Treatment of Adults with Autism and Major Depressive Disorder Using Transcranial Magnetic Stimulation: An Open Label Pilot Study.
Treatment of Adults with Autism and Major Depressive Disorder Using Transcranial Magnetic Stimulation: An Open Label Pilot Study.
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DOI：
10.1002/aur.2266
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发表时间：
2020-03
期刊：
影响因子：
4.7
通讯作者：
George, Mark S.
中科院分区：
文献类型：
--
作者：
Gwynette, McLeod Frampton;Lowe, Danielle W.;Henneberry, Erin A.;Sahlem, Gregory L.;Wiley, Melanie Gail;Alsarraf, Hussam;Russo, Sarah Brice;Joseph, Jane E.;Summers, Philipp M.;Lohnes, Laura;George, Mark S.
关键词：
自闭症谱系障碍（ASD）患者合并重度抑郁症（MDD）的风险很高，这可能严重损害功能和生活质量。重复经颅磁刺激（rTMS）是一种非侵入性脑刺激技术，经FDA批准用于治疗MDD。尽管在抑郁症的治疗中证明了有效性，但在ASD和共病MDD患者中使用rTMS的数据有限。我们假设MDD的标准rTMS方案将减少ASD和MDD成人的抑郁症状。其次，我们研究了这种治疗是否也会减少核心ASD症状。18-65岁的ASD和MDD参与者在上个月没有任何药物变化，有资格参加这项开放标签试验。参与者接受了25次rTMS（8字形线圈，100- 120%rMT，10 Hz，每次3000个脉冲），应用于左背外侧前额叶皮层（L-DLPFC）。十三名参与者参加了该研究，其中两名因耐受性而退出，一名被排除在分析之外。总体而言，副作用轻微，rTMS耐受性良好。汉密尔顿抑郁量表（HAM-D17）改善13.5分（IQR 5-15），40%的参与者在rTMS治疗后获得缓解（HAM-D17 ≤7）。自闭症核心症状的临床量表也表明rTMS的改善，尽管参与者自己没有观察到变化。因此，这项开放标签试验表明，患有自闭症和MDD的成年人对高频rTMS耐受良好，抑郁症状得到改善，并可能对核心自闭症症状产生影响。本研究评估了重复经颅磁刺激（rTMS）对重度抑郁症和自闭症谱系障碍（ASD）患者抑郁和自闭症症状的安全性和影响。参与者对rTMS的耐受性很好，抑郁症随着治疗而改善，家庭成员对自闭症症状的评估也有所改善。这项研究支持需要进一步的工作来评估自闭症和抑郁症患者的rTMS。
Patients with Autism Spectrum Disorder (ASD) are at high risk for co-morbid major depressive disorder (MDD), which can severely impair functioning and quality of life. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation technique that is FDA-approved for treatment of MDD. Despite demonstrated efficacy in the treatment of depression, there is limited data for the use of rTMS in patients with ASD and co-morbid MDD. We hypothesized a standard rTMS protocol for MDD would reduce depressive symptoms for adults with ASD and MDD. Secondarily, we investigated whether this treatment would also reduce core ASD symptoms. Participants 18-65 years old with ASD and MDD without any medication changes in the last month were eligible for this open label trial. Participants underwent 25 sessions of rTMS (figure-of-eight coil, 100-120% rMT,10 Hz, 3000 pulses per session) applied to the left dorsolateral prefrontal cortex (L-DLPFC). Thirteen participants enrolled in the study, with two withdrawing due to tolerability, and one excluded from analysis. Overall, side effects were mild and rTMS was well tolerated. The Hamilton rating scale for depression (HAM-D17) improved 13.5 points (IQR 5-15), and 40% of participants achieved remission (HAM-D17 ≤7) after rTMS treatment. Informant clinical scales of core symptoms of autism also suggested improvement with rTMS, though no change was observed by the participants themselves. Thus, this open label trial suggests high-frequency rTMS is well-tolerated by adults with autism and MDD, with improvement in depressive symptoms and possible effects on core autism symptoms. This study evaluated the safety and effects of repetitive transcranial magnetic stimulation (rTMS) on depression and autism symptoms in individuals with both Major Depressive Disorder and Autism Spectrum Disorder (ASD). rTMS was well tolerated by the participants, depression improved with treatment, and family members’ assessment of autism symptoms improved as well. This study supports the need for further work to evaluate rTMS in individuals who have both autism and depression.
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