Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA.
Autism Res. 2024 Jan;17(1):17-26. doi: 10.1002/aur.3041. Epub 2023 Oct 23.
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.
非侵入性脑刺激 (NIBS) 技术,包括重复经颅磁刺激 (rTMS) 和经颅直流电刺激 (tDCS),最近已成为各种精神、神经和神经发育疾病的替代非药物干预方法。NIBS 开始在研究和临床环境中应用于治疗自闭症谱系障碍 (ASD) 的核心和相关症状,包括社交沟通障碍、受限和重复行为、易怒、多动、抑郁以及执行功能和感觉运动整合受损。尽管这些针对特定疾病的基于设备的干预措施有很大的前景,但在其他疾病(包括成人重度抑郁症 (MDD) 和强迫症 (OCD),rTMS 已获得 FDA 批准)中,关于这些干预措施在 ASD 患者中的安全性和有效性的数据有限,尤其是在神经发育干预通常开始的年幼儿童中。大多数研究都是开放标签的、小规模的,或者专注于 ASD 患者的一个受限亚组。需要更大规模、随机对照试验,结合神经影像学,以开发治疗反应的预测生物标志物并优化治疗参数。我们认为,在进行这些研究之前,我们对这些技术在整个 ASD 谱系儿童中的安全性和有效性没有足够的估计。因此,目前没有证据支持在该人群中广泛使用这些技术。在这里,我们讨论了使用 NIBS 治疗与 ASD 相关症状的现有数据,并讨论了该领域的未来方向。