The Autism Spectrum

A cognitive neuroscientist explores autism, Asperger's syndrome, and related disorders.

The use of TMS for ASD

I haven't posted an entry in a while because I have been incredibly busy with collecting data for my studies. When thinking about what I was going to write about for this posting, I realized that I haven't really talked about my research, which is in and of itself arguably a controversial topic in autism. Read More

Automatically nervous about new 'treatments'

This is probably unfair, but I tend to feel nervous whenever I hear of a new treatment for ASD. While I've never experienced anything awful, I've just heard too many horror stories about electro-shock or chelation.

I also worry about people focusing too much on trying to fix autism, instead of figuring out how to help people cope with it. Of course, the opposite is also true.

Overall, I'm inclined to be open minded about TMS, but I wouldn't be lining up to try it myself.

Thank you for remaining open minded.

Fair enough. Though TMS is fairly new as it relates to autism (over the past 6-7 years) it actually has been used in neurology for over 20 years. It is not ver similar to ECT or chelation which are much less focused in their effects. If you would like to learn more about TMS, you are welcome to look at our lab website, tmslab.org where there is more information about TMS in general and its applications. -Lindsay

This is amazing!

I just attended a book reading by John Robison and so am just beginning to "google" TMS and autism (I have a 6 1/2 yr old son I'd describe as having medium-functioning autism). Some of the changes Mr. Robison underwent b/c of TMS are obviously still with him 5 months later, which is at odds with the temporary nature you assert above. Can you talk a little bit about that?

And how quickly do you think you'll be able to move through Clinical Trial II and III stages? (ballparking).

Thanks!

Science takes time, but we are very optimistic!

Dear Michelle, Thank you for your comments on the TMS studies. The study that John Robison participated in we thought would only have an effect for less than an hour, but as you said, he feels that the effect has lasted much longer. Now, it is hard to say (as everyone has not had as big of a response) whether it was a result of the TMS or the TMS combined with other things that John has been doing. We are hoping to begin some Clinical Trials in the Spring, but just to give you an idea, the first clinical trials for TMS with Depression were in the early 1990's and it was just approved by the FDA this Fall. Unfortunately, Science is slow, but I do encourage you to get involved in the experimental trails, as one thing that takes time is recruiting participants! You also asked if we have an idea why John (and others) may have had an effect last much longer. This we believe is more evidence for this hyperplasticity that I have been studying. That the brains of people with autism and Asperger's are set up to respond differently to incoming stimuli (TMS or more regular visual or sensory information). Specifically, it seems that this new information is encoded much more in them than in typically developing individuals, perhaps resulting in longer lasting effects. This is all quite new, but very exciting!

I am very happy to see a new

I am very happy to see a new and such an innovative approach to treating people with autism. To think there is a way that we can help alleviate the symptoms of autism in autistic people while staying away the many detrimental side effects of medication is amazing. Although I am in intrigued by this treatment I have some questions that would need to be answered before I could fully offer my support.

You claim that you are able to target a very small part of the brain. Could focusing the brain’s electrical current to one small area have negative effects in or damage other parts of the brain?

I have read that TMS has been related to greater risks of seizures in patients who have undergone it. Have any of the subjects that you or your associates have treated experienced a seizure during or after TMS treatment?

You say that TMS has a very small risk of side effects. What are those side effects?

The beneficial effects of TMS only last for a very short amount of time (1-30 minutes). Are there any initiatives being taken to try to extend that time?

And lastly,

How does TMS effect the way that neurons fire?

Since TMS is not a cure for autism and more of a temporary fix, I think that the money and time would be best used for finding ways to help autistics cope with their illness and finding ways to better integrate them into society.

I wish you the best of luck in your future research.

