个性化theta爆发刺激增强了轻度语言障碍自闭症幼儿的社交技能：一项双盲随机对照试验。

Personalized Theta Burst Stimulation Enhances Social Skills in Young Minimally Verbal Children With Autism: A Double-Blind Randomized Controlled Trial.

作者信息

Xiao Jinming, Ming Yating, Li Lei, Huang Xinyue, Zhou Yuanyue, Ou Jianjun, Kou Juan, Feng Rui, Ma Rui, Zheng Qingyu, Shan Xiaolong, Meng Yao, Liao Wei, Zhang Yingli, Wang Ting, Kuang Yangying, Cao Jing, Li Shijun, Lai Hua, Chen Jia, Wang Qi, Dong Xiaoli, Kang Xiaodong, Chen Huafu, Menon Vinod, Duan Xujun

机构信息

Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China; MOE Key Laboratory for Neuro Information, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, China.

Department of Medical Psychology, The First Affiliated Hospital, Hainan Medical University, Haikou, Hainan, China.

出版信息

Biol Psychiatry. 2025 Jan 10. doi: 10.1016/j.biopsych.2025.01.002.

DOI:10.1016/j.biopsych.2025.01.002

PMID:39800205

Abstract

BACKGROUND

Minimally verbal children with autism are understudied and lack effective treatment options. Personalized continuous theta burst stimulation (cTBS) targeting the amygdala and its circuitry may be a potential therapeutic approach for this population.

METHODS

In a double-blind randomized controlled trial, minimally verbal children with autism (ages 2-8 years) received 4 weeks of cTBS. An amygdala-optimized functional connectivity (AOFC) group (n = 23) received personalized stimulation targeting a left dorsolateral prefrontal cortex site functionally connected with the amygdala. A non-optimized (NO) control group (n = 21) received stimulation at a standard prefrontal site. We assessed changes in Autism Diagnostic Observation Schedule scores, amygdala volume, spontaneous neural activity, and FC.

RESULTS

Personalized AOFC-guided cTBS improved social and communication skills with an effect size twice that of the NO group (Cohen's d = 0.55 vs. 0.24). The AOFC group showed greater reductions in amygdala volume, spontaneous neural activity, and hyperconnectivity. Network-level amygdala connectivity changes with default mode, frontoparietal, and dorsal attention networks were correlated with clinical improvements. Field mapping analysis revealed that greater electric field overlap between standard and optimized targets predicted better treatment outcomes.

CONCLUSIONS

Personalized AOFC-guided cTBS enhanced social skills and communication in minimally verbal children with autism by modulating amygdala structure and connectivity. Changes in amygdala network connectivity predicted clinical improvements, suggesting a mechanistic link between neural circuit plasticity and behavioral outcomes. These findings demonstrate the potential of precision-targeted neuromodulation in addressing a critical gap in autism treatment for this understudied population.

摘要

背景

患有自闭症的极少言语儿童研究不足，且缺乏有效的治疗方案。针对杏仁核及其神经回路的个性化连续theta爆发刺激（cTBS）可能是针对这一群体的一种潜在治疗方法。

方法

在一项双盲随机对照试验中，患有自闭症的极少言语儿童（2至8岁）接受了4周的cTBS治疗。一个杏仁核优化功能连接（AOFC）组（n = 23）接受了针对与杏仁核功能相连的左侧背外侧前额叶皮质部位的个性化刺激。一个非优化（NO）对照组（n = 21）在标准前额叶部位接受刺激。我们评估了自闭症诊断观察量表得分、杏仁核体积、自发神经活动和功能连接的变化。

结果

个性化AOFC引导的cTBS改善了社交和沟通技能，效应大小是NO组的两倍（科恩d值 = 0.55对0.24）。AOFC组在杏仁核体积减少、自发神经活动和过度连接方面表现出更大程度的降低。杏仁核与默认模式、额顶叶和背侧注意网络的网络层面连接变化与临床改善相关。场映射分析表明，标准靶点和优化靶点之间更大的电场重叠预示着更好的治疗效果。