Neuromodulation Integrating rTMS and Neurofeedback for the Treatment of Autism Spectrum Disorder: An Exploratory Study

Abstract

Autism spectrum disorder (ASD) is a pervasive developmental disorder characterized by deficits in social interaction, language, stereotyped behaviors, and restricted range of interests. In previous studies low frequency repetitive transcranial magnetic stimulation (rTMS) has been used, with positive behavioral and electrophysiological results, for the experimental treatment in ASD. In this study we combined prefrontal rTMS sessions with electroencephalographic (EEG) neurofeedback (NFB) to prolong and reinforce TMS-induced EEG changes. The pilot trial recruited 42 children with ASD (~14.5 yrs). Outcome measures included behavioral evaluations and reaction time test with event-related potential (ERP) recording. For the main goal of this exploratory study we used rTMS-neurofeedback combination (TMS-NFB, N=20) and waitlist (WTL, N=22) groups to examine effects of 18 sessions of integrated rTMS-NFB treatment or wait period) on behavioral responses, stimulus and response-locked ERPs, and other functional and clinical outcomes. The underlying hypothesis was that combined TMS-NFB will improve executive functions in autistic patients as compared to the waitlist group. Behavioral and ERP outcomes were collected in preand post-treatment tests in both groups. Results of the study supported our hypothesis by demonstration of positive effects of combined TMS-NFB neurotherapy in active treatment group as compared to control waitlist group, as the TMS-NFB group showed significant improvements in behavioral and functional outcomes as compared to the waitlist group.

Transcranial Magnetic and Direct Current Stimulation in Children

“…Treatment significantly reduced repetitive and compulsive behavior as measured by the RBS-R, and scores on the lethargy/social withdrawal and hyperactivity subscales of the ABC. rTMS-NFB also improved event-related potential (ERP) indices in patients with ASD [78]. However, HF-rTMS has also been used to increase excitability in inhibited cortical regions in children with ASD with intellectual disability.…”

Event-related Potentials (ERP) in Cognitive Neuroscience Research and Applications

“…Our studies Baruth et al, 2011;Casanova et al, 2012;Sokhadze, Baruth, ElBaz, et al, 2010;Sokhadze et al, 2012a;Sokhadze et al, 2012b;Sokhadze, El-Baz, et al, 2009;Sokhadze, El-Baz, Tasman, et al 2014) suggest that nontarget ERP responses in oddball paradigms should be routinely studied along with target responses in order to improve the diagnostic capabilities of cognitive ERPs. Notably, nontarget responses may help to decide whether abnormal responses to target (P3a, P3b) are related or not to a deficit in the mobilization of attentional resources (García-Larrea et al, 1992).…”

Effects of repetitive transcranial magnetic stimulation on children with low‐function autism

“…Low‐frequency rTMS of 1 Hz and 90% MT was applied. There were 180 pulses each time with 18 trains with 10 pulses and an interval of 20 seconds . The waitlist group received the same process but the figure‐eight coil was placed vertically on the scalp with no magnetic field penetrated through the skull.…”

“…Schematic presentation of rTMS modified from . About 5 min, EEG data were recorded before and after 18 sessions.…”