, USA
| | - Alexander Rotenberg
- Department of Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center - Harvard Medical School Boston, MA, USA ; Neuromodulation Program and Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital - Harvard Medical School Boston, MA, USA
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Sokhadze EM, El-Baz AS, Sears LL, Opris I, Casanova MF. rTMS neuromodulation improves electrocortical functional measures of information processing and behavioral responses in autism. Front Syst Neurosci 2014; 8:134. [PMID: 25147508 PMCID: PMC4123734 DOI: 10.3389/fnsys.2014.00134] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 07/09/2014] [Indexed: 11/13/2022] Open
Abstract
Objectives: Reports in autism spectrum disorders (ASD) of a minicolumnopathy with consequent deficits of lateral inhibition help explain observed behavioral and executive dysfunctions. We propose that neuromodulation based on low frequency repetitive Transcranial Magnetic Stimulation (rTMS) will enhance lateral inhibition through activation of inhibitory double bouquet interneurons and will be accompanied by improvements in the prefrontal executive functions. In addition we proposed that rTMS will improve cortical excitation/inhibition ratio and result in changes manifested in event-related potential (ERP) recorded during cognitive tests. Materials and Methods: Along with traditional clinical behavioral evaluations the current study used ERPs in a visual oddball task with illusory figures. We compared clinical, behavioral and electrocortical outcomes in two groups of children with autism (TMS, wait-list group). We predicted that 18 session long course in autistic patients will have better behavioral and ERP outcomes as compared to age- and IQ-matched WTL group. We used 18 sessions of 1 Hz rTMS applied over the dorso-lateral prefrontal cortex in 27 individuals with ASD diagnosis. The WTL group was comprised of 27 age-matched subjects with ASD tested twice. Both TMS and WTL groups were assessed at the baseline and after completion of 18 weekly sessions of rTMS (or wait period) using clinical behavioral questionnaires and during performance on visual oddball task with Kanizsa illusory figures. Results: Post-TMS evaluations showed decreased irritability and hyperactivity on the Aberrant Behavior Checklist (ABC), and decreased stereotypic behaviors on the Repetitive Behavior Scale (RBS-R). Following rTMS course we found decreased amplitude and prolonged latency in the frontal and fronto-central N100, N200 and P300 (P3a) ERPs to non-targets in active TMS treatment group. TMS resulted in increase of P2d (P2a to targets minus P2a to non-targets) amplitude. These ERP changes along with increased centro-parietal P100 and P300 (P3b) to targets are indicative of more efficient processing of information post-TMS treatment. Another important finding was decrease of the latency and increase of negativity of error-related negativity (ERN) during commission errors that may reflect improvement in error monitoring and correction function. Enhanced information processing was also manifested in lower error rate. In addition we calculated normative post-error treaction time (RT) slowing response in both groups and found that rTMS treatment was accompanied by post-error RT slowing and higher accuracy of responses, whereas the WTL group kept on showing typical for ASD post-error RT speeding and higher commission and omission error rates. Conclusion: Results from our study indicate that rTMS improves executive functioning in ASD as evidenced by normalization of ERP responses and behavioral reactions (RT, accuracy) during executive function test, and also by improvements in clinical evaluations.
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Affiliation(s)
- Estate M Sokhadze
- Department of Psychiatry and Behavioral Sciences, University of Louisville Louisville, KY, USA
| | - Ayman S El-Baz
- Department of Bioengineering, University of Louisville Louisville, KY, USA
| | - Lonnie L Sears
- Department of Pediatrics, University of Louisville Louisville, KY, USA
| | - Ioan Opris
- Department of Physiology and Pharmacology, Wake Forest University Winston-Salem, NC, USA
| | - Manuel F Casanova
- Department of Psychiatry and Behavioral Sciences, University of Louisville Louisville, KY, USA
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Davis NJ. Transcranial stimulation of the developing brain: a plea for extreme caution. Front Hum Neurosci 2014; 8:600. [PMID: 25140146 PMCID: PMC4122183 DOI: 10.3389/fnhum.2014.00600] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 07/18/2014] [Indexed: 11/13/2022] Open
Affiliation(s)
- Nick J Davis
- Department of Psychology, Swansea University Swansea, UK
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