Key result
Low-frequency rTMS increases cardiac R-R intervals by ~39 ms from baseline in children with autism.
Why the study?
Autism spectrum disorder may present with autonomic nervous system dysfunction, and the effect of low frequency rTMS on autonomic function in children with ASD was unclear.
Does 18 sessions of weekly low-frequency rTMS improve autonomic function and behavioral symptoms in children with autism spectrum disorder?
Does 18 sessions of weekly low-frequency rTMS improve autonomic function and behavioral symptoms in children with autism spectrum disorder?
Mean Difference: 39.08 (95% CI 8.13–70.04)
Absolute Event Rate: 723.8% vs 684.7%
p-value: p=0.017
18 sessions of low-frequency rTMS may increase cardiac vagal control, reduce sympathetic arousal, and improve behavioral symptoms in children with ASD.
May suggest LF rTMS alters autonomic function in ASD children; leaves open clinical utility pending randomized trials.
The term autism spectrum disorder (ASD) describes a range of conditions characterized by impairments in social interactions, communication, and by restricted and repetitive behaviors. Autism spectrum disorder may also present with symptoms suggestive of autonomic nervous system (ANS) dysfunction. The objective of this study was to determine the effect of 18 sessions of low frequency (LF) repetitive transcranial magnetic stimulation (rTMS) on autonomic function in children with ASD by recording electrocardiogram (ECG) and electrodermal activity (EDA) pre- post- and during each rTMS session. The autonomic measures of interest in this study were R-R cardiointervals in EKG (R-R), time and frequency domain measures of heart rate variability (HRV) and skin conductance level (SCL). Heart rate variability measures such as R-R intervals, standard deviation of cardiac intervals, pNN50 (percentage of cardiointervals >50 ms different from preceding interval), power of high frequency (HF) and LF components of HRV spectrum, LF/HF ratio, were then derived from the recorded EKG. We expected that the course of 18 weekly inhibitory LF rTMS applied to the dorsolateral prefrontal cortex (DLPFC) would enhance autonomic balance by facilitating frontal inhibition of limbic activity thus resulting in decreased overall heart rate (HR), increased HRV (in a form of increased HF power), decreased LF power (resulting in decreased LF/HF ratio), and decreased SCL. Behavioral evaluations post-18 TMS showed decreased irritability, hyperactivity, stereotype behavior and compulsive behavior ratings while autonomic measures indicated a significant increase in cardiac interval variability and a decrease of tonic SCL. The results suggest that 18 sessions of LF rTMS in ASD results in increased cardiac vagal control and reduced sympathetic arousal.
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Casanova et al. (2014) studied Autism spectrum disorder (n=18). Low-frequency repetitive transcranial magnetic stimulation (rTMS) vs. Pre-TMS baseline was evaluated on R-R cardiointervals in EKG (MD 39.08, 95% CI 8.13-70.04, p=0.017). 18 weekly sessions of low-frequency rTMS significantly increased cardiac R-R intervals by a mean of 39.08 ms compared to baseline in children with autism spectrum disorder.