Stimulation magnétique transcrânienne répétitive pour le traitement des déficits des fonctions exécutives dans le trouble du spectre de l'autisme: approche par essai clinique

Aperçu: G.M.

Les déficits de la fonction exécutive (EF) chez les personnes avec un diagnostic de trouble du spectre de l'autisme (TSA) sont omniprésents et peu étudiés. En outre, il n'existe pas de traitements efficaces basés sur la neuroscience pour traiter cette caractéristique invalidante des TSA.
La stimulation magnétique transcrânienne répétitive (SMTr) a démontré la promesse de s'attaquer aux déficits de l'EF dans les troubles neuropsychiatriques chez l'adulte. L'article décrit la conception d'un essai randomisé et contrôlé, actuellement en cours, de rTMS bilatéral de 20MHz, , appliquée au cortex préfrontal dorsolatéral (DLPFC) pour le traitement des déficits de l'EF dans les TSA .

J Child Adolesc Psychopharmacol. 2017 Mar 27. doi: 10.1089/cap.2016.0146.

Repetitive Transcranial Magnetic Stimulation for the Treatment of Executive Function Deficits in Autism Spectrum Disorder: Clinical Trial Approach

Ameis SH^1,2,3, Daskalakis ZJ^3,4, Blumberger DM^3,4, Desarkar P^3,4, Drmic I⁵, Mabbott DJ^6,7, Lai MC^1,2,3, Croarkin PE⁸, Szatmari P^1,2,3.

Author information

1

1 Centre for Brain and Mental Health, The Hospital for Sick Children , Toronto, Canada .

2

2 The Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Campbell Family Mental Health Research Institute, The Centre for Addiction and Mental Health, University of Toronto , Toronto, Canada .

3

3 Department of Psychiatry, Faculty of Medicine, University of Toronto , Toronto, Canada .

4

4 Temerty Centre for Therapeutic Brain Intervention, Campbell Family Mental Health Research Institute , Centre for Addiction and Mental Health, Toronto, Ontario, Canada .

5

5 Genetics and Genome Biology and Autism Research Unit, The Centre for Applied Genomics, The Hospital for Sick Children , Toronto, Canada .

6

6 Program in Neurosciences and Mental Health, Research Institute , The Hospital for Sick Children, Toronto, Canada .

7

7 Department of Psychology, Faculty of Graduate Studies, University of Toronto , Toronto, Canada .

8

8 Division of Child and Adolescent Psychiatry, Department of Psychiatry and Psychology, Mayo Clinic , Rochester, Minnesota.

Abstract

OBJECTIVE:

Executive function (EF) deficits in patients with autism spectrum disorder (ASD) are ubiquitous and understudied. Further, there are no effective, neuroscience-based treatments to address this impairing feature of ASD. Repetitive transcranial magnetic stimulation (rTMS) has demonstrated promise in addressing EF deficits in adult neuropsychiatric disorders. This article will outline the design of a novel randomized-controlled trial of bilateral, 20 Hz, rTMS applied to the dorsolateral prefrontal cortex (DLPFC) for treatment of EF deficits in ASD that is currently ongoing. We describe prior therapeutic rTMS research for ASD and prior rTMS trials targeting EFs in adult neuropsychiatric disorders. A neurophysiological rationale for rTMS treatment of EF deficits in ASD is presented.

METHODS:

An ongoing protocol will enroll participants aged 16-35 with ASD and no intellectual disability. Psychotropic medications will be continued during the 4-week trial of active 20 Hz versus sham rTMS applied to the DLPFC. Twenty, active treatment sessions consisting of 25 stimulation trains at a 90% motor threshold will be administered. The primary outcome measure is the Cambridge Neuropsychological Test Automated Battery (CANTAB) spatial working memory task. At present, recruitment, enrollment, and treatment within the described clinical trial are ongoing.

CONCLUSIONS:

EF deficits are common and impairing symptoms of ASD. There are no evidence-based treatments for EF deficits in ASD. The protocol described here will provide important preliminary data on the feasibility and efficacy of 20 Hz rTMS to DLPFC for EF deficits in ASD.

PMID: 28346865

DOI: 10.1089/cap.2016.0146