Autism spectrum disorder (ASD) is a genetically heterogeneous group of neurodevelopmental disorders that affect 1 in 36 children (CDC data) and have recognizable core deficits in common, including repetitive stereotyped behaviors and difficulties in social interaction and communication. Pharmacological interventions moderate some ASD comorbidities, but do not alleviate core deficits and have significant side effects. While many behavioral therapies are inadequate, a very intensive form called applied behavioral analysis (ABA) is demonstrably effective. ABA is based on graded progression and immediate feedback. ABA has raised concerns over its intensive nature and has triggered unease about being too harsh. One solution may derive from a widespread hypothesis of ASD pathogenesis, which posits that the brain in ASD is overexcited, i.e., excitation dominates over inhibition, and electroencephalographic (EEG) alpha band oscillatory activity is altered, which degrades sensory input and task management. This may also disrupt the brain mesolimbic dopaminergic reward cascade causing social interactions to be unrewarding, leading to deleterious social behavior and poor communication. We hypothesize that a comprehensive, personalized form of spectral EEG guided repetitive transcranial magnetic stimulation that we term PrTMS, can normalize alpha EEG oscillations, E/I balance, and dopaminergic reward signaling, to facilitate improved psychosocial behavior. The goal is for PrTMS to synergize with behavioral interventions, so that ABA for example, could be less intensive. This may hold the promise of making self-determination more readily attainable for ASD persons, and could also democratize ASD therapy by rendering it more affordable.

中文翻译：

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由频谱脑电图引导的个性化重复经颅磁刺激可以增强自闭症谱系障碍的治疗并使之民主化

自闭症谱系障碍 (ASD) 是一组遗传异质性神经发育障碍，每 36 名儿童中就有 1 人受到影响（CDC 数据），并且具有可识别的共同核心缺陷，包括重复的刻板行为以及社交互动和沟通困难。药物干预可以缓解一些 ASD 合并症，但不能缓解核心缺陷，并且具有显着的副作用。虽然许多行为疗法都不够充分，但一种称为应用行为分析（ABA）的非常强化的形式显然是有效的。 ABA 基于分级进展和即时反馈。 ABA 对其密集性质提出了担忧，并引发了对其过于严厉的不安。一种解决方案可能源于广泛传播的自闭症谱系障碍 (ASD) 发病机制假说，该假说认为自闭症谱系障碍 (ASD) 患者的大脑过度兴奋，即兴奋超过抑制，并且脑电图 (EEG) α 带振荡活动发生改变，从而降低感觉输入和任务管理能力。这也可能破坏大脑中边缘多巴胺能奖励级联，导致社交互动没有回报，导致有害的社交行为和沟通不良。我们假设一种全面、个性化的频谱脑电图引导重复经颅磁刺激（我们称之为 PrTMS）可以使 α 脑电图振荡、E/I 平衡和多巴胺能奖励信号正常化，从而促进改善社会心理行为。 PrTMS 的目标是与行为干预措施产生协同作用，从而降低 ABA 的强度。这可能有望使自闭症谱系障碍者更容易实现自决，并且还可以通过使自闭症谱系障碍治疗变得更便宜来使治疗民主化。