1
|
Xu X, Li F, Liu C, Wang Y, Yang Z, Xie G, Zhang T. Low-frequency repetitive transcranial magnetic stimulation alleviates abnormal behavior in valproic acid rat model of autism through rescuing synaptic plasticity and inhibiting neuroinflammation. Pharmacol Biochem Behav 2024; 240:173788. [PMID: 38734150 DOI: 10.1016/j.pbb.2024.173788] [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: 04/08/2024] [Revised: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 05/13/2024]
Abstract
Autism is a complex neurodevelopmental disorder with no effective treatment available currently. Repetitive transcranial magnetic stimulation (rTMS) is emerging as a promising neuromodulation technique to treat autism. However, the mechanism how rTMS works remains unclear, which restrict the clinical application of magnetic stimulation in the autism treatment. In this study, we investigated the effect of low-frequency rTMS on the autistic-like symptoms and explored if this neuroprotective effect was associated with synaptic plasticity and neuroinflammation in the hippocampus. A rat model of autism was established by intraperitoneal injection of valproic acid (VPA) in pregnant rats and male offspring were treated with 1 Hz rTMS daily for two weeks continuously. Behavior tests were performed to identify behavioral abnormality. Synaptic plasticity was measured by in vivo electrophysiological recording and Golgi-Cox staining. Synapse and inflammation associated proteins were detected by immunofluorescence and Western blot analyses. Results showed prenatal VPA-exposed rats exhibited autistic-like and anxiety-like behaviors, and cognitive impairment. Synaptic plasticity deficits and the abnormality expression of synapse-associated proteins were found in the hippocampus of prenatal VPA-exposed rats. Prenatal VPA exposure increased the level of inflammation cytokines and promoted the excessive activation of microglia. rTMS significantly alleviated the prenatal VPA-induced abnormalities including behavioral and synaptic plasticity deficits, and excessive neuroinflammation. TMS maybe a potential strategy for autism therapy via rescuing synaptic plasticity and inhibiting neuroinflammation.
Collapse
Affiliation(s)
- Xinxin Xu
- State Key Laboratory of Reliability and Intelligence of Electrical Equipment, School of Health Sciences and Biomedical Engineering, Hebei University of Technology, 300130 Tianjin, China; College of Life Sciences and Key Laboratory of Bioactive Materials Ministry of Education, Nankai University, 300071 Tianjin, China
| | - Fangjuan Li
- College of Life Sciences and Key Laboratory of Bioactive Materials Ministry of Education, Nankai University, 300071 Tianjin, China
| | - Chunhua Liu
- School of Medicine, State Key Laboratory of Medicinal Chemical Biology, Nankai University, 300071 Tianjin, China
| | - Yue Wang
- School of Medicine, State Key Laboratory of Medicinal Chemical Biology, Nankai University, 300071 Tianjin, China
| | - Zhuo Yang
- School of Medicine, State Key Laboratory of Medicinal Chemical Biology, Nankai University, 300071 Tianjin, China
| | - Guoming Xie
- Ningbo Medical Center Lihuili Hospital, 315040 Ningbo, Zhejiang, China.
| | - Tao Zhang
- College of Life Sciences and Key Laboratory of Bioactive Materials Ministry of Education, Nankai University, 300071 Tianjin, China.
| |
Collapse
|
2
|
Yan J, Zhang Y, Wang J, Zhu G, Fang K. Effects of transcranial magnetic stimulation on sleep structure and quality in children with autism. Front Psychiatry 2024; 15:1413961. [PMID: 39006818 PMCID: PMC11239541 DOI: 10.3389/fpsyt.2024.1413961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 06/18/2024] [Indexed: 07/16/2024] Open
Abstract
Introduction Sleep disorders are common in children with autism spectrum disorder (ASD). Transcranial magnetic stimulation (TMS) can influence the excitability of neuronal cells in stimulated areas, leading to improvements in sleep and other autistic symptoms. However, studies on clinical mechanisms of TMS in treating sleep disorders associated with ASD are limited. Therefore, we aimed to explore the effects of TMS on sleep structure and quality in children with ASD. Methods Between January 2020 and December 2021, recruitment was advertised through child and adolescent outpatient clinics and online platforms by the Hangzhou Seventh People's Hospital and Lishui Second People's Hospital. Sixty children with ASD who met the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, were selected and randomly divided into the active TMS and sham TMS treatment groups. Thirty healthy children of the same age were recruited as controls. The active TMS group received bilateral low-frequency (0.5 Hz) TMS targeting the dorsolateral prefrontal cortex on both sides in children with ASD, whereas the sham TMS group received sham stimulation with the same stimulation time and location as the experimental group. Both groups were treated for 6 weeks, and the participants were assessed using the Sleep Disturbance Scale for Children (SDSC) before treatment, at 3 weeks, and at 6 weeks of intervention. Independent sample t-tests and difference t-tests were used for statistical analysis of the data. Results No significant differences were observed in general demographic variables, such as age and sex, between the ASD and control groups (P>0.05). Independent sample t-test analysis showed that the total SDSC score, difficulty falling asleep, sleep maintenance, awakening disorders, sleep-wake transition disorders, excessive daytime sleepiness, and nocturnal hyperhidrosis scores were significantly higher in the ASD group than in the control group (P<0.05). Before treatment, no significant differences were observed in the factor or total SDSC scores between the sham TMS group and the active TMS group (P>0.05). After 15 and 30 treatment sessions, the total SDSC score, difficulty falling asleep, sleep maintenance, sleep-wake transition disorders, and excessive daytime sleepiness scores were significantly higher in the sham TMS group than in the active TMS group (P<0.05). The difference t-test analysis showed that after 30 treatment sessions, the reduction rates of the total SDSC score, difficulty falling asleep, sleep maintenance, awakening disorders, sleep-wake transition disorders, excessive daytime sleepiness, and nocturnal hyperhidrosis dimensions were significantly higher in the active TMS group than in the sham TMS group (P<0.05). Conclusion Low-frequency TMS targeting the dorsolateral prefrontal cortex in children with ASD can effectively improve their sleep status, and significant improvement can be achieved after 6 weeks (30 sessions) of treatment.
Collapse
Affiliation(s)
- Juan Yan
- Quality Control Office, Hangzhou Seventh People’s Hospital, Hangzhou, Zhejiang, China
| | - Yan Zhang
- Administration Office, Lishui Second People’s Hospital, Lishui, Zhejiang, China
| | - Junjie Wang
- Quality Control Office, Hangzhou Seventh People’s Hospital, Hangzhou, Zhejiang, China
| | - Guidong Zhu
- Administration Office, Lishui Second People’s Hospital, Lishui, Zhejiang, China
| | - Kaijie Fang
- Quality Control Office, Hangzhou Seventh People’s Hospital, Hangzhou, Zhejiang, China
| |
Collapse
|
3
|
Gallop L, Westwood SJ, Hemmings A, Lewis Y, Campbell IC, Schmidt U. Effects of repetitive transcranial magnetic stimulation in children and young people with psychiatric disorders: a systematic review. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02475-x. [PMID: 38809301 DOI: 10.1007/s00787-024-02475-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 05/18/2024] [Indexed: 05/30/2024]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) has demonstrated benefits in adults with psychiatric disorders, but its clinical utility in children and young people (CYP) is unclear. This PRISMA systematic review used published and ongoing studies to examine the effects of rTMS on disorder-specific symptoms, mood and neurocognition in CYP with psychiatric disorders. We searched Medline via PubMed, Embase, PsychINFO via OVID, and Clinicaltrials.gov up to July 2023. Eligible studies involved multiple-session (i.e., treatment) rTMS in CYP (≤ 25 years-old) with psychiatric disorders. Two independent raters assessed the eligibility of studies and extracted data using a custom-built form. Out of 78 eligible studies (participant N = 1389), the majority (k = 54; 69%) reported an improvement in at least one outcome measure of disorder-specific core symptoms. Some studies (k = 21) examined rTMS effects on mood or neurocognition,: findings were largely positive. Overall, rTMS was well-tolerated with minimal side-effects. Of 17 ongoing or recently completed studies, many are sham-controlled RCTs with better blinding techniques and a larger estimated participant enrolment. Findings provide encouraging evidence for rTMS-related improvements in disorder-specific symptoms in CYP with different psychiatric disorders. However, in terms of both mood (for conditions other than depression) and neurocognitive outcomes, evidence is limited. Importantly, rTMS is well-tolerated and safe. Ongoing studies appear to be of improved methodological quality; however, future studies should broaden outcome measures to more comprehensively assess the effects of rTMS and develop guidance on dosage (i.e., treatment regimens).
Collapse
Affiliation(s)
- Lucy Gallop
- Centre for Research in Eating and Weight Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, PO Box 59, London, SE5 8AF, UK.
| | - Samuel J Westwood
- Department of Psychology, School of Social Science, University of Westminster, London, W1W 6UW, UK
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AB, UK
| | - Amelia Hemmings
- Centre for Research in Eating and Weight Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, PO Box 59, London, SE5 8AF, UK
| | - Yael Lewis
- Centre for Research in Eating and Weight Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, PO Box 59, London, SE5 8AF, UK
- Hadarim Eating Disorder Unit, Shalvata Mental Health Centre, Hod Hasharon, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Iain C Campbell
- Centre for Research in Eating and Weight Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, PO Box 59, London, SE5 8AF, UK
| | - Ulrike Schmidt
- Centre for Research in Eating and Weight Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, PO Box 59, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| |
Collapse
|
4
|
Shi Z, Wang S, Chen M, Hu A, Long Q, Lee Y. The effect of music therapy on language communication and social skills in children with autism spectrum disorder: a systematic review and meta-analysis. Front Psychol 2024; 15:1336421. [PMID: 38774719 PMCID: PMC11106491 DOI: 10.3389/fpsyg.2024.1336421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 04/12/2024] [Indexed: 05/24/2024] Open
Abstract
Background Studies have shown that music therapy can be used as a therapeutic aid for clinical disorders. To evaluate the effects of music therapy (MT) on language communication and social skills in children with autism spectrum disorder (ASD), a meta-analysis was performed on eligible studies in this field. Methods A systematic search was conducted in eight databases: PubMed, Embase, Web of Science, Cochrane Library databases, the China National Knowledge Infrastructure (CNKI), Wanfang Data, the Chinese Biomedical Literature (CBM) Database, and the VIP Chinese Science and Technology Periodicals Database. The standard mean difference (SMD) values were used to evaluate outcomes, and the pooled proportions and SMD with their 95% confidence intervals (CIs) were also calculated. Results Eighteen randomized controlled trial (RCT) studies were included, with a total of 1,457 children with ASD. This meta-analysis revealed that music therapy improved their language communication [SMD = -1.20; 95%CI -1.45, -0.94; χ2 (17) = 84.17, I2 = 80%, p < 0.001] and social skills [SMD = -1. 13; 95%CI -1.49, -0.78; χ2 (17) = 162.53, I2 = 90%, p < 0.001]. In addition, behavior [SMD = -1.92; 94%CI -2.56, -1.28; χ2 (13) = 235.08, I2 = 95%, p < 0.001], sensory perception [SMD = -1.62; 95%CI -2.17, -1.08; χ2 (16) = 303.80, I2 = 95%, p < 0.001], self-help [SMD = -2. 14; 95%CI -3.17, -1.10; χ2 (6) = 173.07, I2 = 97%, p < 0.001] were all improved. Conclusion Music therapy has a positive effect on the improvement of symptoms in children with ASD. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/.
Collapse
Affiliation(s)
- Zijuan Shi
- North Sichuan Medical College, Nanchong, China
| | - Si Wang
- North Sichuan Medical College, Nanchong, China
| | | | - Aimin Hu
- North Sichuan Medical College, Nanchong, China
| | | | - Yujun Lee
- North Sichuan Medical College, Nanchong, China
- The Graduate School of Xi’an International Studies University, Shaanxi, China
| |
Collapse
|
5
|
Yeh CH, Lin PC, Tseng RY, Chao YP, Wu CT, Chou TL, Chen RS, Gau SSF, Ni HC, Lin HY. Lack of effects of eight-week left dorsolateral prefrontal theta burst stimulation on white matter macro/microstructure and connection in autism. Brain Imaging Behav 2024:10.1007/s11682-024-00874-x. [PMID: 38492129 DOI: 10.1007/s11682-024-00874-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2024] [Indexed: 03/18/2024]
Abstract
Whether brain stimulation could modulate brain structure in autism remains unknown. This study explored the impact of continuous theta burst stimulation (cTBS) over the left dorsolateral prefrontal cortex (DLPFC) on white matter macro/microstructure in intellectually able children and emerging adults with autism. Sixty autistic participants were randomized (30 active) and received active or sham cTBS for eight weeks twice per week, 16 total sessions using a double-blind (participant-, rater-, analyst-blinded) design. All participants received high-angular resolution diffusion MR imaging at baseline and week 8. Twenty-eight participants in the active group and twenty-seven in the sham group with good imaging quality entered the final analysis. With longitudinal fixel-based analysis and network-based statistics, we found no significant difference between the active and sham groups in changes of white matter macro/microstructure and connections following cTBS. In addition, we found no association between baseline white matter macro/microstructure and autistic symptom changes from baseline to week 8 in the active group. In conclusion, we did not find a significant impact of left DLPFC cTBS on white matter macro/microstructure and connections in children and emerging adults with autism. These findings need to be interpreted in the context that the current intellectually able cohort in a single university hospital site limits the generalizability. Future studies are required to investigate if higher stimulation intensities and/or doses, other personal factors, or rTMS parameters might confer significant brain structural changes visible on MRI in ASD.
Collapse
Affiliation(s)
- Chun-Hung Yeh
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, No.5 Fusing St. Gueishan, Taoyuan, 333, Taiwan
| | - Po-Chun Lin
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, No.5 Fusing St. Gueishan, Taoyuan, 333, Taiwan
| | - Rung-Yu Tseng
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Ping Chao
- Deparment of Computer Science and Information Engineering, Chang Gung University, Taoyuan, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Chen-Te Wu
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Tai-Li Chou
- Department of Psychology, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taipei, Taiwan
- Neurobiology and Cognitive Science Center, National Taiwan University, Taipei, Taiwan
| | - Rou-Shayn Chen
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Susan Shur-Fen Gau
- Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Hsing-Chang Ni
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, No.5 Fusing St. Gueishan, Taoyuan, 333, Taiwan.
