BACKGROUND: The role of Transcranial Magnetic Stimulation (TMS) has been studied in neurobiological aspects of Autism Spectrum Disorders (ASD) with potential therapeutic applications in improving social skills, repetitive behaviours, and sensory sensitivities.

OBJECTIVE: To assess the impact of Theta Burst TMS (TBS) on core function deficits ASD children aged 5-15yrs in adjunction to standard therapy.

METHODS: Sixty-one children were randomized into intervention (n=31) and sham (n=30) groups. Children with syndromic ASD, uncontrolled epilepsy, TBS contraindications were excluded. Intervention arm received TBS targeting dorsolateral prefrontal cortex of non-dominant side. Outcome measures included mean difference in RBS-R (Repetitive Behaviour Scale Revised), CY-BOCS (Children's Yale-Brown Obsessive Compulsive scale), SRS2 (Social Responsiveness Scale-2), CARS-2 (Childhood Autism Rating Scale-2) and PedsQ(Paediatric Quality of life), and executive/cognitive skill assessment by time to Stroop & Wisconsin Card Sorting. In a subset, we explored quantitative EEG(qEEG) pre-and post-TBS.

RESULTS: At four weeks, intervention group showed significant difference in RBS-R (8.35 vs. 3.84), and by 12weeks (10.71 vs. 6.37) compared to sham group (p<0.001). PedsQL differences were significant (6.35 vs. 2.97 at 4weeks and 8.19 vs. 4.67 at 12weeks, p<0.001). No significant changes were noted in other tests. TBS was well tolerated. Post-TBS qEEG showed increased beta band coherence between Limbic and Frontal lobes with no change in spectral power.

CONCLUSIONS: TBS offers potential as a therapeutic tool for treatment of children with ASD, especially those with repetitive behaviours, with improved quality of life noted post TMS therapy. Role of qEEG to detect changes post TBS needs further exploration.

Sheffali Gulati
All India Institute of Medical Sciences
India

Richa Tiwari
All India Institute of Medical Sciences
India

Biswaroop Chakrabarty
All India Institute of Medical Sciences
India

Prashant Jauhari
All India Institute of Medical Sciences
India

Shivam Pandey
All India Institute of Medical Sciences
India

Ravindra Mohan Pandey
All India Institute of Medical Sciences
India

Ratna Sharma
All India Institute of Medical Sciences
India

Renu Bhatia
All India Institute of Medical Sciences
India

Vishal Sondhi
Armed Forces Medical College
India

Gautam Kamila
All India Institute of Medical Sciences
India