title: A double-blind, randomized trial of deep repetitive transcranial magnetic stimulation (rTMS) for autism spectrum disorder.
abstract: BACKGROUND
  Biomedical treatment options for autism spectrum disorder (ASD) are extremely limited. Repetitive transcranial magnetic stimulation (rTMS) is a safe and efficacious technique when targeting specific areas of cortical dysfunction in major depressive disorder, and a similar approach could yield therapeutic benefits in ASD, if applied to relevant cortical regions.
  
  
  OBJECTIVE
  The aim of this study was to examine whether deep rTMS to bilateral dorsomedial prefrontal cortex improves social relating in ASD.
  
  
  METHODS
  28 adults diagnosed with either autistic disorder (high-functioning) or Asperger's disorder completed a prospective, double-blind, randomized, placebo-controlled design with 2 weeks of daily weekday treatment. This involved deep rTMS to bilateral dorsomedial prefrontal cortex (5 Hz, 10-s train duration, 20-s inter-train interval) for 15 min (1500 pulses per session) using a HAUT-Coil. The sham rTMS coil was encased in the same helmet of the active deep rTMS coil, but no effective field was delivered into the brain. Assessments were conducted before, after, and one month following treatment.
  
  
  RESULTS
  Participants in the active condition showed a near significant reduction in self-reported social relating symptoms from pre-treatment to one month follow-up, and a significant reduction in social relating symptoms (relative to sham participants) for both post-treatment assessments. Those in the active condition also showed a reduction in self-oriented anxiety during difficult and emotional social situations from pre-treatment to one month follow-up. There were no changes for those in the sham condition.
  
  
  CONCLUSIONS
  Deep rTMS to bilateral dorsomedial prefrontal cortex yielded a reduction in social relating impairment and socially-related anxiety. Further research in this area should employ extended rTMS protocols that approximate those used in depression in an attempt to replicate and amplify the clinical response.
authors.affiliation: Monash Alfred Psychiatry Research Centre, The Alfred and Central Clinical School, Monash University, Level 4, 607 St Kilda Road, Melbourne, Victoria 3004, Australia. Electronic address: peter.enticott@deakin.edu.au.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Enticott
authors.affiliation: Monash Alfred Psychiatry Research Centre, The Alfred and Central Clinical School, Monash University, Level 4, 607 St Kilda Road, Melbourne, Victoria 3004, Australia.
authors.forename: Bernadette M
authors.initials: BM
authors.lastname: Fitzgibbon
authors.affiliation: Monash Alfred Psychiatry Research Centre, The Alfred and Central Clinical School, Monash University, Level 4, 607 St Kilda Road, Melbourne, Victoria 3004, Australia.
authors.forename: Hayley A
authors.initials: HA
authors.lastname: Kennedy
authors.affiliation: Monash Alfred Psychiatry Research Centre, The Alfred and Central Clinical School, Monash University, Level 4, 607 St Kilda Road, Melbourne, Victoria 3004, Australia.
authors.forename: Sara L
authors.initials: SL
authors.lastname: Arnold
authors.affiliation: Monash Alfred Psychiatry Research Centre, The Alfred and Central Clinical School, Monash University, Level 4, 607 St Kilda Road, Melbourne, Victoria 3004, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Elliot
authors.affiliation: Monash Alfred Psychiatry Research Centre, The Alfred and Central Clinical School, Monash University, Level 4, 607 St Kilda Road, Melbourne, Victoria 3004, Australia.
authors.forename: Amy
authors.initials: A
authors.lastname: Peachey
authors.affiliation: Ben Gurion University, Beer-Sheva, Israel.
authors.forename: Abraham
authors.initials: A
authors.lastname: Zangen
authors.affiliation: Monash Alfred Psychiatry Research Centre, The Alfred and Central Clinical School, Monash University, Level 4, 607 St Kilda Road, Melbourne, Victoria 3004, Australia.
authors.forename: Paul B
authors.initials: PB
authors.lastname: Fitzgerald
mesh_terms: D000293:Adolescent; D000328:Adult; D020817:Asperger Syndrome / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D001321:Autistic Disorder / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017397:Prefrontal Cortex / Q000503:physiopathology*; D011446:Prospective Studies; D012917:Social Adjustment; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Autism spectrum disorder; Deep rTMS; Medial prefrontal cortex; Mentalizing; Social relating