-Peter

Response to Peter

Dear Peter, Thank you for your interest in our studies. Here is some more information... You claim that you are able to target a very small part of the brain. Could focusing the brain’s electrical current to one small area have negative effects in or damage other parts of the brain? Actually, we are not focusing the brain's electrical current. Rather, we are selectively increasing or decreasing a specific part of the brain's ability to respond. The magnetic field does not damage or have any negative effects on other parts of the brain. I have read that TMS has been related to greater risks of seizures in patients who have undergone it. Have any of the subjects that you or your associates have treated experienced a seizure during or after TMS treatment? No. This risk is EXTREMELY small. In someone who does not have a history of Epilepsy or brain damage (stroke or traumatic brain injury) it has occurred in fewer than 10 people in the over 25 years and thousands of people who have undergone TMS. It is not something that unfortunately the public response has created a fear that is unsubstantiated by the reality. You say that TMS has a very small risk of side effects. What are those side effects? Headache, nausea, and changes in mood and attention have been reported in 10% or less of the participants. The risk of these things also depends on where you are stimulating. Additionally, mood change may be the effect you are looking for (rather than a side effect). The beneficial effects of TMS only last for a very short amount of time (1-30 minutes). Are there any initiatives being taken to try to extend that time? Yes, it seems that application of TMS over several sessions increases its time that the effect lasts. There are also different sequences of TMS that have greater or lesser effect. And lastly, How does TMS effect the way that neurons fire? Because neurons work by electrical impulses, and because electrical currents can be induced by a fluctuating magnetic field, TMS is able to depolarize the neuron and thus increase its chances of firing. You can get more information on our lab website, tmslab.org Thank you for your interest in our research.

Response to Michelle Dyson's comment

First of all, Michelle, Lindsay is one of the scientists at the lab where I've participated in experiments. But the experiments that produced change in me are from a different study than the plasticity study described here.

As she points out, TMS is a very targeted therapy.

You ask why there seem to be long term changes in me when the TMS effect was thought to be temporary. Lindsay may have a different take on this, but here's my own opinion . . .

The TMS effects were indeed temporary, but while they were there, my brain liked what it saw. That caused my brain to initiate a process of rewiring that continues to this day, in pursuit of what my brain now knows is possible.

I believe the TMS precipitated powerful self-change.

If I were to hazard a guess, a TMS stimulation of, say, the nerves that move the thumb . . . that will not trigger a similar process of change because it does not show the brain something new and exciting.

But no one really knows . . .

Response to Michelle Dyson and John

Thank you, John for responding on my behalf. Sometimes I get so busy with research it is hard for me to keep up with the blog. TMS is a tool that we (as researchers) can use to create activity in the brain. It has two main usages in the area of Neuroscience. The first is to explore on an experimental basis how the brain works and what happens when a certain area of the brain is active. This can tell us a huge amount more than simple imaging like EEG and fMRI because it allows us to control what area of the brain is active rather than depend on response to a task. The other purpose is to change the functioning of the brain through the processes of neuroplasticity. We know that if a certain region is activating over and over (either naturally, or because we stimulate it repetitively) it's functioning can change long term. So, there is some therapeutic benefit of TMS for certain conditions under certain protocols, but there are not any (to my knowledge) approved TMS treatments for ASD. We are currently developing protocols and testing them out with hopes of getting to the clinical trial stage soon, but there are a lot of phases of testing that has to be done first.

TMS and Aspergers

I tend to agree with you John about the brain rewiring itself because it liked what it saw. I would go even further and say that perhaps your brain Remembers what it saw and that replaying it actually helps your brain rewire itself. It's all so interesting. There is a vast difference in your videos of before and after TMS therapy. Many things may be playing into this difference beyond the TMS therapy, but it seems unlikely to me that certain changes I observed from your after video could have happened by just observing other people or talking more or whatever. After all, you have been talking and observing people all your life like the rest of us. I do hope TMS moves forward in a positive manner and becomes available for more folks across the nation, even if it is just in clinical trials. Well worth the try!

TMS for ADHD?

Hi Lindsay,

I have been following the work of your lab and other TMS research centers with great interest.

My 15 year old daughter, originally considered "possible PDD" was eventually diagnosed with ADHD and processing issues. She's a lovely "high functioning" teen, who's still plagued by many of her deficits in part because she does not tolerate medications very well.

We have been hoping to see news of TMS work in ADHD.

Can you shed any light?

Thanks!

