mental stimulationExcitement abounds about the potentials of research in neuroplasticity and Trancranial Magnetic Stimulation in particular (TMS) for the treatment of autistic spectrum disorders. John Elder Robinson, the famous author of “Look Me In The Eye” has written “Switched On,” a book about his life changing experience with TMS. Should people be seeking out TMS now?

First, what is neuroplasticity? Neuroplasticity was described in 2004 as the ability of the brain to have anatomical and not just functional change in response to environmental demands. People used to think that the brain stopped developing after the first years of life. Now, scientists feel that the brain is able to make new connections and actually demonstrate structural change throughout life.

For example, the brains of novice meditators showed structural change with just 8 weeks of meditation. This significantly increased stress resiliency. While meditation isn’t a “stand alone” treatment for major illness, the impact on anxiety (often a problem with AS) can be meaningful.

TMS devices all consist of the same components: a control mechanism that allows for rapid discharge, and a conductive foil through which currents travel to generate a powerful and fluctuating magnetic field. Studies vary in where current is applied, how much brain tissue is stimulated, the dosage of current and the number of doses given.

In 2010 John Elder Robinson described his experience with TMS in his blog, which was followed later by his book. At first, he doubted that the changes he was experiencing were real, but he saw other research participants also having similar effects. He describes these changes as allowing him to “roll the boulder of autistic social disability” out of his path. He describes a world that is “brighter, more colorful, more alive” than what he knew, and that he felt “fully engaged.” He went from feeling like a social outcast to feeling he could talk to anyone.

Not all the results of his change were what he expected; he described it as turning his life upside down. Emotions flooded him. In a NY Times column in 2016, Robison wrote of how he lost customers and ended his marriage when he fully experienced his wife’s longstanding depression. He had imagined reading emotional cues would make him feel closer to others; instead, the feelings were overwhelming as he found people to be scared, greedy, nervous… an entire range of emotion.

A Newsweek magazine article by Lydia Denworth  in September 2015 explored the experiences of Robinson and others. The results have been mixed: some with autism seem to benefit and some don’t.

Wil began TMS for his low functioning autism when he was 8 years old. After 18 weekly treatments, his autism symptoms improved significantly. He’s been better able to control his behavior at school and has more interest in others. With periodic boosters in the 4 years since, at 12 Wil just finished sixth grade in a mainstream school with a full-time aide.

17 year old Nick was diagnosed with autism at age 14. After twice weekly treatment for 10 weeks with TMS, Nick reported “It’s like there’s more of me here now.”  His father was so enthusiastic, he created the Clearly Present Foundation to support further research. Yet after 4 months, Nick’s improvements faded, and he was back to where he started.

In Newsweek and other articles, researchers warn that the use of TMS as a clinical tool has not been adequately investigated. Studies are small and the evidence for the effectiveness of TMS is still very limited.

Peter Enticott, a neuroscientist in Australia quoted in the Newsweek article, emphasizes that TMS should only be used in research studies, and “we’re nowhere near being able to say that TMS is going to be an effective treatment for autism.”

Lindsay Oberman, the director of the Neuroplasticity and Autism Spectrum Disorder Program at Brown University’s Bradley Hospital, has studied how TMS changes neuronal connections. She cautions that despite its promise, TMS should not be used as a treatment for autism outside a research setting. “It’s worrisome.” she says in the Newsweek article. “You could make somebody worse if you don’t know what you’re doing.”

However, many families feel desperate for help. When people feel urgent need, there is money, and where there is money, the market responds. Hundreds of for-profit clinics have already begun treating people with autism. Enticott comments, “People are paying tens of thousands of dollars for this completely unvalidated treatment. It’s obscene.”

At this point, TMS for autism is exciting and extremely promising… but not ready for prime time.

Anyone interested in ongoing research using TMS for autism at Oberman’s program at Bradley Hospital can contact Anacecilia Panameno, at [email protected] or (401) 432-1073. For studies at Harvard’s Beth Israel Deaconess Berenson Allen Center, contact [email protected] or 617-667-0203. In the Autism Speaks blog, Oberman cites 3 ongoing trial treatment studies in Canada, France and Israel.

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