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Hsiang-Yuan Lin
- Azrieli Adult Neurodevelopmental Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
6
|
Oberman LM, Benussi A. Transcranial Magnetic Stimulation Across the Lifespan: Impact of Developmental and Degenerative Processes. Biol Psychiatry 2024; 95:581-591. [PMID: 37517703 PMCID: PMC10823041 DOI: 10.1016/j.biopsych.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/01/2023]
Abstract
Transcranial magnetic stimulation (TMS) has emerged as a pivotal noninvasive technique for investigating cortical excitability and plasticity across the lifespan, offering valuable insights into neurodevelopmental and neurodegenerative processes. In this review, we explore the impact of TMS applications on our understanding of normal development, healthy aging, neurodevelopmental disorders, and adult-onset neurodegenerative diseases. By presenting key developmental milestones and age-related changes in TMS measures, we provide a foundation for understanding the maturation of neurotransmitter systems and the trajectory of cognitive functions throughout the lifespan. Building on this foundation, the paper delves into the pathophysiology of neurodevelopmental disorders, including autism spectrum disorder, attention-deficit/hyperactivity disorder, Tourette syndrome, and adolescent depression. Highlighting recent findings on altered neurotransmitter circuits and dysfunctional cortical plasticity, we underscore the potential of TMS as a valuable tool for unraveling underlying mechanisms and informing future therapeutic interventions. We also review the emerging role of TMS in investigating and treating the most common adult-onset neurodegenerative disorders and late-onset depression. By outlining the therapeutic applications of noninvasive brain stimulation techniques in these disorders, we discuss the growing body of evidence supporting their use as therapeutic tools for symptom management and potentially slowing disease progression. The insights gained from TMS studies have advanced our understanding of the underlying mechanisms in both healthy and disease states, ultimately informing the development of more targeted diagnostic and therapeutic strategies for a wide range of neuropsychiatric conditions.
Collapse
Affiliation(s)
- Lindsay M Oberman
- National Institute of Mental Health Intramural Research Program, National Institutes of Health, Bethesda, Maryland
| | - Alberto Benussi
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
| |
Collapse
|
7
|
Oberman LM, Francis SM, Lisanby SH. The use of noninvasive brain stimulation techniques in autism spectrum disorder. Autism Res 2024; 17:17-26. [PMID: 37873560 PMCID: PMC10841888 DOI: 10.1002/aur.3041] [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: 05/01/2023] [Accepted: 09/15/2023] [Indexed: 10/25/2023]
Abstract
Noninvasive brain stimulation (NIBS) techniques, including repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), have recently emerged as alternative, nonpharmacological interventions for a variety of psychiatric, neurological, and neurodevelopmental conditions. NIBS is beginning to be applied in both research and clinical settings for the treatment of core and associated symptoms of autism spectrum disorder (ASD) including social communication deficits, restricted and repetitive behaviors, irritability, hyperactivity, depression and impairments in executive functioning and sensorimotor integration. Though there is much promise for these targeted device-based interventions, in other disorders (including adult major depressive disorder (MDD) and obsessive compulsive disorder (OCD) where rTMS is FDA cleared), data on the safety and efficacy of these interventions in individuals with ASD is limited especially in younger children when neurodevelopmental interventions typically begin. Most studies are open-label, small scale, and/or focused on a restricted subgroup of individuals with ASD. There is a need for larger, randomized controlled trials that incorporate neuroimaging in order to develop predictive biomarkers of treatment response and optimize treatment parameters. We contend that until such studies are conducted, we do not have adequate estimates of the safety and efficacy of NIBS interventions in children across the spectrum. Thus, broad off-label use of these techniques in this population is not supported by currently available evidence. Here we discuss the existing data on the use of NIBS to treat symptoms related to ASD and discuss future directions for the field.
Collapse
Affiliation(s)
- Lindsay M Oberman
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Sunday M Francis
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Sarah H Lisanby
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| |
Collapse
|
8
|
Smith JR, DiSalvo M, Green A, Ceranoglu TA, Anteraper SA, Croarkin P, Joshi G. Treatment Response of Transcranial Magnetic Stimulation in Intellectually Capable Youth and Young Adults with Autism Spectrum Disorder: A Systematic Review and Meta-Analysis. Neuropsychol Rev 2023; 33:834-855. [PMID: 36161554 PMCID: PMC10039963 DOI: 10.1007/s11065-022-09564-1] [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: 11/01/2021] [Accepted: 08/31/2022] [Indexed: 11/26/2022]
Abstract
To examine current clinical research on the use of transcranial magnetic stimulation (TMS) in the treatment of pediatric and young adult autism spectrum disorder in intellectually capable persons (IC-ASD). We searched peer-reviewed international literature to identify clinical trials investigating TMS as a treatment for behavioral and cognitive symptoms of IC-ASD. We identified sixteen studies and were able to conduct a meta-analysis on twelve of these studies. Seven were open-label or used neurotypical controls for baseline cognitive data, and nine were controlled trials. In the latter, waitlist control groups were often used over sham TMS. Only one study conducted a randomized, parallel, double-blind, and sham controlled trial. Favorable safety data was reported in low frequency repetitive TMS, high frequency repetitive TMS, and intermittent theta burst studies. Compared to TMS research of other neuropsychiatric conditions, significantly lower total TMS pulses were delivered in treatment and neuronavigation was not regularly utilized. Quantitatively, our multivariate meta-analysis results report improvement in cognitive outcomes (pooled Hedges' g = 0.735, 95% CI = 0.242, 1.228; p = 0.009) and primarily Criterion B symptomology of IC-ASD (pooled Hedges' g = 0.435, 95% CI = 0.359, 0.511; p < 0.001) with low frequency repetitive TMS to the dorsolateral prefrontal cortex. The results of our systematic review and meta-analysis data indicate that TMS may offer a promising and safe treatment option for pediatric and young adult patients with IC-ASD. However, future work should include use of neuronavigation software, theta burst protocols, targeting of various brain regions, and robust study design before clinical recommendations can be made.
Collapse
Affiliation(s)
- Joshua R Smith
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center at Village of Vanderbilt, 1500 21st Avenue South, Suite 2200, Nashville, TN, 37212, USA.
- Vanderbilt Kennedy Center, 110 Magnolia Circle, Nashville, TN, 37203, USA.
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
- Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
| | - Maura DiSalvo
- Clinical and Research Programs in Pediatric Psychopharmacology, and Adult ADHD, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Alan and Lorraine Bressler Clinical and Research Program for Autism Spectrum Disorder, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Allison Green
- Clinical and Research Programs in Pediatric Psychopharmacology, and Adult ADHD, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Alan and Lorraine Bressler Clinical and Research Program for Autism Spectrum Disorder, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Department of Psychological and Brain Sciences, Indiana University, 1101 East 10th Street, Bloomington, IN, 47405, USA
| | - Tolga Atilla Ceranoglu
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
- Clinical and Research Programs in Pediatric Psychopharmacology, and Adult ADHD, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Alan and Lorraine Bressler Clinical and Research Program for Autism Spectrum Disorder, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | | | - Paul Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic, 1216 2nd Street Southwest, Rochester, MN, 55902, USA
| | - Gagan Joshi
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
- Clinical and Research Programs in Pediatric Psychopharmacology, and Adult ADHD, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Alan and Lorraine Bressler Clinical and Research Program for Autism Spectrum Disorder, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| |
Collapse
|
9
|
Effects of repetitive transcranial magnetic stimulation combined with action-observation-execution on social interaction and communication in autism spectrum disorder: Feasibility study. Brain Res 2023; 1804:148258. [PMID: 36702183 DOI: 10.1016/j.brainres.2023.148258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 01/12/2023] [Accepted: 01/20/2023] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To investigate the feasibility of a combined high-frequency rTMS (HF-rTMS) with action observation and execution (AOE) on social interaction and communication in children with Autistic Spectrum Disorder (ASD). MATERIALS AND METHODS Fifteen children underwent 10 sessions of 5-Hz HF-rTMS on the right inferior frontal gyrus combined with AOE. An experimental group received the real HF-rTMS while the control group received the sham one. For the AOE protocol, they were instructed to watch and imitate a video showing the procedure, including reaching and grasping tasks, gustatory tasks, and facial expressions. Their behavioural outcomes were evaluated using the Vineland Adaptive Behaviour Scale (VABS) and electroencephalograms (EEGs) recorded at three time points: baseline, immediately after each treatment, and at the 1-week follow-up after the 10th treatment. RESULTS There were increased VABS subitem scores in the experimental group, including the receptive, expressive, domestic, and community scores but no such increase was observed in the control group. For the EEG, the beta rhythm at C3 and C4 increased in the experimental group. Additionally, positive correlations were observed between changes in the scores for the expressive subitem and changes in the beta rhythm on the C4 electrode at baseline and immediately after treatment in the experimental group. The control group showed no significant differences in any items for both observation and imitation times. CONCLUSION Ten sessions of HF-rTMS combined with AOE could improve both the subitems of communication and daily living skills domain in children aged 7-12 years with ASD. Although it is still inconclusive, this behavioural improvement may be partly attributable to increased cortical activity, as evidenced by beta rhythms.
Collapse
|
10
|
Xiao L, Huo X, Wang Y, Li W, Li M, Wang C, Wang F, Sun T. A bibliometric analysis of global research status and trends in neuromodulation techniques in the treatment of autism spectrum disorder. BMC Psychiatry 2023; 23:183. [PMID: 36941549 PMCID: PMC10026211 DOI: 10.1186/s12888-023-04666-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/08/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Autism spectrum disorder (ASD) is a neurodevelopmental disease which has risen to become the main cause of childhood disability, placing a heavy burden on families and society. To date, the treatment of patients with ASD remains a complicated problem, for which neuromodulation techniques are a promising solution. This study analyzed the global research situation of neuromodulation techniques in the treatment of ASD from 1992 to 2022, aiming to explore the global research status and frontier trends in this field. METHODS The Web of Science (WoS) was searched for literature related to neuromodulation techniques for ASD from 1992 to October 2022. A knowledge atlas to analyze collaboration among countries, institutions, authors, publishing journals, reference co-citation patterns, keyword co-occurrence, keyword clustering, and burst keywords was constructed using Rstudio software, CiteSpace, and VOSviewer. RESULTS In total, 392 publications related to the treatment of ASD using neuromodulation techniques were included. Despite some fluctuations, the number of publications in this field has shown a growing trend in recent years. The United States and Deakin University are the leading country and institution in this field, respectively. The greatest contributing authors are Peter G Enticott, Manuel F Casanova, and Paul B Fitzgerald et al. The most prolific and cited journal is Brain Stimulation and the most commonly co-cited journal is The Journal of Autism and Developmental Disorders. The most frequently cited article was that of Simone Rossi (Safety, ethical considerations, and application guidelines for the use of transverse magnetic stimulation in clinical practice and research, 2009). "Obsessive-compulsive disorder," "transcranial direct current stimulation," "working memory," "double blind" and "adolescent" were identified as hotspots and frontier trends of neuromodulation techniques in the treatment of ASD. CONCLUSION The application of neuromodulation techniques for ASD has attracted the attention of researchers worldwide. Restoring the social ability and improving the comorbid symptoms in autistic children and adults have always been the focus of research. Neuromodulation techniques have demonstrated significant advantages and effects on these issues. Transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) are new therapeutic methods introduced in recent years, and are also directions for further exploration.
Collapse
Affiliation(s)
- Lifei Xiao
- Department of Neurosurgery, General Hospital of Ningxia Medical University, Yinchuan, 750000, China
- Ningxia Key Laboratory of Cerebrocranial Disease, Incubation Base of National Key Laboratory, Ningxia Medical University, Yinchuan, 750000, China
| | - Xianhao Huo
- Department of Neurosurgery, General Hospital of Ningxia Medical University, Yinchuan, 750000, China
- Ningxia Key Laboratory of Cerebrocranial Disease, Incubation Base of National Key Laboratory, Ningxia Medical University, Yinchuan, 750000, China
| | - Yangyang Wang
- Department of Neurosurgery, General Hospital of Ningxia Medical University, Yinchuan, 750000, China
- Ningxia Key Laboratory of Cerebrocranial Disease, Incubation Base of National Key Laboratory, Ningxia Medical University, Yinchuan, 750000, China
| | - Wenchao Li
- Department of Neurosurgery, General Hospital of Ningxia Medical University, Yinchuan, 750000, China
- Ningxia Key Laboratory of Cerebrocranial Disease, Incubation Base of National Key Laboratory, Ningxia Medical University, Yinchuan, 750000, China
| | - Mei Li
- Department of Neurosurgery, General Hospital of Ningxia Medical University, Yinchuan, 750000, China
- Ningxia Key Laboratory of Cerebrocranial Disease, Incubation Base of National Key Laboratory, Ningxia Medical University, Yinchuan, 750000, China
| | - Chaofan Wang
- Department of Neurosurgery, General Hospital of Ningxia Medical University, Yinchuan, 750000, China
- Ningxia Key Laboratory of Cerebrocranial Disease, Incubation Base of National Key Laboratory, Ningxia Medical University, Yinchuan, 750000, China
| | - Feng Wang
- Department of Neurosurgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, China.
| | - Tao Sun
- Department of Neurosurgery, General Hospital of Ningxia Medical University, Yinchuan, 750000, China.