TMS for ADHD

Thank you for your interest in TMS. I am not aware of any studies using TMS as a therapeutic intervention for ADHD. But I will ask my clinical colleagues and see if they know of any.

TMS for ADHD?

Thanks -- I look forward to any news, particularly any TMS work in adhd being done in the NYC area!

Re: TMS for ADHD

I did ask a colleague of mine and he also said he was not aware of any clinical trials for TMS for ADHD, but keep your eye out. I wouldn't be surprised if they begin soon.

Lack of ethical consideration

Well perhaps you would like to indulge in a session of percussive cognitive defrag then? that would certainly alter those phrenologists bumps!

Where did you leave your ethics precisely?

I am sorry you feel this way.

I am sorry you feel this way. I can assure you that all participants are fulling informed of the risks and side effects of TMS and volunteer to be participants. It is your right not to participate, however, I can assure you that all ethical considerations are addressed in this study.

I've just realised that I

I've just realised that I probably have Aspergers (first I realised a male relative had it, and then found out I match the female description of ASD). But, I also have Chronic Fatigue Syndrome - would the presence of another illness make you reluctant to use TMS on someone like me? (I realise this is hard to answer as CFS is apparently several different illnesses all given the same label according to Nancy Klimas. She is talking about CD26 as a biomarker for CFS)

Could TMS also work on dyslexia? I do not have dyslexia, but from what I know of it, it sounds a bit similar to Aspergers, i.e. a problem with processing information automatically, and instead you have to work it all out piece by piece.

The addition of a condition

The addition of a condition such as Chronic Fatigue would probably not disqualify you for TMS. Theotretically TMS may be useful for dyslexia, though this is not my area of expertise. But you are correct that if we can rewire the brains using rTMS, this may be beneficial for any number of disorders.

Using a machine to turn on

Using a machine to turn on the social circuits of someone with Aspergers seems a low priority compared to the possibility of using a machine to turn on the conscience circuits of a psychopath. I'm not saying I wouldn't like the Asperger treatment to be available, of course I would, but curing psychopaths seems a lot more important. Of course you'd need a permanent cure, not just turning it on for a few minutes at a time and then having it fade away.

It raises some interesting religious questions. I daresay science fiction has dealt with this already.

Response to "Using a machine to turn on"

There are current studies ongoing in our lab to evaluate TMS in individuals with Schizophrenia. It is very interesting to look at Schizophrenia and Autism Spectrum Disorders as in many respects they are very similar, but in others, they are quite opposite. I would also suggest that though many higher functioning individuals with Asperger's might not "need" treatment as urgently as someone with severe psychopathy, that disorders on the Autism Spectrum involve disabilities that can hinder someone's functioning and happiness as much as someone with psychopathy.

I would like to know more

I would like to know more about the similarities between schizophrenia and ASD, all I really know about schizophrenia is that a normal person knows what is inside his head, and what is outside his head. But a schizophrenic has this filter missing. Things that originate inside his head appear to be coming from outside his head. So to me this sounds similar to when the experts say an Aspie has no theory of mind because they think that others know what they know, i.e. trouble knowing what's only inside your own head. But that's the only thing I know (or think I know!) about schizophrenia. I know this blog is about ASD, but if you have another blog or something where you discuss both conditions and the similarities and differences, I'd be interested to see it.

I agree with what you say about ASD and disbilities hindering functioning and happiness, but I think psychopaths are quite happy being psychopaths, they seem to enjoy it.

similarities between ASD and schizophenia

When I talk about similarities, I am largely talking about the negative symptoms of both. So, when we think about ASD we often think about what they lack (negative symptoms) (deficits in language and social skills) and when we think about schizophrenia we largely think about positive symptoms (things they have that they shouldn't) (e.g. halucinations), but if you compare negative to negative and positive to positive you often find that both groups have restricted interests and obsessional thoughts and behaviors, both have high comorbidities with anxiety and depression. And both have deficits in theory of mind and disordered language. So, despite being different on several levels, there are a number of similarities.

Oh thank you. I know there is

Oh thank you. I know there is an article saying that they are on a spectrum written by Christopher Badcock, but I found it very hard to understand, I will look again.

