非侵入性脑刺激技术在自闭症谱系障碍中的运用

作者：

Lindsay M. Oberman  Sunday M. Francis  Sarah H. Lisanby

摘要：

Noninvasive brain stimulation (NIBS) techniques, including repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), have recently emerged as alternative, nonpharmacological interventions for a variety of psychiatric, neurological, and neurodevelopmental conditions. NIBS is beginning to be applied in both research and clinical settings for the treatment of core and associated symptoms of autism spectrum disorder (ASD) including social communication deficits, restricted and repetitive behaviors, irritability, hyperactivity, depression and impairments in executive functioning and sensorimotor integration. Though there is much promise for these targeted device-based interventions, in other disorders (including adult major depressive disorder (MDD) and obsessive compulsive disorder (OCD) where rTMS is FDA cleared), data on the safety and efficacy of these interventions in individuals with ASD is limited especially in younger children when neurodevelopmental interventions typically begin. Most studies are open-label, small scale, and/or focused on a restricted subgroup of individuals with ASD. There is a need for larger, randomized controlled trials that incorporate neuroimaging in order to develop predictive biomarkers of treatment response and optimize treatment parameters. We contend that until such studies are conducted, we do not have adequate estimates of the safety and efficacy of NIBS interventions in children across the spectrum. Thus, broad off-label use of these techniques in this population is not supported by currently available evidence. Here we discuss the existing data on the use of NIBS to treat symptoms related to ASD and discuss future directions for the field.

非侵入性脑刺激( NIBS )技术，包括重复经颅磁刺激( r TMS )和经颅直流电刺激( t DCS )，最近已成为多种精神、神经和神经发育状况的替代非药物干预措施。NIBS已开始应用于自闭症谱系障碍( ASD )核心及相关症状的研究和临床治疗，包括社会交往障碍、限制性和重复性行为、易激惹、多动、抑郁、执行功能和感觉运动整合障碍等。尽管这些基于设备的有针对性的干预措施很有希望，但在其他疾病中(包括成人重性抑郁障碍( MDD ))。大多数研究都是开放性的，小规模的，和/或集中在ASD患者的一个受限亚组。为了开发治疗反应的预测生物标志物和优化治疗参数，需要纳入神经成像的更大的随机对照试验。我们认为，在进行这些研究之前，我们没有足够的估计在整个范围内儿童NIBS干预的安全性和有效性。因此，这些技术在该人群中的广泛超说明书使用没有得到现有证据的支持。在此，我们讨论使用NIBS治疗ASD相关症状的现有数据，并讨论该领域的未来方向