- Ningxia Key Laboratory of Cerebrocranial Disease, Incubation Base of National Key Laboratory, Ningxia Medical University, Yinchuan, 750000, China.
| |
Collapse
|
11
|
Pal M, Mandal N, Ray A, Saha PK. The Role of Repetitive Transcranial Magnetic Stimulation in the Treatment of Autism Spectrum Disorder. JOURNAL OF INDIAN ASSOCIATION FOR CHILD AND ADOLESCENT MENTAL HEALTH 2022. [DOI: 10.1177/09731342221141028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Introduction: Autism spectrum disorder (ASD) is a neurodevelopmental disorder with impairments in language acquisition, social functioning, and restricted and repetitive behaviors. There is no definitive management for the ASD spectrum. The management options available are not beyond criticism. Hence, the search for new options is actively in progress. Noninvasive brain stimulation interventions such as repetitive transcranial magnetic stimulation (rTMS) appears to be a promising tool for the treatment of ASD. However, the available literature on TMS use in ASD is preliminary. Methods: This was a hospital-based longitudinal study conducted over 50 patients with ASD of 6 to 16 years of age. The Indian Scale for Assessment of Autism (ISAA) was used for the assessment of the extent of disability in these children. They were given 10 sessions of rTMS over a period of 10 days over the left dorsolateral prefrontal cortex (l-DLPFC) and reassessed for any improvement in ISAA score after 1 day and 3 months of completion of all the sessions of rTMS. Results: There was no statistically significant change in the total ISAA score or any of the 6 domains of ISAA after 1 day and 3 months of giving 10 sessions of TMS. There were no significant adverse effects after giving rTMS. In a few patients, mild headache, neck pain, or discomfort at the stimulation site was noted. Conclusion: This study has shown that low-frequency rTMS does not have any significant improvement on the various symptoms of ASD. However, there are no major adverse effects after giving rTMS. Also, it points toward the need for further studies.
Collapse
Affiliation(s)
- Mainak Pal
- Department of Psychiatry, Institute of Psychiatry-COE, IPGME & R, Kolkata, West Bengal, India
| | - Nikhiles Mandal
- Department of Psychiatry, Institute of Psychiatry-COE, IPGME & R, Kolkata, West Bengal, India
| | - Anirban Ray
- Department of Psychiatry, Institute of Psychiatry-COE, IPGME & R, Kolkata, West Bengal, India
| | - Pradip Kumar Saha
- Department of Psychiatry, Institute of Psychiatry-COE, IPGME & R, Kolkata, West Bengal, India
| |
Collapse
|
12
|
Kang J, Li X, Casanova MF, Sokhadze EM, Geng X. Impact of repetitive transcranial magnetic stimulation on the directed connectivity of autism EEG signals: a pilot study. Med Biol Eng Comput 2022; 60:3655-3664. [DOI: 10.1007/s11517-022-02693-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 10/06/2022] [Indexed: 11/11/2022]
|
13
|
Jiang L, He R, Li Y, Yi C, Peng Y, Yao D, Wang Y, Li F, Xu P, Yang Y. Predicting the long-term after-effects of rTMS in autism spectrum disorder using temporal variability analysis of scalp EEG. J Neural Eng 2022; 19. [PMID: 36223728 DOI: 10.1088/1741-2552/ac999d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/12/2022] [Indexed: 12/24/2022]
Abstract
Objective.Repetitive transcranial magnetic stimulation (rTMS) emerges as a useful therapy for autism spectrum disorder (ASD) clinically. Whereas the mechanisms of action of rTMS on ASD are not fully understood, and no biomarkers until now are available to reliably predict the follow-up rTMS efficacy in clinical practice.Approach.In the current work, the temporal variability was investigated in resting-state electroencephalogram of ASD patients, and the nonlinear complexity of related time-varying networks was accordingly evaluated by fuzzy entropy.Main results.The results showed the hyper-variability in the resting-state networks of ASD patients, while three week rTMS treatment alleviates the hyper fluctuations occurring in the frontal-parietal and frontal-occipital connectivity and further contributes to the ameliorative ASD symptoms. In addition, the changes in variability network properties are closely correlated with clinical scores, which further serve as potential predictors to reliably track the long-term rTMS efficacy for ASD.Significance.The findings consistently demonstrated that the temporal variability of time-varying networks of ASD patients could be modulated by rTMS, and related variability properties also help predict follow-up rTMS efficacy, which provides the potential for formulating individualized treatment strategies for ASD (ChiCTR2000033586).
Collapse
Affiliation(s)
- Lin Jiang
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu 611731, People's Republic of China.,School of Life Science and Technology, Center for Information in BioMedicine, University of Electronic Science and Technology of China, Chengdu 611731, People's Republic of China
| | - Runyang He
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu 611731, People's Republic of China.,School of Life Science and Technology, Center for Information in BioMedicine, University of Electronic Science and Technology of China, Chengdu 611731, People's Republic of China
| | - Yuqin Li
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu 611731, People's Republic of China.,School of Life Science and Technology, Center for Information in BioMedicine, University of Electronic Science and Technology of China, Chengdu 611731, People's Republic of China
| | - Chanlin Yi
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu 611731, People's Republic of China.,School of Life Science and Technology, Center for Information in BioMedicine, University of Electronic Science and Technology of China, Chengdu 611731, People's Republic of China
| | - Yueheng Peng
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu 611731, People's Republic of China.,School of Life Science and Technology, Center for Information in BioMedicine, University of Electronic Science and Technology of China, Chengdu 611731, People's Republic of China
| | - Dezhong Yao
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu 611731, People's Republic of China.,School of Life Science and Technology, Center for Information in BioMedicine, University of Electronic Science and Technology of China, Chengdu 611731, People's Republic of China.,School of Electrical Engineering, Zhengzhou University, Zhengzhou 450001, People's Republic of China.,Research Unit of NeuroInformation, Chinese Academy of Medical Sciences, 2019RU035 Chengdu, People's Republic of China
| | - Yuping Wang
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, People's Republic of China.,Beijing Key Laboratory of Neuromodulation, Beijing, People's Republic of China.,Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, People's Republic of China
| | - Fali Li
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu 611731, People's Republic of China.,School of Life Science and Technology, Center for Information in BioMedicine, University of Electronic Science and Technology of China, Chengdu 611731, People's Republic of China.,Research Unit of NeuroInformation, Chinese Academy of Medical Sciences, 2019RU035 Chengdu, People's Republic of China
| | - Peng Xu
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu 611731, People's Republic of China.,School of Life Science and Technology, Center for Information in BioMedicine, University of Electronic Science and Technology of China, Chengdu 611731, People's Republic of China.,Research Unit of NeuroInformation, Chinese Academy of Medical Sciences, 2019RU035 Chengdu, People's Republic of China.,Radiation Oncology Key Laboratory of Sichuan Province, 610041 Chengdu, People's Republic of China
| | - Yingxue Yang
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, People's Republic of China.,Beijing Key Laboratory of Neuromodulation, Beijing, People's Republic of China.,Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, People's Republic of China
| |
Collapse
|
14
|
Jangwan NS, Ashraf GM, Ram V, Singh V, Alghamdi BS, Abuzenadah AM, Singh MF. Brain augmentation and neuroscience technologies: current applications, challenges, ethics and future prospects. Front Syst Neurosci 2022; 16:1000495. [PMID: 36211589 PMCID: PMC9538357 DOI: 10.3389/fnsys.2022.1000495] [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] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 08/31/2022] [Indexed: 12/02/2022] Open
Abstract
Ever since the dawn of antiquity, people have strived to improve their cognitive abilities. From the advent of the wheel to the development of artificial intelligence, technology has had a profound leverage on civilization. Cognitive enhancement or augmentation of brain functions has become a trending topic both in academic and public debates in improving physical and mental abilities. The last years have seen a plethora of suggestions for boosting cognitive functions and biochemical, physical, and behavioral strategies are being explored in the field of cognitive enhancement. Despite expansion of behavioral and biochemical approaches, various physical strategies are known to boost mental abilities in diseased and healthy individuals. Clinical applications of neuroscience technologies offer alternatives to pharmaceutical approaches and devices for diseases that have been fatal, so far. Importantly, the distinctive aspect of these technologies, which shapes their existing and anticipated participation in brain augmentations, is used to compare and contrast them. As a preview of the next two decades of progress in brain augmentation, this article presents a plausible estimation of the many neuroscience technologies, their virtues, demerits, and applications. The review also focuses on the ethical implications and challenges linked to modern neuroscientific technology. There are times when it looks as if ethics discussions are more concerned with the hypothetical than with the factual. We conclude by providing recommendations for potential future studies and development areas, taking into account future advancements in neuroscience innovation for brain enhancement, analyzing historical patterns, considering neuroethics and looking at other related forecasts.
Collapse
Affiliation(s)
- Nitish Singh Jangwan
- Department of Pharmacology, School of Pharmaceutical Sciences and Technology, Sardar Bhagwan Singh University, Balawala, India
| | - Ghulam Md Ashraf
- Pre-Clinical Research Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Veerma Ram
- Department of Pharmacology, School of Pharmaceutical Sciences and Technology, Sardar Bhagwan Singh University, Balawala, India
| | - Vinod Singh
- Prabha Harji Lal College of Pharmacy and Paraclinical Sciences, University of Jammu, Jammu, India
| | - Badrah S. Alghamdi
- Pre-Clinical Research Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Physiology, Neuroscience Unit, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Adel Mohammad Abuzenadah
- Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mamta F. Singh
- Department of Pharmacology, School of Pharmaceutical Sciences and Technology, Sardar Bhagwan Singh University, Balawala, India
| |
Collapse
|
15
|
Wei D, Tsheringla S, McPartland JC, Allsop AZASA. Combinatorial approaches for treating neuropsychiatric social impairment. Philos Trans R Soc Lond B Biol Sci 2022; 377:20210051. [PMID: 35858103 PMCID: PMC9274330 DOI: 10.1098/rstb.2021.0051] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 05/13/2022] [Indexed: 01/30/2023] Open
Abstract
Social behaviour is an essential component of human life and deficits in social function are seen across multiple psychiatric conditions with high morbidity. However, there are currently no FDA-approved treatments for social dysfunction. Since social cognition and behaviour rely on multiple signalling processes acting in concert across various neural networks, treatments aimed at social function may inherently require a combinatorial approach. Here, we describe the social neurobiology of the oxytocin and endocannabinoid signalling systems as well as translational evidence for their use in treating symptoms in the social domain. We leverage this systems neurobiology to propose a network-based framework that involves pharmacology, psychotherapy, non-invasive brain stimulation and social skills training to combinatorially target trans-diagnostic social impairment. Lastly, we discuss the combined use of oxytocin and endocannabinoids within our proposed framework as an illustrative strategy to treat specific aspects of social function. Using this framework provides a roadmap for actionable treatment strategies for neuropsychiatric social impairment. This article is part of the theme issue 'Interplays between oxytocin and other neuromodulators in shaping complex social behaviours'.
Collapse
Affiliation(s)
- Don Wei
- Department of Psychiatry, UCLA, Los Angeles, CA, USA
| | | | | | | |
Collapse
|
16
|
Eldaief MC, Dickerson BC, Camprodon JA. Transcranial Magnetic Stimulation for the Neurological Patient: Scientific Principles and Applications. Semin Neurol 2022; 42:149-157. [PMID: 35213900 PMCID: PMC9838190 DOI: 10.1055/s-0041-1742265] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Non-invasive brain stimulation has been increasingly recognized for its potential as an investigational, diagnostic and therapeutic tool across the clinical neurosciences. Transcranial magnetic stimulation (TMS) is a non-invasive method of focal neuromodulation. Diagnostically, TMS can be used to probe cortical excitability and plasticity, as well as for functional mapping. Therapeutically, depending on the pattern employed, TMS can either facilitate or inhibit stimulated cortex potentially modulating maladaptive physiology through its effects on neuroplasticity. Despite this potential, applications of TMS in neurology have only been approved for diagnostic clinical neurophysiology, pre-surgical mapping of motor and language cortex, and the treatment of migraines. In this article, we discuss the principles of TMS and its clinical applications in neurology, including experimental applications in stroke rehabilitation, seizures, autism spectrum disorder, neurodegenerative disorders, movement disorders, tinnitus, chronic pain and functional neurological disorder. To promote increased cross-talk across neurology and psychiatry, we also succinctly review the TMS literature for the treatment of major depression and obsessive compulsive disorder. Overall, we argue that larger clinical trials that are better informed by circuit-level biomarkers and pathophysiological models will lead to an expansion of the application of TMS for patients cared for by neurologists.
Collapse
Affiliation(s)
- Mark C. Eldaief
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts,Department of Psychology, Center for Brain Science, Neuroimaging Facility, Harvard University, Cambridge, Massachusetts
| | - Bradford C. Dickerson
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
| | - Joan A. Camprodon
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
| |
Collapse
|
17
|
Bejenaru AM, Malhi NK. Use of Repetitive Transcranial Magnetic Stimulation in Child Psychiatry. INNOVATIONS IN CLINICAL NEUROSCIENCE 2022; 19:11-22. [PMID: 35958966 PMCID: PMC9341313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive diagnostic and therapeutic technique that has showed benefits in various psychiatric disorders. Although there is a large body of literature available on its use in adult populations, existing research in pediatric populations is very limited. Current research has primarily focused on its use in adolescent treatment-resistant depression. However, recently, rTMS has gained attention among researchers to find its utility in other neuropsychiatric disorders, such as autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD), tics, and psychosis. There is a lack of systematic data on the safety of rTMS in children and adolescents. The aim of this article was to present an overview of the existing literature on the use of rTMS in children and adolescents and examine the relevant safety considerations. METHODS We conducted a literature review of the English literature in PubMed on TMS in children and adolescents, using comprehensive search terms and expanding our review to include sources cited by these reports. We reviewed the application of rTMS in psychiatric disorders in the pediatric population. RESULTS rTMS has been used for depression and anxiety disorders, OCD, ADHD, Tourette syndrome/tics, ASD, and schizophrenia, with variable results. CONCLUSION rTMS is a promising treatment in children and adolescents with psychiatric disorders, although larger, sham-controlled, randomized, controlled trials (RCTs) will be required to definitely demonstrate efficacy, as well as to support a safety profile.
