Transcranial magnetic stimulation (TMS) therapy for autism consensus conference

With five congresses to attend in May and 4 more in June my head has started to spin. However, I am hoping to enjoy the experience as all of the congresses are related in one way or another to autism.

The first congress for this month spanned the 2 days before the International Meeting for Autism Research (IMFAR). It was organized by Kimberley Taylor CEO of the Clearly Present Foundation. I am presently a member of the Scientific Advisory Board for that foundation. The meting was closed to the public and participation was gained through invitation. The meeting was an attempt to establish a consensus on transcranial magnetic stimulation therapy for autism spectrum disorders and it was sponsored by both Autism Speaks and Neuronetics. As I can tell they primarily paid for food, nothing else. There were only a handful of speakers: Peter Enticott, James T McCracken, Lindsay Oberman, Alvaro Pascual-Leone, and Manuel Casanova (myself). Among those attending were: Stephanie Ameis, David Brock, Paul Croarkin, Geraldine Dawson, Mark Demitrack, Donald Gilbert, Margaret Grabb, Eric Hollander, Marco Iacoboni, Kelvin Lim, Stewart Mostofsky, Ernest Pedapati, Alexander Rotenberg, Susna Swedo, Kim Hollingsworth Taylor, Christopher Wall, Paul Wang and Winfred Wu.

Although there were only a few speakers, we provided for 17 hours of lectures and healthy discussion. Since 2009 there have been 15 papers on TMS (half of them by my group, including the first article ever published on the subject). Only six research groups are doing TMS world-wide: 2 in the US, 2 in Germany, 1 in Italy and 1 in Australia. It was the consensus of opinion that mot studies used small samples and that each study population was markedly heterogeneous (by age, diagnosis, IQ, gender and medications) thus preventing straight comparisons. However, all studies have shown positive effects. There has been an emphasis on stimulating the frontal lobes and in using low frequencies (in order to build inhibition). Still, major problems that need to be overcome is the lack of outcome measures that are severity dependent and reflect on core symptomatology for autism spectrum disorders. Parent rating were usually suspect and tended to rate higher improvements than clinicians. There has been little research in regards to quality of life (does improvements translate to better living conditions?), durability of effects, inclusion of minorities and gender differences.

Most studies have avoided including young children, and have used higher functioning patients. There have been concerns that younger children may be more prone to side effects due to: 1) TMS’s stimulation may outpace the stapedius (middle ear) reflex and due to the noise by the machine provide for hearing damage (nobody has found good ear plugs for children), 2) head size and scalp thickness differences may provide for larger induced currents, and 3) the degree of brain myelination (or lack of the same)may provide for unreliable motor thresholds and we may misjudge the intensity of stimuli used in a study.

8 responses to “Transcranial magnetic stimulation (TMS) therapy for autism consensus conference

  1. Dr. Casanova, Thank you for the update. Keenly following this part of your research and I hope to avail of it as soon as circumstances allow it. Best regards, Prasanna

    Best regards, Prasanna

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  2. I have attempted to read some stuff about TMS, but hard for me to learn as much as I would like due to my disability. I’m still skeptical that stimulating the dorsolateral frontal lobe (whatever it is if i am getting this wrong) or any other specific brain area would infleunce autism neurologically. From what I do know, TMS only affects a very small area of the brain and only over the cerebral cortex. It does not affect deep nuclei such as sthose in the lmbic system. I know the theory is that the insula and other parts of the frontal lobe may be connected to the amygdala and other limbic areas, but I’m skeptical that stimulating certain areas would influence areas they are connected to. Also, TMS only affects neurons and not glia cells that might be involved in autism since glia don’t have action potentials. I know the theory is that influencing neurons might influence their interactions with glia, so not sure I buy that and glia may be involved in autism somehow. I’d be interested in a much more sophisticated magneit that could influence the amygdala. I guess TMS can penetrate the meninges and dura and get to the cerebral cortex, but I guess i don’t understand how.

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    • We tried to explain in our first article that we were hoping for TMS to correct initially a focal deficit within a particular area of the cortex. However, later on, because that area was corrected, it would serve to fix other areas connected to the same. This cascading effect is well know within neurosciences. We selected the dorsolateral prefrontal cortex not only because it was involved by described minicolumnar abnormalities, but also because it is so richly interconnected to other brain regions.

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  3. TMS has been used by Alan Snyder director of the Centre for the Mind at the University of Sydney, Australia. He made experiments to try to reproduce Savant skills through TMS with some success but on a limited sample of “NT” people who had not previously shown special talents.

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    • I had the opportunity to meet him and discuss his studies when we both presented at the Royal Society of Medicine in London several years ago. Nice person.

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