The other difference that strikes me is that the stereotype of autism is that you get it when you are 3, and the stereotype of schizophrenia is that you get it when you are 20. If we had vaccines at 20, maybe schizophrenia would be attributed to them too.

Sorry to post again, I don't

Sorry to post again, I don't require a reply, just to get these thoughts out.

What you said about similarities makes more sense to me than the two being at opposites ends of a spectrum. I feel there is a fuzzy common boundary between autism and schizophrenia. I feel that I am basically an Aspie living in the Aspie house, but occasionally I go across the boundary to visit next door to my schizophrenic neighbours house for a while. (I also commented on two posts about Black Aspies on John Elder Robison's blog on this site. Now I'm wondering about mixed race people.)

TMS Risk

As it induces an electrical current in the human brain, TMS and rTMS can produce a seizure. The risk is very low with TMS except in patients with epilepsy and patients on medications. The risk is significantly higher, but still very low, in rTMS especially when given at rates >5Hz at high intensity.
The only other effects of TMS which are reported in most subjects are:

* Discomfort or pain from the stimulation of the scalp and associated nerves and muscles on the overlying skin
* Hearing the loud click made by the TMS pulse

The long-term effects of TMS remain unknown, although no effects on cognitive capacities (such as memory) have been reported yet.

This is all correct, however

This is all correct, however I would like to add that rTMS treatments have been approved by the FDA for Depression and there is enough evidence for benefit for Chronic Pain to merit treatment with TMS for Chronic Pain. There are also several clinical trials for other disorders including stroke rehabilitation and we hope to begin exploring the use of TMS for treatment of ASD as well. I would venture to guess that TMS will offer treatment options for several disorders that previously have been resistant to drug or other types of treatments.

The exact details of how TMS

The exact details of how TMS functions are still being explored. The effects of TMS can be divided into two types depending on the mode of stimulation:

* Single or paired pulse TMS. The pulse(s) causes a population of neurons in the neocortex to depolarise and discharge an action potential. If used in the primary motor cortex, it produces a motor-evoked potential (MEP) which can be recorded on electromyography (EMG). If used on the occipital cortex, 'phosphenes' (flashes of light) might be detected by the subject. In most other areas of the cortex, the participant does not consciously experience any effect, but his or her behaviour may be slightly altered (e.g. slower reaction time on a cognitive task), or changes in brain activity may be detected using Positron Emission Tomography or fMRI. These effects do not outlast the period of stimulation. A review of TMS can be found in the Handbook of Transcranial Magnetic Stimulation.

* Repetitive TMS (rTMS) produces effects which last longer than the period of stimulation. rTMS can increase or decrease the excitability of corticospinal or corticocortical pathways depending on the intensity of stimulation, coil orientation and frequency of stimulation. The mechanism of these effects is not clear although it is widely believed to reflect changes in synaptic efficacy akin to long-term potentiation (LTP) and long-term depression (LTD). A recent review of rTMS can be found in Fitzgerald et al, 2006

As such, it is important to distinguish TMS from repetitive TMS (rTMS) as they are used in different ways for different purposes.

ASD and rTMS

Hi
I am a psychiatrist at UofL in KY. just want to know the success rate and response of using rTMS with Asperger's d/o. Your feedback is highly appreciated.

Reply to ASD and rTMS

There are no clinical trials to my knowledge exploring TMS as a therapeutic intervention in Asperger's Syndrome. All our research is currently experimental.

Thank you for your interest.

ASD with depression

Hi,

I would like to know if there have been any depressed patients that were successfully treated with TMS who also had ASD? If so, was any effect seen on their ASD as well? Would having ASD be any reason not to try TMS for recalcitrant depression?

Thanks for this blog and for any information you might have on this combination.

Marjie

ASD with depression

Hi,

I would like to know if there have been any depressed patients that were successfully treated with TMS who also had ASD? If so, was any effect seen on their ASD as well? Would having ASD be any reason not to try TMS for recalcitrant depression?

Thanks for this blog and for any information you might have on this combination.

Marjie

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Lindsay M. Oberman, Ph.D. is a cognitive neuroscientist studying autism spectrum disorders.

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