Collapse
Affiliation(s)
- Anca Maria Bejenaru
- Drs. Bejenaru and Malhi are with the Department of Psychiatry and Behavioral Health, Christiana Care in Wilmington, Delaware
| | - Narpinder Kaur Malhi
- Drs. Bejenaru and Malhi are with the Department of Psychiatry and Behavioral Health, Christiana Care in Wilmington, Delaware
| |
Collapse
|
18
|
Tian J, Gao X, Yang L. Repetitive Restricted Behaviors in Autism Spectrum Disorder: From Mechanism to Development of Therapeutics. Front Neurosci 2022; 16:780407. [PMID: 35310097 PMCID: PMC8924045 DOI: 10.3389/fnins.2022.780407] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 02/09/2022] [Indexed: 01/28/2023] Open
Abstract
Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder characterized by deficits in social communication, social interaction, and repetitive restricted behaviors (RRBs). It is usually detected in early childhood. RRBs are behavioral patterns characterized by repetition, inflexibility, invariance, inappropriateness, and frequent lack of obvious function or specific purpose. To date, the classification of RRBs is contentious. Understanding the potential mechanisms of RRBs in children with ASD, such as neural connectivity disorders and abnormal immune functions, will contribute to finding new therapeutic targets. Although behavioral intervention remains the most effective and safe strategy for RRBs treatment, some promising drugs and new treatment options (e.g., supplementary and cell therapy) have shown positive effects on RRBs in recent studies. In this review, we summarize the latest advances of RRBs from mechanistic to therapeutic approaches and propose potential future directions in research on RRBs.
Collapse
|
19
|
Oliveira JS, Manning MC, Kavanaugh BC. Cognitive Control Deficits in Depression: A Novel Target to Improve Suboptimal Outcomes in Childhood. J Neuropsychiatry Clin Neurosci 2021; 33:307-313. [PMID: 34261346 DOI: 10.1176/appi.neuropsych.20090236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Cognitive control deficits are one of three primary endophenotypes in depression, and the enhanced targeting of these deficits in clinical and research work is expected to lead to improved depression outcomes. Cognitive control is a set of self-regulatory processes responsible for goal-oriented behavior that predicts clinical/functional outcomes across the spectrum of brain-based disorders. In depression, cognitive control deficits emerge by the first depressive episode, persist during symptom remission, and worsen over the course of depression. In addition, the presence of these deficits predicts a poor response to evidence-based depression treatments, including psychotherapy and antidepressant medication. This is particularly relevant to childhood depression, as 1%-2% of children are diagnosed with depression, yet there are very limited evidence-based treatment options. Cognitive control deficits may be a previously underaddressed factor contributing to poor outcomes, although there remains a dearth of research examining the topic. The investigators describe the prior literature on cognitive control in depression to argue for the need for increased focus on this endophenotype. They then describe cognitive control-focused clinical and research avenues that would likely lead to improved treatments and outcomes for this historically undertreated aspect of childhood depression.
Collapse
Affiliation(s)
- Jane S Oliveira
- Bradley Hospital, East Providence, R.I. (Oliveira, Kavanaugh); Alpert Medical School of Brown University, Providence, R.I. (Oliveira, Kavanaugh); and Department of Applied Psychology, Northeastern University, Boston (Manning)
| | - Madeline C Manning
- Bradley Hospital, East Providence, R.I. (Oliveira, Kavanaugh); Alpert Medical School of Brown University, Providence, R.I. (Oliveira, Kavanaugh); and Department of Applied Psychology, Northeastern University, Boston (Manning)
| | - Brian C Kavanaugh
- Bradley Hospital, East Providence, R.I. (Oliveira, Kavanaugh); Alpert Medical School of Brown University, Providence, R.I. (Oliveira, Kavanaugh); and Department of Applied Psychology, Northeastern University, Boston (Manning)
| |
Collapse
|
20
|
Moxon-Emre I, Daskalakis ZJ, Blumberger DM, Croarkin PE, Lyon RE, Forde NJ, Tani H, Truong P, Lai MC, Desarkar P, Sailasuta N, Szatmari P, Ameis SH. Modulation of Dorsolateral Prefrontal Cortex Glutamate/Glutamine Levels Following Repetitive Transcranial Magnetic Stimulation in Young Adults With Autism. Front Neurosci 2021; 15:711542. [PMID: 34690671 PMCID: PMC8527173 DOI: 10.3389/fnins.2021.711542] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/13/2021] [Indexed: 12/29/2022] Open
Abstract
Altered excitatory and inhibitory neurotransmission has been implicated in autism spectrum disorder (ASD). Interventions using repetitive transcranial magnetic stimulation (rTMS) to enhance or inhibit cortical excitability are under study for various targets, though the mechanistic effects of rTMS have yet to be examined in ASD. Here, we examined whether an excitatory rTMS treatment course modulates glutamatergic (Glx) or γ-aminobutyric acid (GABA) metabolite levels in emerging adults with ASD. Twenty-eight participants with ASD and executive function impairment [23.3 ± 4.69 years; seven-female] underwent two magnetic resonance spectroscopy (MRS) scans of the left dorsolateral prefrontal cortex (DLPFC). MRS scans were acquired before and after participants with ASD were randomized to receive a 20-session course of active or sham rTMS to the DLPFC. Baseline MRS data was available for 19 typically developing controls [23.8 ± 4.47 years; six-female]. Metabolite levels for Glx and GABA+ were compared between ASD and control groups, at baseline, and metabolite level change, pre-to-post-rTMS treatment, was compared in ASD participants that underwent active vs. sham rTMS. Absolute change in Glx was greater in the active vs. sham-rTMS group [F(1,19) = 6.54, p = 0.02], though the absolute change in GABA+ did not differ between groups. We also examined how baseline metabolite levels related to pre/post-rTMS metabolite level change, in the active vs. sham groups. rTMS group moderated the relation between baseline Glx and pre-to-post-rTMS Glx change, such that baseline Glx predicted Glx change in the active-rTMS group only [b = 1.52, SE = 0.32, t(18) = 4.74, p < 0.001]; Glx levels increased when baseline levels were lower, and decreased when baseline levels were higher. Our results indicate that an interventional course of excitatory rTMS to the DLPFC may modulate local Glx levels in emerging adults with ASD, and align with prior reports of glutamatergic alterations following rTMS. Interventional studies that track glutamatergic markers may provide mechanistic insights into the therapeutic potential of rTMS in ASD. Clinical Trial Registration:Clinicaltrials.gov (ID: NCT02311751), https://clinicaltrials.gov/ct2/show/NCT02311751?term=ameis&rank=1; NCT02311751.
Collapse
Affiliation(s)
- Iska Moxon-Emre
- Cundill Centre for Child and Youth Depression, The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Zafiris J Daskalakis
- Temerty Centre for Therapeutic Brain Intervention, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Paul E Croarkin
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Rachael E Lyon
- Cundill Centre for Child and Youth Depression, The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Natalie J Forde
- Cundill Centre for Child and Youth Depression, The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
| | - Hideaki Tani
- Cundill Centre for Child and Youth Depression, The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Peter Truong
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Meng-Chuan Lai
- Cundill Centre for Child and Youth Depression, The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Pushpal Desarkar
- Temerty Centre for Therapeutic Brain Intervention, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Napapon Sailasuta
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Peter Szatmari
- Cundill Centre for Child and Youth Depression, The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Stephanie H Ameis
- Cundill Centre for Child and Youth Depression, The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| |
Collapse
|
21
|
Casanova MF, Shaban M, Ghazal M, El-Baz AS, Casanova EL, Sokhadze EM. Ringing Decay of Gamma Oscillations and Transcranial Magnetic Stimulation Therapy in Autism Spectrum Disorder. Appl Psychophysiol Biofeedback 2021; 46:161-173. [PMID: 33877491 DOI: 10.1007/s10484-021-09509-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Research suggest that in autism spectrum disorder (ASD) a disturbance in the coordinated interactions of neurons within local networks gives rise to abnormal patterns of brainwave activity in the gamma bandwidth. Low frequency transcranial magnetic stimulation (TMS) over the dorsolateral prefrontal cortex (DLPFC) has been proven to normalize gamma oscillation abnormalities, executive functions, and repetitive behaviors in high functioning ASD individuals. In this study, gamma frequency oscillations in response to a visual classification task (Kanizsa figures) were analyzed and compared in 19 ASD (ADI-R diagnosed, 14.2 ± 3.61 years old, 5 girls) and 19 (14.8 ± 3.67 years old, 5 girls) age/gender matched neurotypical individuals. The ASD group was treated with low frequency TMS (1.0 Hz, 90% motor threshold, 18 weekly sessions) targeting the DLPFC. In autistic subjects, as compared to neurotypicals, significant differences in event-related gamma oscillations were evident in amplitude (higher) pre-TMS. In addition, recordings after TMS treatment in our autistic subjects revealed a significant reduction in the time period to reach peak amplitude and an increase in the decay phase (settling time). The use of a novel metric for gamma oscillations. i.e., envelope analysis, and measurements of its ringing decay allowed us to characterize the impedance of the originating neuronal circuit. The ringing decay or dampening of gamma oscillations is dependent on the inhibitory tone generated by networks of interneurons. The results suggest that the ringing decay of gamma oscillations may provide a biomarker reflective of the excitatory/inhibitory balance of the cortex and a putative outcome measure for interventions in autism.
Collapse
Affiliation(s)
- Manuel F Casanova
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, 701 Grove Rd, Greenville, SC, 29605, USA
| | - Mohamed Shaban
- Electrical and Computer Engineering, University of South Alabama, Mobile, AL, USA
| | - Mohammed Ghazal
- Electrical and Computer Engineering Department, Abu Dhabi University, Abu Dhabi, United Arab Emirates
| | - Ayman S El-Baz
- Department of Bioengineering, Speed School of Engineering, University of Louisville, Louisville, KY, USA
| | - Emily L Casanova
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, 701 Grove Rd, Greenville, SC, 29605, USA
| | - Estate M Sokhadze
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, 701 Grove Rd, Greenville, SC, 29605, USA.
| |
Collapse
|
22
|
Luckhardt C, Schütz M, Mühlherr A, Mössinger H, Boxhoorn S, Dempfle A, Salvador R, Ruffini G, Pereira HC, Castelo-Branco M, Latinus M, Bonnet-Brilhault F, Siemann J, Siniatchkin M, Ecker C, Freitag CM. Phase-IIa randomized, double-blind, sham-controlled, parallel group trial on anodal transcranial direct current stimulation (tDCS) over the left and right tempo-parietal junction in autism spectrum disorder-StimAT: study protocol for a clinical trial. Trials 2021; 22:248. [PMID: 33823927 PMCID: PMC8025356 DOI: 10.1186/s13063-021-05172-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 03/06/2021] [Indexed: 01/01/2023] Open
Abstract
Background Autism spectrum disorder (ASD) is characterized by impaired social communication and interaction, and stereotyped, repetitive behaviour and sensory interests. To date, there is no effective medication that can improve social communication and interaction in ASD, and effect sizes of behaviour-based psychotherapy remain in the low to medium range. Consequently, there is a clear need for new treatment options. ASD is associated with altered activation and connectivity patterns in brain areas which process social information. Transcranial direct current stimulation (tDCS) is a technique that applies a weak electrical current to the brain in order to modulate neural excitability and alter connectivity. Combined with specific cognitive tasks, it allows to facilitate and consolidate the respective training effects. Therefore, application of tDCS in brain areas relevant to social cognition in combination with a specific cognitive training is a promising treatment approach for ASD. Methods A phase-IIa pilot randomized, double-blind, sham-controlled, parallel-group clinical study is presented, which aims at investigating if 10 days of 20-min multi-channel tDCS stimulation of the bilateral tempo-parietal junction (TPJ) at 2.0 mA in combination with a computer-based cognitive training on perspective taking, intention and emotion understanding, can improve social cognitive abilities in children and adolescents with ASD. The main objectives are to describe the change in parent-rated social responsiveness from baseline (within 1 week before first stimulation) to post-intervention (within 7 days after last stimulation) and to monitor safety and tolerability of the intervention. Secondary objectives include the evaluation of change in parent-rated social responsiveness at follow-up (4 weeks after end of intervention), change in other ASD core symptoms and psychopathology, social cognitive abilities and neural functioning post-intervention and at follow-up in order to explore underlying neural and cognitive mechanisms. Discussion If shown, positive results regarding change in parent-rated social cognition and favourable safety and tolerability of the intervention will confirm tDCS as a promising treatment for ASD core-symptoms. This may be a first step in establishing a new and cost-efficient intervention for individuals with ASD. Trial registration The trial is registered with the German Clinical Trials Register (DRKS), DRKS00014732. Registered on 15 August 2018. Protocol version This study protocol refers to protocol version 1.2 from 24 May 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05172-1.
