Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
Azrieli Adult Neurodevelopmental Centre & Adult Neurodevelopmental and Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Biomed J. 2022 Aug;45(4):696-707. doi: 10.1016/j.bj.2021.07.008. Epub 2021 Aug 3.
Theta burst stimulation (TBS), a patterned repetitive transcranial magnetic stimulation (rTMS) protocol with shorter simulation duration and lower stimulus intensity, could be a better protocol for individuals with autism spectrum disorder (ASD). Our study aimed to explore the impacts of intermittent TBS (iTBS) over the bilateral posterior superior temporal sulcus (pSTS) on intellectually able adults with ASD.
In this randomized, single-blinded, sham-controlled crossover trial, 13 adults with ASD completed iTBS for 5 consecutive days over the bilateral pSTS and inion (as a sham control) in a 16-weeks interval and in a randomly assigned order. The neuropsychological function was measured with the Wisconsin Card Sorting Test (WCST) for cognitive flexibility while the clinical outcomes were measured with both self-rate and parents-rate Autism Spectrum Quotient (AQ) before and after 5-day iTBS interventions.
The results revealed significantly immediate effects of multi-session iTBS over the bilateral pSTS on parent-rate autistic symptoms in adults with ASD. The post-hoc analysis revealed the impacts of multi-session iTBS on cognitive flexibility were affected by baseline social-communicative impairment and baseline cognitive performance. Besides, the impacts of multi-session iTBS on clinical symptoms was affected by the concurrent psychotropic medication use and baseline autistic symptoms.
Given the caveat of the small sample size and discrepancy of multiple informants, this pilot study suggests the therapeutic potential of 5-day multi-session iTBS over the pSTS in adults with ASD. Individual factors modulating the response to rTMS should be explicitly considered in the future trial.
Theta 爆发刺激（TBS）是一种模式化重复经颅磁刺激（rTMS）方案，具有更短的刺激持续时间和更低的刺激强度，可能更适合自闭症谱系障碍（ASD）患者。我们的研究旨在探讨双侧后上颞叶（pSTS）间歇性 TBS（iTBS）对智力正常的成年 ASD 患者的影响。
在这项随机、单盲、假对照交叉试验中，13 名 ASD 成人在 16 周的间隔内，以随机分配的顺序，连续 5 天接受双侧 pSTS 和顶骨（作为假对照）的 iTBS，并在干预前后分别使用威斯康星卡片分类测试（WCST）测量认知灵活性的神经心理学功能，以及自我评分和父母评分的自闭症谱系商数（AQ）。
结果显示，多疗程双侧 pSTS 的 iTBS 对 ASD 成人的父母评分的自闭症症状有显著的即时影响。事后分析显示，多疗程 iTBS 对认知灵活性的影响受基线社交沟通障碍和基线认知表现的影响。此外，多疗程 iTBS 对临床症状的影响受同期精神药物使用和基线自闭症症状的影响。
鉴于样本量小和多个信息提供者的差异，这项初步研究表明，5 天多疗程 pSTS 的 iTBS 对 ASD 成人有治疗潜力。在未来的试验中，应明确考虑个体因素对 rTMS 反应的调节作用。
