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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5250_Библиотеки_им_академика_М_И_Перельмана.pdf
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S.-B. Wang et al.
However, it is recommended that the dose for children and adolescents be lower,
ranging from 0.5 to 1mA. The stimulation time typically lasts between 10 and
40min, often set at 20min, and the stimulation frequency is between 5 and 20 sessions per day, which has been shown to yield the best therapeutic outcomes.
9.3.1.4 Clinical Recommendations
A large number of randomized controlled trials and systematic reviews have conrmed the efcacy of stimulation targeting the left DLPFC, but other stimulation
targets, such as the rTPJ, are still in the stage of case study or pilot study. Additionally,
it is recommended that randomized controlled trials (RCTs) involving tDCS in children and adolescents systematically evaluate side effects, as they may be more sensitive and potentially unblind the treatment more easily.
9.3.2 HD-tDCS
9.3.2.1 Efficacy
Compared to conventional tDCS, HD-tDCS devices enable more specic stimulation of the targeted cortical region. However, research on their efcacy for autism is
limited. Only two studies have reported that stimulation of the right temporoparietal
junction (rTPJ) improved autism-spectrum quotient (AQ) scores and emotional face
processing in individuals with high autistic traits [64, 65], and a pilot study found
signicant effects when stimulating the ventrolateral prefrontal cortex (VLPFC) [66].
9.3.2.2 Safety
Only a few recent studies have reported short-term adverse effects, the most common being itching and scalp pain.
9.3.2.3 Treatment Regimen
The most common target for stimulation is the rTPJ, with the stimulation current and
duration typically set at 2mA and 20min, respectively. The stimulation frequency is
usually once per day, and the number of sessions typically ranges from 5 to 20.
9.3.2.4 Clinical Recommendations
RCTs that investigate the treatment efcacy of HD-tDCS for autism are scarce, with
most studies concentrating on individuals with high autistic traits. The clinical recommendation level for tDCS was unclear (Table9.2).
Table 9.2 tDCS in ASD
Clinical recommendations
tDCS
Conventional
tDCS
HD-tDCS unclear unclear unclear unclear unclear unclear
Anode
position
unclear unclear unclear unclear unclear unclear
Cathode
position
Intensity
(mA) Length (min)
Duration
(sessions)
Levels
+References
9 Autism Spectrum Disorder
255
9.4 TMS Vs. tDCS
9.4.1 Efficacy
9.4.1.1 Cognitive Effects
TMS may enhance cognitive function by affecting the activity or connectivity of
neural networks. For instance, it can stimulate the release of dopamine and boost the
functional neuroanatomical connections between the DLPFC and subcortical structures, such as the anterior cingulate cortex and the striatum [67]. Additionally, TMS
has been shown to improve neural efciency in cognitive processing speed and
cortical plasticity, potentially accelerating cognitive processes [67].
According to a systematic review and meta-analysis, stimulation of the DLPFC
through tDCS can yield partial cognitive benets in various disorders, including
depression and schizophrenia. These benets manifest as improvements in attention/vigilance, working memory, executive function, processing speed, verbal uency, verbal learning, and social cognition [68]. Another study indicated that tDCS
alone did not exhibit superior cognitive enhancement effects compared to the sham
stimulation group. Nonetheless, this suggests that tDCS has the potential to improve
cognition, but it requires more focused targeting of specic areas [67].
The mechanism of tDCS for cognitive facilitation is similar to that of TMS,
affecting the target regions and the connected neural networks. For instance, it has
been reported that the application of tDCS to the DLPFC can increase the release of
striatal dopamine.
A meta-analysis revealed that both TMS (effect size [ES]=0.17, p=0.015) and
tDCS (ES= 0.17, p = 0.021) exhibited small yet signicant effects on working
memory. Additionally, tDCS outperformed sham stimulation in attention/vigilance
(ES=0.20, p=0.020) [67]. Another study indicated that both tDCS and TMS can
yield cognitive benets, and the combination of these two interventions appears to
create a synergistic effect [68]. When tDCS is utilized as a prestimulation followed
by repetitive transcranial magnetic stimulation (rTMS), it can induce more enduring
changes in cortical excitability and plasticity.
Thus, both TMS and tDCS can enhance cognitive function in patients with ASD
to some degree, particularly in areas such as working memory and attention/vigilance. tDCS appears to have a more pronounced effect on improving attention/vigilance, whereas TMS might enhance cognitive function by affecting the activity and
connectivity of neural networks. The concurrent application of these two techniques
could potentially yield a synergistic effect, but further research is required to ascertain their respective benets and the most effective ways to apply them in
treating ASD.