Collapse
Affiliation(s)
- Christina Luckhardt
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe University, Deutschordenstr.50, 60528, Frankfurt, Germany.
| | - Magdalena Schütz
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe University, Deutschordenstr.50, 60528, Frankfurt, Germany
| | - Andreas Mühlherr
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe University, Deutschordenstr.50, 60528, Frankfurt, Germany
| | - Hannah Mössinger
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe University, Deutschordenstr.50, 60528, Frankfurt, Germany
| | - Sara Boxhoorn
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe University, Deutschordenstr.50, 60528, Frankfurt, Germany
| | - Astrid Dempfle
- Institute of Medical Informatics and Statistics (IMIS), Kiel University, Brunswiker Str. 10, 24105, Kiel, Germany
| | - Ricardo Salvador
- Neuroelectrics SLU, Av. Tibidabo 47 Bis, 08035, Barcelona, Spain
| | - Giulio Ruffini
- Neuroelectrics SLU, Av. Tibidabo 47 Bis, 08035, Barcelona, Spain
| | - Helena C Pereira
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), ICNAS, Faculty of Medicine, Academic Clinical Centre, University of Coimbra (UC), Paco das Escolas, 3001 451, Coimbra, Portugal
| | - Miguel Castelo-Branco
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), ICNAS, Faculty of Medicine, Academic Clinical Centre, University of Coimbra (UC), Paco das Escolas, 3001 451, Coimbra, Portugal
| | - Marianne Latinus
- UMR 1253, iBrain, Université de Tours, Inserm, Centre de Pédopsychiatrie, CHRU Bretonneau, 2 bd Tonnellé, 37044, Tours Cedex 9, France
| | - Frédérique Bonnet-Brilhault
- UMR 1253, iBrain, Université de Tours, Inserm, Centre de Pédopsychiatrie, CHRU Bretonneau, 2 bd Tonnellé, 37044, Tours Cedex 9, France.,Centre Hospitalier Universitaire de Tours (CHUT), Centre Universitaire de Pédopsychiatrie, UMR930 INSERM / Equipe autism, CHRU Tours / Hôpital Bretonneau, 2 Bd Tonnellé, 37044, Tours Cedex 9, France
| | - Julia Siemann
- Clinic of Child and Adolescent Psychiatry and Psychotherapy, Protestant Hospital Bethel, EvKB, Remterweg 13a, 33617, Bielefeld, Germany
| | - Michael Siniatchkin
- Clinic of Child and Adolescent Psychiatry and Psychotherapy, Protestant Hospital Bethel, EvKB, Remterweg 13a, 33617, Bielefeld, Germany
| | - Christine Ecker
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe University, Deutschordenstr.50, 60528, Frankfurt, Germany
| | - Christine M Freitag
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe University, Deutschordenstr.50, 60528, Frankfurt, Germany
| |
Collapse
|
23
|
Hou Y, Zhao J, Yang D, Xuan R, Xie R, Wang M, Mo H, Liang L, Wang W, Wu S, Wang Y, Liu X. LF-rTMS ameliorates social dysfunction of FMR1 -/- mice via modulating Akt/GSK-3β signaling. Biochem Biophys Res Commun 2021; 550:22-29. [PMID: 33677132 DOI: 10.1016/j.bbrc.2021.02.086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 02/19/2021] [Indexed: 12/29/2022]
Abstract
Autism spectrum disorders (ASD) are a group of neurological disorders which affect approximately 1% of children around the world. Social dysfunction is one of the two core syndromes of ASD, and still lacks effective treatment. Transcranial magnetic stimulation (TMS) is a noninvasive and safe procedure that uses magnetic fields to modulate neural activity. Whether it were effective in modulating social function remains unclear. By using 3-chamber test, ultrasonic vocalization recording and Western-blotting, we demonstrated that FMR1 (fragile X mental retardation protein) mutant mice, a model of ASD, exhibited obvious defects in social preference and ultrasonic communication. In addition, we detected increase of p-Akt (S473) and p-GSK-3β (S9), and decrease of p-PSD-95 (T19) in the anterior cingulate cortex (ACC) of FMR1-/- mice. Treating FMR1-/- mice with 1 Hz repetitive TMS (rTMS) exerted a long lasting effect in improving both the ultrasonic communication and social preference, as well as restoring the levels of Akt/GSK-3β activity and spine density in the FMR1-/-ACC. Our data, for the first time, demonstrated a beneficial effect of low frequency rTMS (LF-rTMS) on the social function of FMR1-/- mice and an involvement of Akt/GSK-3β signaling in this process, indicating LF-rTMS as a potential therapeutic strategy for ASD patients.
Collapse
Affiliation(s)
- Yilin Hou
- Department of Military Psychology, Fourth Military Medical University, Xi'an, Shaanxi, 710032, PR China
| | - Jiqian Zhao
- Department of Neurobiology and Institute of Neurosciences, School of Basic Medicine, Fourth Military Medical University, Xi'an, Shaanxi, 710032, PR China
| | - Dingding Yang
- Department of Neurobiology and Institute of Neurosciences, School of Basic Medicine, Fourth Military Medical University, Xi'an, Shaanxi, 710032, PR China
| | - Runkang Xuan
- Department of Neurobiology and Institute of Neurosciences, School of Basic Medicine, Fourth Military Medical University, Xi'an, Shaanxi, 710032, PR China
| | - Rougang Xie
- Department of Neurobiology and Institute of Neurosciences, School of Basic Medicine, Fourth Military Medical University, Xi'an, Shaanxi, 710032, PR China
| | - Mengmeng Wang
- Department of Neurobiology and Institute of Neurosciences, School of Basic Medicine, Fourth Military Medical University, Xi'an, Shaanxi, 710032, PR China
| | - Huiming Mo
- Department of Physiology, Medicine College of Yanan University, Yan'an, 716000, PR China
| | - Lirong Liang
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Engineering Research, Center for Dental Materials and Advanced Manufacture, Department of Anethesiology, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, 710032, PR China
| | - Wenting Wang
- Department of Neurobiology and Institute of Neurosciences, School of Basic Medicine, Fourth Military Medical University, Xi'an, Shaanxi, 710032, PR China
| | - Shengxi Wu
- Department of Neurobiology and Institute of Neurosciences, School of Basic Medicine, Fourth Military Medical University, Xi'an, Shaanxi, 710032, PR China
| | - Yazhou Wang
- Department of Neurobiology and Institute of Neurosciences, School of Basic Medicine, Fourth Military Medical University, Xi'an, Shaanxi, 710032, PR China.
| | - Xufeng Liu
- Department of Military Psychology, Fourth Military Medical University, Xi'an, Shaanxi, 710032, PR China.
| |
Collapse
|
24
|
Wei W, Yi X, Ruan J, Duan X, Luo H. The efficacy of repetitive transcranial magnetic stimulation on emotional processing in apathetic patients with Parkinson's disease: A Placebo-controlled ERP study. J Affect Disord 2021; 282:776-785. [PMID: 33601718 DOI: 10.1016/j.jad.2020.12.099] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/21/2020] [Accepted: 12/24/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Few studies have examined the effect of rTMS on impaired emotional processing in apathetic Parkinson's disease (PD) patients, which impelled us to use a combination of repetitive transcranial magnetic stimulation (rTMS) with event-related potentials (ERPs) to gain insight into the underlying mechanisms. METHODS Apathetic and non-apathetic patients diagnosed with PD performed a facial emotion categorization task, and ERP data were collected before and after HF-rTMS or sham stimulation over the right dorsolateral prefrontal cortex (DLPFC). We observed the behavioural results and early components of P100 and N170. RESULTS After rTMS, accuracy (ACC) was higher for negative expressions, and reaction times (RTs) were shorter for all expressions in both apathetic and non-apathetic patients. P100 amplitudes significantly increased except for negative expressions in the right hemisphere, and hemisphere lateralization was reversed in apathetic patients. P100 amplitudes increased for all expressions bilaterally in non-apathetic patients. N170 amplitudes in apathetic patients increased, and hemisphere lateralization was normalized. Neither the apathetic sham group nor the non-apathetic cohort of patients showed changes in P100 or N170 lateralization. LIMITATIONS The effects of rTMS on PD patients relative to normal subjects should be compared and observed over a long period of time. CONCLUSIONS HF-rTMS over the right DLPFC is beneficial for emotional processing in both apathetic and non-apathetic PD patients but shows different sensitivities. The effect of rTMS on emotional processing impairments in apathetic PD patients is profound. Treatment with rTMS may be an important, novel nonpharmaceutical approach for apathy in PD patients.
Collapse
Affiliation(s)
- Wei Wei
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan, China
| | - Xingyang Yi
- Department of Neurology, People's Hospital of Deyang City, Deyang 618000, Sichuan, China
| | - Jianghai Ruan
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan, China
| | - Xiaodong Duan
- Department of Rehabilitation Medicine, the Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan, China.
| | - Hua Luo
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan, China.
| |
Collapse
|
25
|
Khaleghi A, Zarafshan H, Vand SR, Mohammadi MR. Effects of Non-invasive Neurostimulation on Autism Spectrum Disorder: A Systematic Review. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2020; 18:527-552. [PMID: 33124586 PMCID: PMC7609207 DOI: 10.9758/cpn.2020.18.4.527] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 12/11/2022]
Abstract
Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder characterized by major impairments in social communication, stereotyped and ritualistic behaviors and deficits in sensory reactivity. Recently, noninvasive brain stimulation (NIBS) methods, namely transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS), have been examined as possible new therapeutic options for modifying the pathological neuroplasticity involved in neuropsychiatric disorders including ASD. Therefore, we conducted a systematic review on the therapeutic uses of tDCS and repetitive TMS (rTMS) in ASD patients. A systematic search was performed on Scopus, Web of Science, PubMed, Cochrane and Embase. Original articles reporting the use of tDCS or rTMS to treat ASD were screened and studied by two researchers independently based on PRISMA guidelines. We found 32 eligible studies including 8 tDCS reports, 23 rTMS reports and one report with both tDCS and rTMS. These studies comprised 6 case-reports, 9 non-controlled trials and 17 controlled trials which assessed NIBS effects on the three cognitive, behavioral and biological dimensions in ASD. Existing evidence demonstrates that NIBS methods could be helpful for treating some dimensions of ASD such as repetitive behavior, sociability or some aspects of executive and cognitive functions. However, such evidence should be regarded with care because of the quality of original researches and serious publication bias as well as the heterogeneity of data. Further randomized, double-blind, sham-controlled trials with appropriate follow-up periods should be designed to assess the efficacy of NIBS methods for ASD treatment.
Collapse
Affiliation(s)
- Ali Khaleghi
- Psychiatry and Psychology Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hadi Zarafshan
- Psychiatry and Psychology Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Safa Rafiei Vand
- Faculty of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran
| | - Mohammad Reza Mohammadi
- Psychiatry and Psychology Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
26
|
Casanova MF, Sokhadze EM, Casanova EL, Li X. Transcranial Magnetic Stimulation in Autism Spectrum Disorders: Neuropathological Underpinnings and Clinical Correlations. Semin Pediatr Neurol 2020; 35:100832. [PMID: 32892959 PMCID: PMC7477302 DOI: 10.1016/j.spen.2020.100832] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Despite growing knowledge about autism spectrum disorder (ASD), research findings have not been translated into curative treatment. At present, most therapeutic interventions provide for symptomatic treatment. Outcomes of interventions are judged by subjective endpoints (eg, behavioral assessments) which alongside the highly heterogeneous nature of ASD account for wide variability in the effectiveness of treatments. Transcranial magnetic stimulation (TMS) is one of the first treatments that targets a putative core pathologic feature of autism, specifically the cortical inhibitory imbalance that alters gamma frequency synchronization. Studies show that low frequency TMS over the dorsolateral prefrontal cortex of individuals with ASD decreases the power of gamma activity and increases the difference between gamma responses to target and nontarget stimuli. TMS improves executive function skills related to self-monitoring behaviors and the ability to apply corrective actions. These improvements manifest themselves as a reduction of stimulus bound behaviors and diminished sympathetic arousal. Results become more significant with increasing number of sessions and bear synergism when used along with neurofeedback. When applied at low frequencies in individuals with ASD, TMS appears to be safe and to improve multiple patient-oriented outcomes. Future studies should be conducted in large populations to establish predictors of outcomes (eg, genetic profiling), length of persistence of benefits, and utility of booster sessions.
Collapse
Affiliation(s)
- Manuel F. Casanova
- Director of Childhood Neurotherapeutics, Greenville Health System, Departments of Pediatrics, Division of Developmental Behavioral Pediatrics, Greenville, SC, USA and Professor of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC, USA
| | - Estate M. Sokhadze
- Research Professor, University of South Carolina School of Medicine Greenville, Greenville, SC, USA
| | - Emily L. Casanova
- Research Assistant Professor, University of South Carolina School of Medicine Greenville, Greenville, SC, USA
| | - Xiaoli Li
- Director, State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China; Center for Collaboration and Innovation in Brain and Learning Sciences, Beijing Normal University, Beijing, China
| |
Collapse
|
27
|
Increased Accuracy of Emotion Recognition in Individuals with Autism-Like Traits after Five Days of Magnetic Stimulations. Neural Plast 2020; 2020:9857987. [PMID: 32714385 PMCID: PMC7355343 DOI: 10.1155/2020/9857987] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 05/13/2020] [Accepted: 06/18/2020] [Indexed: 12/17/2022] Open
Abstract
Individuals with autism-like traits (ALT) belong to a subclinical group with similar social deficits as autism spectrum disorders (ASD). Their main social deficits include atypical eye contact and difficulty in understanding facial expressions, both of which are associated with an abnormality of the right posterior superior temporal sulcus (rpSTS). It is still undetermined whether it is possible to improve the social function of ALT individuals through noninvasive neural modulation. To this end, we randomly assigned ALT individuals into the real (n = 16) and sham (n = 16) stimulation groups. All subjects received five consecutive days of intermittent theta burst stimulation (iTBS) on the rpSTS. Eye tracking data and functional magnetic resonance imaging (fMRI) data were acquired on the first and sixth days. The real group showed significant improvement in emotion recognition accuracy after iTBS, but the change was not significantly larger than that in the sham group. Resting-state functional connectivity (rsFC) between the rpSTS and the left cerebellum significantly decreased in the real group than the sham group after iTBS. At baseline, rsFC in the left cerebellum was negatively correlated with emotion recognition accuracy. Our findings indicated that iTBS of the rpSTS could improve emotion perception of ALT individuals by modulating associated neural networks. This stimulation protocol could be a vital therapeutic strategy for the treatment of ASD.
Collapse
|
28
|
Casanova MF, Shaban M, Ghazal M, El-Baz AS, Casanova EL, Opris I, Sokhadze EM. Effects of Transcranial Magnetic Stimulation Therapy on Evoked and Induced Gamma Oscillations in Children with Autism Spectrum Disorder. Brain Sci 2020; 10:E423. [PMID: 32635201 PMCID: PMC7408068 DOI: 10.3390/brainsci10070423] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 11/16/2022] Open
Abstract
Autism spectrum disorder (ASD) is a behaviorally diagnosed neurodevelopmental condition of unknown pathology. Research suggests that abnormalities of elecltroencephalogram (EEG) gamma oscillations may provide a biomarker of the condition. In this study, envelope analysis of demodulated waveforms for evoked and induced gamma oscillations in response to Kanizsa figures in an oddball task were analyzed and compared in 19 ASD and 19 age/gender-matched neurotypical children. The ASD group was treated with low frequency transcranial magnetic stimulation (TMS), (1.0 Hz, 90% motor threshold, 18 weekly sessions) targeting the dorsolateral prefrontal cortex. In ASD subjects, as compared to neurotypicals, significant differences in evoked and induced gamma oscillations were evident in higher magnitude of gamma oscillations pre-TMS, especially in response to non-target cues. Recordings post-TMS treatment in ASD revealed a significant reduction of gamma responses to task-irrelevant stimuli. Participants committed fewer errors post-TMS. Behavioral questionnaires showed a decrease in irritability, hyperactivity, and repetitive behavior scores. The use of a novel metric for gamma oscillations. i.e., envelope analysis using wavelet transformation allowed for characterization of the impedance of the originating neuronal circuit. The results suggest that gamma oscillations may provide a biomarker reflective of the excitatory/inhibitory balance of the cortex and a putative outcome measure for interventions in autism.
