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Treatment of Executive Function Deficits in Autism Spectrum Disorder with Repetitive Transcranial Magnetic Stimulation: A double-blind, sham-controlled, pilot trial
Brain Stimulation ( IF 7.7 ) Pub Date : 2020-05-01 , DOI: 10.1016/j.brs.2020.01.007
Stephanie H Ameis 1 , Daniel M Blumberger 2 , Paul E Croarkin 3 , Donald J Mabbott 4 , Meng-Chuan Lai 5 , Pushpal Desarkar 2 , Peter Szatmari 1 , Zafiris J Daskalakis 2
Affiliation  

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.

中文翻译:

用重复经颅磁刺激治疗自闭症谱系障碍的执行功能缺陷:一项双盲、假对照、试验性试验

背景 在患有自闭症谱系障碍 (ASD) 的青年和年轻人中,执行功能 (EF) 缺陷可能是一个有前景的治疗目标,对日常功能有潜在影响。目标进行一项试点随机、双盲、平行、对照试验,评估重复经颅磁刺激 (rTMS) 对 ASD EF 缺陷的影响。方法 在安大略省的多伦多(2014 年 11 月至 2017 年 6 月),针对背外侧前额叶皮层 (DLPFC) (90%RMT) 的 20 节课、4 周疗程的 20 Hz rTMS 与 16-35 岁的假刺激进行了比较患有 ASD(28 名男性/12 名女性),无智力障碍,日常 EF 表现受损(n = 20 主动/n = 20 假)。结果测量评估了主动与假 rTMS 对 EF 性能的方案可行性和临床效果。探讨了基线功能的调节作用。结果 在符合条件的参与者中,95% 被纳入,95% 的随机参与者完成了方案。跨治疗组的不良事件为轻度至中度。主动与假 rTMS 对 EF 性能没有显着差异。基线适应性功能缓和了 rTMS 的影响,因此基线功能较低的参与者在主动组与假组中经历了显着的 EF 改善。结论 我们的试点 RCT 证明了在患有自闭症的青年和年轻人中使用针对 DLPFC 的高频 rTMS 的可行性和可接受性。没有证据表明主动与假 rTMS 对 EF 性能的疗效。然而,我们发现了有希望的初步证据表明,在患有更严重的适应性功能缺陷的 ASD 参与者中,主动与假 rTMS 相比,EF 表现有所改善。未来的工作可以集中在检查 rTMS 在这个需求更高的人群中的功效。临床试验注册 重复经颅磁刺激 (rTMS) 治疗自闭症谱系障碍中的执行功能缺陷和对大脑结构的影响:一项试点研究;https://clinicaltrials.gov/ct2/show/NCT02311751?term = ameis&rank = 1; NCT02311751。该试验由以下资助:美国儿童和青少年精神病学学会 (AACAP) 试点研究奖、安大略学术健康科学中心替代资助计划的创新基金和安大略心理健康基金会 (OMHF) 项目资助和新研究员奖学金。
更新日期:2020-05-01
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