Collapse
Affiliation(s)
- Manuel F. Casanova
- Department of Biomedical Sciences, University of South Carolina School of Medicine-Greenville, 701 Grove Rd., Greenville, SC 29605, USA; (M.F.C.); (E.L.C.)
- Department of Psychiatry & Behavioral Sciences, University of Louisville, 401 E Chestnut Str., #600, Louisville, KY 40202, USA
| | - Mohamed Shaban
- Department of Electrical and Computer Engineering, University of South Alabama, Mobile, AL 36688, USA;
| | - Mohammed Ghazal
- BioImaging Research Lab, Electrical and Computer Engineering Abu Dhabi University, Abu Dhabi 59911, UAE;
| | - Ayman S. El-Baz
- Department of Bioengineering, University of Louisville, Louisville, KY 40202, USA;
| | - Emily L. Casanova
- Department of Biomedical Sciences, University of South Carolina School of Medicine-Greenville, 701 Grove Rd., Greenville, SC 29605, USA; (M.F.C.); (E.L.C.)
| | - Ioan Opris
- School of Medicine, University of Miami, Miami, FL 33136, USA;
| | - Estate M. Sokhadze
- Department of Biomedical Sciences, University of South Carolina School of Medicine-Greenville, 701 Grove Rd., Greenville, SC 29605, USA; (M.F.C.); (E.L.C.)
- Department of Psychiatry & Behavioral Sciences, University of Louisville, 401 E Chestnut Str., #600, Louisville, KY 40202, USA
| |
Collapse
|
29
|
Casanova MF, Sokhadze EM, Casanova EL, Opris I, Abujadi C, Marcolin MA, Li X. Translational Neuroscience in Autism: From Neuropathology to Transcranial Magnetic Stimulation Therapies. Psychiatr Clin North Am 2020; 43:229-248. [PMID: 32439019 PMCID: PMC7245584 DOI: 10.1016/j.psc.2020.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The presence of heterotopias, increased regional density of neurons at the gray-white matter junction, and focal cortical dysplasias all suggest an abnormality of neuronal migration in autism spectrum disorder (ASD). The abnormality is borne from a dissonance in timing between radial and tangentially migrating neuroblasts to the developing cortical plate. The uncoupling of excitatory and inhibitory cortical cells disturbs the coordinated interactions of neurons within local networks, thus providing abnormal patterns of brainwave activity in the gamma bandwidth. In ASD, gamma oscillation abnormalities and autonomic markers offer measures of therapeutic progress and help in the identification of subgroups.
Collapse
Affiliation(s)
- Manuel F Casanova
- Department of Pediatrics, Division of Developmental Behavioral Pediatrics, Greenville Health System, 200 Patewood Drive, Suite A200, Greenville, SC 29615, USA.
| | - Estate M Sokhadze
- University of South Carolina School of Medicine Greenville, 200 Patewood Drive, Greenville, SC 29615, USA
| | - Emily L Casanova
- University of South Carolina School of Medicine Greenville, 200 Patewood Drive, Greenville, SC 29615, USA. https://twitter.com/EmLyWill
| | - Ioan Opris
- University of Miami, Miller School of Medicine, Department Miami Project to Cure Paralysis, Miami, FL 33136, USA
| | - Caio Abujadi
- Department of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Marco Antonio Marcolin
- Department of Neurology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Xiaoli Li
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| |
Collapse
|
30
|
Romero-Martínez Á, Bressanutti S, Moya-Albiol L. A Systematic Review of the Effectiveness of Non-Invasive Brain Stimulation Techniques to Reduce Violence Proneness by Interfering in Anger and Irritability. J Clin Med 2020; 9:jcm9030882. [PMID: 32213818 PMCID: PMC7141522 DOI: 10.3390/jcm9030882] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/06/2020] [Accepted: 03/19/2020] [Indexed: 11/16/2022] Open
Abstract
The field of neurocriminology has proposed several treatments (e.g., pharmacological, brain surgery, androgen-deprivation therapy, neurofeedback) to reduce violence proneness, but unfortunately, their effectiveness has been limited due to their side-effects. Therefore, it is necessary to explore alternative techniques to improve patients’ behavioural regulation with minimal undesirable effects. In this regard, non-invasive brain stimulation techniques, which are based on applying changing magnetic fields or electric currents to interfere with cortical excitability, have revealed their usefulness in alleviating the symptomatology of several mental disorders. However, to our knowledge, there are no reviews that assess whether these techniques are useful for reducing violence proneness. Therefore, we conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria using the following databases: PsycINFO, PubMed, Dialnet, Psicodoc, Web of Knowledge, and the Cochrane Library. We initially identified 3746 entries, and eventually included 56 publications. Most of the studies were unanimous in concluding that the application of these techniques over the prefrontal cortex (PFC) was not sufficient to promote anger and irritability reductions in euthymic individuals of both genders. Nevertheless, the application of non-invasive brain stimulation techniques, especially transcranial direct current stimulation, over the right PFC seemed to reduce violent reactions in these individuals by interfering with the interpretation of the unfavourable situations (e.g., threating signals) or inner states that evoked anger. In antisocial and pathological populations, the conclusions were provided by a few pilot studies with important methodological weaknesses. The main conclusion of these studies was that bilateral stimulation of the PFC satisfactorily reduced anger and irritability only in inmates, patients with autism spectrum disorders (ASD), people who suffered a closed-head injury, and agitated patients with Alzheimer’s disease. Moreover, combining these techniques with risperidone considerably reduced aggressiveness in these patients. Therefore, it is necessary to be cautious about the benefits of these techniques to control anger, due the methodological weaknesses of these studies. Nonetheless, they offer valuable opportunities to prevent violence by designing new treatments combining brain stimulation with current strategies, such as psychotherapy and psychopharmacology, in order to promote lasting changes.
Collapse
|
31
|
Yuan J, Liu W, Liang Q, Cao X, Lucas MV, Yuan TF. Effect of Low-Frequency Repetitive Transcranial Magnetic Stimulation on Impulse Inhibition in Abstinent Patients With Methamphetamine Addiction: A Randomized Clinical Trial. JAMA Netw Open 2020; 3:e200910. [PMID: 32167568 PMCID: PMC7070234 DOI: 10.1001/jamanetworkopen.2020.0910] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
IMPORTANCE Impulsivity during periods of abstinence is a critical symptom of patients who use methamphetamine (MA). OBJECTIVE To evaluate changes in impulse inhibition elicited by repetitive transcranial magnetic stimulation (rTMS) in patients with MA addiction. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial was conducted in Da Lian Shan Addiction Rehabilitation Center, Nanjing, China, from December 1, 2018, to April 20, 2019. Effects of the intervention were examined at 3 time points: after a single session (day 1), 24 hours after 10 repeated sessions (day 11), and at 3 weeks of follow-up (day 31). Men with MA addiction and healthy male control participants were recruited for this study. Data analysis was performed from March 2019 to October 2019. INTERVENTIONS Patients who use MA were randomized to undergo sham rTMS (36 patients) and or 1-Hz rTMS (37 patients) to the left prefrontal cortex, receiving daily TMS treatments for 10 consecutive days. MAIN OUTCOMES AND MEASURES The primary outcome was impulse inhibition, which is primarily embodied by accuracy reduction (ie, accuracy cost) from standard to deviant trials in a 2-choice oddball task (80% standard and 20% deviant trials). RESULT The study included 73 men with MA addiction (mean [SD] age, 38.49 [7.69] years) and 33 male healthy control participants without MA addiction (mean [SD] age, 35.15 [9.68] years). The mean (SD) duration of abstinence for the men with MA addiction was 9.27 (4.61) months. Compared with the control group, patients with MA addiction exhibited greater impulsivity (accuracy cost, 3.3% vs 6.2%). The single session of 1-Hz rTMS over the left prefrontal cortex significantly increased accuracy from 91.4% to 95.7% (F1,36 = 9.58; P < .001) and reaction time delay from 50 milliseconds to 77 milliseconds (F1,36 = 22.66; P < .001) in deviant trials. These effects were seen consistently after 10 sessions of 1-Hz rTMS treatment (day 11 vs day 1, t26 = 1.59; P = .12), and the behavioral improvement was maintained at least for 3 weeks after treatment (day 31 vs day 1, t26 = 0.26; P = .80). These improvement effects of impulse inhibition were coupled with a reduction in addictive symptoms as measured by cue-induced craving. The pretest accuracy cost was positively correlated with the change in impulse inhibition (r = 0.615; P < .001) and change in craving (r = 0.334; P = .01), suggesting that these 2 behaviors may be modified simultaneously. CONCLUSIONS AND RELEVANCE These findings suggest that repeated rTMS sessions have sustained effects on impulse inhibition in patients with MA addiction and provide novel data on impulsivity management strategies for addiction rehabilitation. TRIAL REGISTRATION ChiCTR-ROC-16008541.
Collapse
Affiliation(s)
- Jiajin Yuan
- Institute of Brain and Psychological Sciences, Sichuan Normal University, Chengdu, China
- Key Laboratory of Cognition and Personality of Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, China
| | - Weijun Liu
- Key Laboratory of Cognition and Personality of Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, China
| | - Qiongdan Liang
- Key Laboratory of Cognition and Personality of Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, China
| | - Xinyu Cao
- Da Lian Shan Institute of Addiction Rehabilitation, Nanjing, China
| | - Molly V. Lucas
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, California
| | - Ti-Fei Yuan
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu, China
| |
Collapse
|
32
|
Ameis SH, Blumberger DM, Croarkin PE, Mabbott DJ, Lai MC, Desarkar P, Szatmari P, Daskalakis ZJ. Treatment of Executive Function Deficits in autism spectrum disorder with repetitive transcranial magnetic stimulation: A double-blind, sham-controlled, pilot trial. Brain Stimul 2020; 13:539-547. [PMID: 32289673 PMCID: PMC8129776 DOI: 10.1016/j.brs.2020.01.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 12/25/2019] [Accepted: 01/08/2020] [Indexed: 01/08/2023] Open
Abstract
Background: In youth and young adults with autism spectrum disorder (ASD), executive function (EF) deficits may be a promising treatment target with potential impact on everyday functioning. Objective: To conduct a pilot randomized, double-blind, parallel, controlled trial evaluating repetitive transcranial magnetic stimulation (rTMS) for EF deficits in ASD. Method: In Toronto, Ontario (November 2014 to June 2017), a 20-session, 4-week course of 20 Hz rTMS targeting dorsolateral prefrontal cortex (DLPFC) (90%RMT) was compared to sham stimulation in 16—35 year-olds with ASD (28 male/12 female), without intellectual disability, who had impaired everyday EF performance (n = 20 active/n = 20 sham). Outcome measures evaluated protocol feasibility and clinical effects of active vs. sham rTMS on EF performance. The moderating effect of baseline functioning was explored. Results: Of eligible participants, 95% were enrolled and 95% of randomized participants completed the protocol. Adverse events across treatment arms were mild-to-moderate. There was no significant difference between active vs. sham rTMS on EF performance. Baseline adaptive functioning moderated the effect of rTMS, such that participants with lower baseline functioning experienced significant EF improvement in the active vs. sham group. Conclusions: Our pilot RCT demonstrated the feasibility and acceptability of using high frequency rTMS targeting DLPFC in youth and young adults with autism. No evidence for efficacy of active versus sham rTMS on EF performance was found. However, we found promising preliminary evidence of EF performance improvement following active versus sham rTMS in participants with ASD with more severe adaptive functioning deficits. Future work could focus on examining efficacy of rTMS in this higher-need population. Clinical trial registration: Repetitive Transcranial Magnetic Stimulation (rTMS) for Executive Function Deficits in Autism Spectrum Disorder and Effects on Brain Structure: A Pilot Study; https://clinicaltrials.gov/ct2/show/NCT02311751?term=ameis&rank=1; NCT02311751. The trial was funded by: an American Academy of Child and Adolescent Psychiatry (AACAP) Pilot Research Award, the Innovation Fund from the Alternate Funding Plan of the Academic Health Sciences Centres of Ontario, and an Ontario Mental Health Foundation (OMHF) Project A Grant and New Investigator Fellowship.
Collapse
Affiliation(s)
- Stephanie H Ameis
- Centre for Brain and Mental Health, Program in Neurosciences & Mental Health, Sick Kids Research Institute, The Hospital for Sick Children, Toronto, Canada; The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Campbell Family Mental Health Research Institute, The Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, 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
| | - Paul E Croarkin
- Department of Psychiatry and Psychology, Division of Child and Adolescent Psychiatry, Mayo Clinic, Rochester, MN, USA
| | - Donald J Mabbott
- Centre for Brain and Mental Health, Program in Neurosciences & Mental Health, Sick Kids Research Institute, The Hospital for Sick Children, Toronto, Canada; Department of Psychology, University of Toronto, Toronto, Canada
| | - Meng-Chuan Lai
- Centre for Brain and Mental Health, Program in Neurosciences & Mental Health, Sick Kids Research Institute, The Hospital for Sick Children, Toronto, Canada; The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Campbell Family Mental Health Research Institute, The Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada; Department of Psychology, University of Toronto, Toronto, 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
| | - Peter Szatmari
- Centre for Brain and Mental Health, Program in Neurosciences & Mental Health, Sick Kids Research Institute, The Hospital for Sick Children, Toronto, Canada; The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Campbell Family Mental Health Research Institute, The Centre for Addiction and Mental Health, 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
| |
Collapse
|
33
|
Repetitive TMS over the left dorsolateral prefrontal cortex modulates the error positivity: An ERP study. Neuropsychologia 2019; 133:107153. [DOI: 10.1016/j.neuropsychologia.2019.107153] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 06/25/2019] [Accepted: 07/31/2019] [Indexed: 01/03/2023]
|
34
|
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.
Collapse
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
| |
Collapse
|
35
|
Finisguerra A, Borgatti R, Urgesi C. Non-invasive Brain Stimulation for the Rehabilitation of Children and Adolescents With Neurodevelopmental Disorders: A Systematic Review. Front Psychol 2019; 10:135. [PMID: 30787895 PMCID: PMC6373438 DOI: 10.3389/fpsyg.2019.00135] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 01/15/2019] [Indexed: 12/18/2022] Open
Abstract
In the last years, there has been a growing interest in the application of different non-invasive brain stimulation techniques to induce neuroplasticity and to modulate cognition and behavior in adults. Very recently, different attempts have been made to induce functional plastic changes also in pediatric populations. Importantly, not only sensorimotor processing, but also higher-level functions have been addressed, with the aim to boost rehabilitation in different neurodevelopmental disorders. However, efficacy and safety of using these techniques in pediatric population is still debated. The current article aims to review the non-invasive brain stimulation studies conducted in pediatric populations using Transcranial Magnetic Stimulation or transcranial Direct Current Stimulation. Specifically, the available proofs concerning the efficacy and safety of these techniques on Autism Spectrum Disorder, Attention-deficit/hyperactivity disorder, Dyslexia, Tourette syndrome, and tic disorders are systematically reviewed and discussed. The article also aims to provide an overview about other possible applications of these and other stimulation techniques for rehabilitative purposes in children and adolescents.
Collapse
Affiliation(s)
| | - Renato Borgatti
- Child Neuropsychiatry and Neurorehabilitation Unit, Scientific Institute, IRCCS E. Medea, Bosisio Parini, Italy
| | - Cosimo Urgesi
- Scientific Institute, IRCCS E. Medea, Pasian di Prato, Udine, Italy.,Child Neuropsychiatry and Neurorehabilitation Unit, Scientific Institute, IRCCS E. Medea, Bosisio Parini, Italy.,Laboratory of Cognitive Neuroscience, Department of Languages, Literatures, Communication, Education and Society, University of Udine, Udine, Italy
| |
Collapse
|
36
|
Masuda F, Nakajima S, Miyazaki T, Tarumi R, Ogyu K, Wada M, Tsugawa S, Croarkin PE, Mimura M, Noda Y. Clinical effectiveness of repetitive transcranial magnetic stimulation treatment in children and adolescents with neurodevelopmental disorders: A systematic review. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2019; 23:1614-1629. [PMID: 30663323 DOI: 10.1177/1362361318822502] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Neurodevelopmental disorders, including autism spectrum disorder, are common in children and adolescents, but treatment strategies remain limited. Although repetitive transcranial magnetic stimulation has been studied for neurodevelopmental disorders, there is no clear consensus on its therapeutic effects. This systematic review examined literature on repetitive transcranial magnetic stimulation for children and adolescents with neurodevelopmental disorders published up to 2018 using the PubMed database. The search identified 264 articles and 14 articles met eligibility criteria. Twelve of these studies used conventional repetitive transcranial magnetic stimulation and two studies used theta burst stimulation. No severe adverse effects were reported in these studies. In patients with autism spectrum disorder, low-frequency repetitive transcranial magnetic stimulation and intermittent theta burst stimulation applied to the dorsolateral prefrontal cortex may have therapeutic effects on social functioning and repetitive behaviors. In patients with attention deficit/hyperactivity disorder, low-frequency repetitive transcranial magnetic stimulation applied to the left dorsolateral prefrontal cortex and high-frequency repetitive transcranial magnetic stimulation applied to the right dorsolateral prefrontal cortex may target inattention, hyperactivity, and impulsivity. In patients with tic disorders, low-frequency repetitive transcranial magnetic stimulation applied to the bilateral supplementary motor area improved tic symptom severity. This systematic review suggests that repetitive transcranial magnetic stimulation may be a promising intervention for children and adolescents with neurodevelopmental disorders. The results warrant further large randomized controlled trials of repetitive transcranial magnetic stimulation in children with neurodevelopmental disorders.
Collapse
Affiliation(s)
- Fumi Masuda
- 1 Keio University School of Medicine, Japan.,2 Shiga University of Medical Science, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Yang Y, Wang H, Xue Q, Huang Z, Wang Y. High-Frequency Repetitive Transcranial Magnetic Stimulation Applied to the Parietal Cortex for Low-Functioning Children With Autism Spectrum Disorder: A Case Series. Front Psychiatry 2019; 10:293. [PMID: 31143132 PMCID: PMC6520602 DOI: 10.3389/fpsyt.2019.00293] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 04/15/2019] [Indexed: 02/02/2023] Open
Abstract
Background: Repetitive transcranial magnetic stimulation (rTMS) is a safe and efficacious technique to stimulate specific areas of cortical dysfunction in several neuropsychiatric diseases; however, it is not known whether high-frequency rTMS (HF-rTMS) over the left inferior parietal lobule, in low functioning children with autism spectrum disorder (ASD), improves core symptoms. Method: Eleven low-functioning children with ASD completed two separate HF-rTMS treatment courses, 6 weeks apart. Each treatment course involved five 5-s trains at 20 Hz, with 10-min inter-train intervals, on left inferior parietal lobule each consecutive weekday for a 3-week period (15 treatments per course). Subjects were assessed at five time points: immediately before and after the first HF-rTMS course, immediately before and after the second HF-rTMS course, and 6 weeks after the second rTMS treatment course. Treatment effectiveness was evaluated using the Verbal Behavior Assessment Scale (VerBAS) and Autism Treatment Evaluation Checklist (ATEC). The latter test consists of four subtest scales: Language, Sociability, Sensory, and Behavior. In addition, daily treatment logbooks completed by parents were considered as one of the outcome measures. Results: Participants showed a significant reduction in language- and social-related symptoms measured by ATEC from pretreatment to the 6-week follow-up after the second treatment course. Moreover, some possible improvements in imitation and cognition were reported by caregivers. Conclusions: Our findings suggest that HF-rTMS over the left parietal cortex might improve core deficits in low-functioning children with ASD.
Collapse
Affiliation(s)
- Yingxue Yang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Beijing, China.,Center of Epilepsy, Beijing Institute for Brain Disorders, Laboratory of Brain Disorders, Capital Medical University, Ministry of Science and Technology, Beijing, China
| | - Hongxing Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Beijing, China.,Center of Epilepsy, Beijing Institute for Brain Disorders, Laboratory of Brain Disorders, Capital Medical University, Ministry of Science and Technology, Beijing, China
| | - Qing Xue
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Beijing, China.,Center of Epilepsy, Beijing Institute for Brain Disorders, Laboratory of Brain Disorders, Capital Medical University, Ministry of Science and Technology, Beijing, China
| | - Zhaoyang Huang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Beijing, China.,Center of Epilepsy, Beijing Institute for Brain Disorders, Laboratory of Brain Disorders, Capital Medical University, Ministry of Science and Technology, Beijing, China
| | - Yuping Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Beijing, China.,Center of Epilepsy, Beijing Institute for Brain Disorders, Laboratory of Brain Disorders, Capital Medical University, Ministry of Science and Technology, Beijing, China
| |
Collapse
|
38
|
Esse Wilson J, Trumbo MC, Wilson JK, Tesche CD. Transcranial direct current stimulation (tDCS) over right temporoparietal junction (rTPJ) for social cognition and social skills in adults with autism spectrum disorder (ASD). J Neural Transm (Vienna) 2018; 125:1857-1866. [PMID: 30341695 DOI: 10.1007/s00702-018-1938-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 10/02/2018] [Indexed: 12/17/2022]
Abstract
Social deficits are core to autism spectrum disorder (ASD). Current treatments are extremely time- and labor-intensive. Transcranial direct current stimulation (tDCS) may be a promising treatment modality to safely enhance treatments targeting social cognition and social skills. This pilot study investigates the effectiveness of social skills treatment interventions paired with anodal tDCS for six adults 18-58 years with ASD. Differences were predicted on the verbal fluency (VF) test and a test of social skills (TASSK-M) for verum (2.0 mA) vs. sham tDCS, which was randomly assigned in a within-subjects, double-blinded design in adults with ASD with normal or higher cognitive functioning. The anode electrode was placed over right temporoparietal (CP6) and cathode over ipsilateral deltoid. Wilcoxon signed-rank tests for paired data indicated that participants received a significantly higher score on the VF test after receiving verum tDCS compared to sham tDCS, with no significant differences found on the TASSK-M. Post-hoc analysis showed that the emotion-word portion of the VF test, specifically, indicated significant differences when comparing verum to sham tDCS conditions. These findings provide optimism for the use of tDCS as delivered in the current study paired with social skills treatment interventions for ASD, particularly for improving skills of emotion verbal fluency.
Collapse
Affiliation(s)
- Joan Esse Wilson
- Department of Linguistics, University of New Mexico, MSC03 2130 1 University of New Mexico, Albuquerque, NM, 87131, USA
| | - Michael C Trumbo
- Cognitive Science and Applications, Sandia National Laboratory, 1611 Innovation Pkwy SE, Albuquerque, NM, 87123, USA
| | - J Kevin Wilson
- Department of Psychology, University of New Mexico, MSC03 2220 1 University of New Mexico, Albuquerque, NM, 87131, USA
| | - Claudia D Tesche
- Department of Psychology, University of New Mexico, MSC03 2220 1 University of New Mexico, Albuquerque, NM, 87131, USA.
| |
Collapse
|
39
|
Habib S, Hamid U, Jamil A, Zainab AZ, Yousuf T, Habib S, Tariq SM, Ali F. Transcranial Magnetic Stimulation as a Therapeutic Option for Neurologic and Psychiatric Illnesses. Cureus 2018; 10:e3456. [PMID: 30564535 PMCID: PMC6298622 DOI: 10.7759/cureus.3456] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 10/16/2018] [Indexed: 12/27/2022] Open
Abstract
In recent years, transcranial magnetic stimulation has become an area of interest in the field of neurosciences due to its ability to non-invasively induce sufficient electric current to depolarize superficial axons and networks in the cortex and can be used to explore brain functioning. Evidence shows that transcranial magnetic stimulation could be used as a diagnostic and therapeutic tool for various neurological and psychiatric illnesses. The aim of this review is to introduce the basics of this technology to the readers and to bring together an overview of some of its clinical applications investigated thus far.
Collapse
Affiliation(s)
- Sara Habib
- Neurology, Thomas Jefferson University, Philadelphia, USA
| | - Umair Hamid
- Internal Medicine, The Indus Hospital, Lahore, PAK
| | - Ayesha Jamil
- Internal Medicine, Fatima Jinnah Medical University, Lahore, PAK
| | - Aariz Z Zainab
- Radiology, Mayo Hospital King Edward Medical College, Lahore, PAK
| | - Tooba Yousuf
- Family Medicine, Civil Hospital Karachi, Dow University of Health Sciences, Karachi, PAK
| | - Sana Habib
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Syed Maaz Tariq
- Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | - Faryal Ali
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| |
Collapse
|
40
|
Doruk Camsari D, Kirkovski M, Croarkin PE. Therapeutic Applications of Noninvasive Neuromodulation in Children and Adolescents. Psychiatr Clin North Am 2018; 41:465-477. [PMID: 30098658 PMCID: PMC6413505 DOI: 10.1016/j.psc.2018.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Recent advances and growing evidence supporting the safety and efficacy of noninvasive neuromodulatory techniques in adults have facilitated the study of neuromodulation applications in children and adolescents. Noninvasive brain stimulation methods such as transcranial direct current stimulation and transcranial magnetic stimulation have been considered in children with depression, autism spectrum disorder, attention-deficit hyperactivity disorder, and other neuropsychiatric disorders. However, current clinical applications of neuromodulation techniques in children and adolescents are nascent. There is a great need for developmentally informed, large, double-blinded, randomized, controlled clinical trials to demonstrate efficacy and safety of noninvasive brain stimulation in children and adolescents.
Collapse
Affiliation(s)
- Deniz Doruk Camsari
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Melissa Kirkovski
- Deakin Child Study Centre, School of Psychology, Deakin University, Geelong, VIC 3220, Australia
| | - Paul E Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
| |
Collapse
|
41
|
Barahona-Corrêa JB, Velosa A, Chainho A, Lopes R, Oliveira-Maia AJ. Repetitive Transcranial Magnetic Stimulation for Treatment of Autism Spectrum Disorder: A Systematic Review and Meta-Analysis. Front Integr Neurosci 2018; 12:27. [PMID: 30038561 PMCID: PMC6046620 DOI: 10.3389/fnint.2018.00027] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 06/06/2018] [Indexed: 12/05/2022] Open
Abstract
Background: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder manifesting as lifelong deficits in social communication and interaction, as well as restricted repetitive behaviors, interests and activities. While there are no specific pharmacological or other physical treatments for autism, in recent years repetitive Transcranial Magnetic Stimulation (rTMS), a technique for non-invasive neuromodulation, has attracted interest due to potential therapeutic value. Here we report the results of a systematic literature review and meta-analysis on the use of rTMS to treat ASD. Methods: We performed a systematic literature search on PubMed, Web of Science, Science Direct, Bielefeld Academic Search, and Educational Resources Information Clearinghouse. Search terms reflected diagnoses and treatment modalities of interest. Studies reporting use of rTMS to treat core ASD or cognitive symptoms in ASD were eligible. Two researchers performed article selection and data extraction independently, according to PRISMA guidelines. Changes in ASD clinical scores or in cognitive performance were the main outcomes. Random effects meta-analysis models were performed. Results: We found 23 eligible reports, comprising 4 case-reports, 7 non-controlled clinical trials, and 12 controlled clinical trials, comparing the effects of real TMS with waiting-list controls (n = 6) or sham-treatment (n = 6). Meta-analyses showed a significant, but moderate, effect on repetitive and stereotyped behaviors, social behavior, and number of errors in executive function tasks, but not other outcomes. Most studies had a moderate to high risk of bias, mostly due to lack of subject- and evaluator-blinding to treatment allocation. Only 5 studies reported stability of these gains for periods of up 6 months, with descriptions that improvements were sustained over time. Conclusions: Existing evidence supports that TMS could be useful to treat some dimensions of ASD. However, such evidence must be regarded with care, as most studies did not adequately control for placebo effects. Moreover, little is known regarding the most effective stimulation parameters, targets, and schedules. There is an urgent need for further randomized, double-blind, sham-controlled trials, with adequate follow-up periods, to test the efficacy of transcranial magnetic stimulation to treat these disorders. Available evidence must be regarded as preliminary and insufficient, at present, to support offering TMS to treat ASD.
Collapse
Affiliation(s)
- J Bernardo Barahona-Corrêa
- Champalimaud Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal.,Champalimaud Research, Champalimaud Centre for the Unknown, Lisbon, Portugal.,Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.,NOVA Medical School
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.,CADIN-Neurodesenvolvimento e Inclusão, Cascais, Portugal
| | - Ana Velosa
- Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Ana Chainho
- Centro de Investigação e de Intervenção Social (CIS-IUL), Instituto Universitário de Lisboa (ISCTE-IUL), Lisbon, Portugal
| | - Ricardo Lopes
- CADIN-Neurodesenvolvimento e Inclusão, Cascais, Portugal.,Centro de Investigação e de Intervenção Social (CIS-IUL), Instituto Universitário de Lisboa (ISCTE-IUL), Lisbon, Portugal
| | - Albino J Oliveira-Maia
- Champalimaud Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal.,Champalimaud Research, Champalimaud Centre for the Unknown, Lisbon, Portugal.,Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.,NOVA Medical School
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| |
Collapse
|
42
|
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.
Collapse
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
| |
Collapse
|
43
|
Kang J, Cai E, Han J, Tong Z, Li X, Sokhadze EM, Casanova MF, Ouyang G, Li X. Transcranial Direct Current Stimulation (tDCS) Can Modulate EEG Complexity of Children With Autism Spectrum Disorder. Front Neurosci 2018; 12:201. [PMID: 29713261 PMCID: PMC5911939 DOI: 10.3389/fnins.2018.00201] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 03/14/2018] [Indexed: 11/13/2022] Open
Abstract
Autism spectrum disorder (ASD) is a heterogeneous neurodevelopmental disorder which affects the developmental trajectory in several behavioral domains, including impairments of social communication, cognitive and language abilities. Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique, and it was used for modulating the brain disorders. In this paper, we enrolled 13 ASD children (11 males and 2 females; mean ± SD age: 6.5 ± 1.7 years) to participate in our trial. Each patient received 10 treatments over the dorsolateral prefrontal cortex (DLPFC) once every 2 days. Also, we enrolled 13 ASD children (11 males and 2 females; mean ± SD age: 6.3 ± 1.7 years) waiting to receive therapy as controls. A maximum entropy ratio (MER) method was adapted to measure the change of complexity of EEG series. It was found that the MER value significantly increased after tDCS. This study suggests that tDCS may be a helpful tool for the rehabilitation of children with ASD.
Collapse
Affiliation(s)
- Jiannan Kang
- Institute of Electrical Engineering, Yanshan University, Qinhuangdao, China
| | - Erjuan Cai
- Institute of Biomedical Engineering, Yanshan University, Qinhuangdao, China
| | - Junxia Han
- State Key Laboratory of Cognitive Neuroscience and Learning, IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Zhen Tong
- Institute of Electrical Engineering, Yanshan University, Qinhuangdao, China
| | - Xin Li
- Institute of Biomedical Engineering, Yanshan University, Qinhuangdao, China.,Key Laboratory of Measurement Technology and Instrumentation of Hebei Province, Qinhuangdao, China
| | - Estate M Sokhadze
- Department of Biomedical Sciences, School of Medicine Greenville Campus, Greenville Health System, University of South Carolina, Greenville, SC, United States
| | - Manuel F Casanova
- Department of Biomedical Sciences, School of Medicine Greenville Campus, Greenville Health System, University of South Carolina, Greenville, SC, United States
| | - Gaoxiang Ouyang
- Key Laboratory of Measurement Technology and Instrumentation of Hebei Province, Qinhuangdao, China
| | - Xiaoli Li
- State Key Laboratory of Cognitive Neuroscience and Learning, IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| |
Collapse
|
44
|
Transcranial Direct Current Stimulation to the Right Temporoparietal Junction for Social Functioning in Autism Spectrum Disorder: A Case Report. J ECT 2018; 34:e10-e13. [PMID: 28825927 PMCID: PMC6495599 DOI: 10.1097/yct.0000000000000445] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES While there is evidence of improved social functioning after applying transcranial direct current stimulation (tDCS) at the right temporoparietal junction (rTPJ) in individuals who are healthy, no current studies have investigated the use of tDCS at the rTPJ to improve social functioning in individuals with autism spectrum disorder (ASD). This case investigates the use of tDCS applied to the rTPJ to target social functioning in a high-functioning adult with ASD. METHODS The authors present a case of an 18-year old patient with ASD treated successfully with tDCS; 1.5 mA of tDCS was applied once a day for 30 minutes for 8 consecutive days with the anode electrode over rTPJ (CP6 in the 10/10 electroencephalogram system) and the cathode electrode placed on the ipsilateral deltoid. Behavioral outcome was assessed using the Autism Treatment Evaluation Checklist prior to tDCS, after the final tDCS session, and at 2 months after tDCS. An additional, informal follow-up was also made 1 year after tDCS. RESULTS Autism Treatment Evaluation Checklist showed substantial improvement in social functioning from baseline to post-tDCS, which was maintained at 2 months. The patient also reported lessened feelings of anger and frustration over social disappointments. Informal follow-up 1 year after stimulation indicates that the patient continues to maintain many improvements. CONCLUSIONS Anodal tDCS to the rTPJ may represent an effective treatment for improving social functioning in ASD, with a larger clinical trial needed to validate this effect.
Collapse
|
45
|
Decomposing P300 into correlates of genetic risk and current symptoms in schizophrenia: An inter-trial variability analysis. Schizophr Res 2018; 192:232-239. [PMID: 28400070 DOI: 10.1016/j.schres.2017.04.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 03/15/2017] [Accepted: 04/01/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND The P300 event-related potential (ERP) component, which reflects cognitive processing, is a candidate biomarker for schizophrenia. However, the role of P300 in the pathophysiology of schizophrenia remains unclear because averaged P300 amplitudes reflect both genetic predisposition and current clinical status. Thus, we sought to identify which aspects of P300 are associated with genetic risk versus symptomatic status via an inter-trial variability analysis. METHODS Auditory P300, clinical symptoms, and neurocognitive function assessments were obtained from forty-five patients with schizophrenia, thirty-two subjects at genetic high risk (GHR), thirty-two subjects at clinical high risk (CHR), and fifty-two healthy control (HC) participants. Both conventional averaging and inter-trial variability analyses were conducted for P300, and results were compared across groups using analysis of variance (ANOVA). Pearson's correlation was utilized to determine associations among inter-trial variability for P300, current symptoms and neurocognitive status. RESULTS Average P300 amplitude was reduced in the GHR, CHR, and schizophrenia groups compared with that in the HC group. P300 inter-trial variability was elevated in the CHR and schizophrenia groups but relatively normal in the GHR and HC groups. Furthermore, P300 inter-trial variability was significantly related to negative symptom severity and neurocognitive performance results in schizophrenia patients. CONCLUSIONS These results suggest that P300 amplitude is an endophenotype for schizophrenia and that greater inter-trial variability of P300 is associated with more severe negative and cognitive symptoms in schizophrenia patients.
Collapse
|
46
|
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.
Collapse
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
| |
Collapse
|
47
|
Igelström KM, Webb TW, Graziano MSA. Functional Connectivity Between the Temporoparietal Cortex and Cerebellum in Autism Spectrum Disorder. Cereb Cortex 2017; 27:2617-2627. [PMID: 27073219 DOI: 10.1093/cercor/bhw079] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The neural basis of autism spectrum disorder (ASD) is not yet understood. ASD is marked by social deficits and is strongly associated with cerebellar abnormalities. We studied the organization and cerebellar connectivity of the temporoparietal junction (TPJ), an area that plays a crucial role in social cognition. We applied localized independent component analysis to resting-state fMRI data from autistic and neurotypical adolescents to yield an unbiased parcellation of the bilateral TPJ into 11 independent components (ICs). A comparison between neurotypical and autistic adolescents showed that the organization of the TPJ was not significantly altered in ASD. Second, we used the time courses of the TPJ ICs as spatially unbiased "seeds" for a functional connectivity analysis applied to voxels within the cerebellum. We found that the cerebellum contained a fine-grained, lateralized map of the TPJ. The connectivity of the TPJ subdivisions with cerebellar zones showed one striking difference in ASD. The right dorsal TPJ showed markedly less connectivity with the left Crus II. Disturbed cerebellar input to this key region for cognition and multimodal integration may contribute to social deficits in ASD. The findings might also suggest that the right TPJ and/or left Crus II are potential targets for noninvasive brain stimulation therapies.
Collapse
Affiliation(s)
- Kajsa M Igelström
- Princeton Neuroscience Institute.,Department of Psychology, Princeton University, Princeton, NJ 08544, USA
| | - Taylor W Webb
- Princeton Neuroscience Institute.,Department of Psychology, Princeton University, Princeton, NJ 08544, USA
| | - Michael S A Graziano
- Princeton Neuroscience Institute.,Department of Psychology, Princeton University, Princeton, NJ 08544, USA
| |
Collapse
|
48
|
Wang Y, Hensley MK, Tasman A, Sears L, Casanova MF, Sokhadze EM. Heart Rate Variability and Skin Conductance During Repetitive TMS Course in Children with Autism. Appl Psychophysiol Biofeedback 2016; 41:47-60. [PMID: 26341093 DOI: 10.1007/s10484-015-9311-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Autism spectrum disorder (ASD) is a developmental disorder marked by difficulty in social interactions and communication. ASD also often present symptoms of autonomic nervous system (ANS) functioning abnormalities. In individuals with autism the sympathetic branch of the ANS presents an over-activation on a background of the parasympathetic activity deficits, creating an autonomic imbalance, evidenced by a faster heart rate with little variation and increased tonic electrodermal activity. The objective of this study was to explore the effect of 12 sessions of 0.5 Hz repetitive transcranial magnetic stimulation (rTMS) over dorsolateral prefrontal cortex (DLPFC) on autonomic activity in children with ASD. Electrocardiogram and skin conductance level (SCL) were recorded and analyzed during each session of rTMS. The measures of interest were time domain (i.e., R-R intervals, standard deviation of cardiac intervals, NN50-cardio-intervals >50 ms different from preceding interval) and frequency domain heart rate variability (HRV) indices [i.e., power of high frequency (HF) and low frequency (LF) components of HRV spectrum, LF/HF ratio]. Based on our prior pilot studies it was proposed that the course of 12 weekly inhibitory low-frequency rTMS bilaterally applied to the DLPFC will improve autonomic balance probably through improved frontal inhibition of the ANS activity, and will be manifested in an increased length of cardiointervals and their variability, and in higher frequency-domain HRV in a form of increased HF power, decreased LF power, resulting in decreased LF/HF ratio, and in decreased SCL. Our post-12 TMS results showed significant increases in cardiac intervals variability measures and decrease of tonic SCL indicative of increased cardiac vagal control and reduced sympathetic arousal. Behavioral evaluations showed decreased irritability, hyperactivity, stereotype behavior and compulsive behavior ratings that correlated with several autonomic variables.
Collapse
Affiliation(s)
- Yao Wang
- University of Louisville, Louisville, KY, USA
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, No. 19 Xinjiekouwai St., Hai Dian District, Beijing, 100875, People's Republic of China
| | | | | | | | | | | |
Collapse
|
49
|
High-Frequency Stimulation at the Subthalamic Nucleus Suppresses Excessive Self-Grooming in Autism-Like Mouse Models. Neuropsychopharmacology 2016; 41:1813-21. [PMID: 26606849 PMCID: PMC4869050 DOI: 10.1038/npp.2015.350] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 11/19/2015] [Accepted: 11/20/2015] [Indexed: 01/15/2023]
Abstract
Approximately one quarter of individuals with an autism spectrum disorder (ASD) display self-injurious behavior (SIB) ranging from head banging to self-directed biting and punching. Sometimes, these behaviors are extreme and unresponsive to pharmacological and behavioral therapies. We have found electroconvulsive therapy (ECT) can produce life-changing results, with more than 90% suppression of SIB frequency. However, these patients typically require frequent maintenance ECT (mECT), as often as every 5 days, to sustain the improvement gained during the acute course. Long-term consequences of such frequent mECT started as early as childhood in some cases are unknown. Accordingly, there is a need for alternative forms of chronic stimulation for these patients. To explore the feasibility of deep brain stimulation (DBS) for intractable SIB seen in some patients with an ASD, we utilized two genetically distinct mouse models demonstrating excessive self-grooming, namely the Viaat-Mecp2(-/y) and Shank3B(-/-) lines, and administered high-frequency stimulation (HFS) via implanted electrodes at the subthalamic nucleus (STN-HFS). We found that STN-HFS significantly suppressed excessive self-grooming in both genetic lines. Suppression occurs both acutely when stimulation is switched on, and persists for several days after HFS is stopped. This effect was not explained by a change in locomotor activity, which was unaffected by STN-HFS. Likewise, social interaction deficits were not corrected by STN-HFS. Our data show STN-HFS suppresses excessive self-grooming in two autism-like mouse models, raising the possibility DBS might be used to treat intractable SIB associated with ASDs. Further studies are required to explore the circuitry engaged by STN-HFS, as well as other potential stimulation sites. Such studies might also yield clues about pathways, which could be modulated by non-invasive stimulatory techniques.
Collapse
|
50
|
Advances in the Application of Electroconvulsive Therapy. Curr Behav Neurosci Rep 2016. [DOI: 10.1007/s40473-016-0074-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|