9.4.1.2 Emotional andBehavioral Effects
Studies have demonstrated that TMS can inuence emotional recognition in patients
with ASD.For instance, research has found that the accuracy of emotional recognition in ASD patients who received TMS treatment was improved. Specically, when
TMS was applied to the right posterior superior temporal sulcus (rpSTS), it enhanced
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S.-B. Wang et al.
the emotional perception of ASD patients by regulating the relevant neural networks
[69]. TMS has also been proposed as a treatment for the depressive aspects of ASD
and is considered a well-tolerated treatment modality. In a study, 25 sessions of
rTMS were administered to 10 individuals with a moderate burden of depressive
and autistic symptoms. The results indicated an improvement in the depressive
symptoms of ASD and suggested a potential impact on the behavioral aspects of the
disorder [70].
tDCS has been utilized to enhance the behavioral and functional outcomes of
individuals with ASD.In a particular study, 26 children diagnosed with ASD underwent tDCS treatment. The evaluation was conducted using the autism behavior
checklist (ABC) scores, and the results indicated signicant improvements in the
ABC scores of the experimental group following tDCS treatment [69]. tDCS contributes to emotional regulation and behavioral aspects in patients with ASD by
modulating activity in the DLPFC.Another study revealed that the severity of autistic symptoms, theory of mind, emotional regulation strategies, and emotion- behavior
functions were enhanced in ASD patients who received tDCS treatment [71].
Both TMS and tDCS have demonstrated potential for improving the emotional
and behavioral symptoms of patients with ASD.TMS, in particular, has shown efcacy in enhancing emotional recognition and alleviating depressive symptoms,
whereas tDCS has demonstrated benets in improving behavioral and functional
outcomes [72].
9.4.1.3 Biological Effects
TMS has the capability to inuence the neuroplasticity of patients with ASD by
altering synaptic strength, akin to the long-term potentiation (LTP) effect [73]. TMS
can modulate cortical excitability. For instance, studies conducted by Oberman
etal. revealed that following iTBS, the corticospinal excitability in the ASD group
was enhanced more persistently. Conversely, after cTBS, the inhibition was more
persistent, indicating that individuals with ASD may exhibit enhanced plasticity [1].
Research by Sokhadze etal. showed that after TMS treatment, the prefrontal P3a
amplitude in ASD patients decreased, and repetitive behaviors were reduced [74].
tDCS signicantly inuences the regulation of brain activity and cortical functional connectivity in children with ASD.Studies have indicated that tDCS, when
compared to sham stimulation, can decrease resting-state functional connectivity
[74]. Furthermore, tDCS has the potential to enhance functional connectivity within
the Default Mode Network (DMN), which is vital for processing self-related and
other-related information, retrieving episodic and autobiographical memories, and
understanding the mental states of others. It may also improve the responsiveness of
individuals with ASD to sensory inputs, thereby enhancing their multisensory integration and social abilities. Additionally, tDCS can increase the functional connectivity of key regions within the Dorsal Attention Network (DAN), potentially
improving attention control and top-down goal-directed processing in individuals
with ASD [74].
Both TMS and tDCS can inuence the neuroplasticity and cortical excitability of
patients with ASD to some extent, but their mechanisms of action and stimulation
9 Autism Spectrum Disorder
257
targets differ. TMS affects neural activity through magnetic elds, whereas tDCS
inuences neural excitability via weak direct current. Notably, tDCS exhibits effects
in regulating the functional connectivity of the DMN, Sensorimotor Network
(SMN), and DAN, which are associated with the core symptoms of
ASD.Consequently, both TMS and tDCS have the potential to improve the biological effects in patients with ASD to some degree. However, their distinct mechanisms
of action and stimulation targets result in varying effects on different biological
aspects of ASD.Further research is required to ascertain the optimal stimulation
parameters and methods, as well as their comparative advantages in the treatment of ASD.
9.4.2 Safety
The side effects of TMS typically include headaches, scalp discomfort, and, in rare
cases, seizures. Research has indicated that TMS appears to be safe when used at
low frequencies in individuals with ASD and can enhance various patient-oriented
outcomes [75].
tDCS is relatively safe and well-tolerated. The side effects are typically mild,
such as a tingling sensation, itching, or a slight headache. However, it is important
to note that tDCS is largely unregulated and lacks certication. Home-use devices
operated by nonmedical professionals or services provided by nonprofessional
institutions cannot ensure the safety controls found in a clinical setting. In 19 tDCS
studies involving over 500 participants, the participants received 1 to 10 tDCS treatments, each lasting 5 to 30min at an intensity of 1 to 2mA.Thirteen of these studies
reported no adverse events (either severe or non-severe) [76]. Another review indicated that tDCS is a simple, safe, convenient, cost-effective, and well-tolerated
method that has been used for cognitive modication and the alleviation of cognitive symptoms in healthy individuals for over 20years [73].
Both TMS and tDCS are generally well-tolerated by patients with ASD.When
comparing the safety proles of TMS and tDCS, the side effects of tDCS are typically less severe than those of TMS.Nevertheless, the use of tDCS devices outside
of clinical settings, such as at home, carries potential risks due to the lack of widespread regulation and certication for these devices. In contrast, TMS is subject to
stricter safety protocols when administered in a clinical environment, whereas tDCS
may not have equivalent safeguards when used in domestic or nonprofessional contexts. Therefore, it is essential that both treatments be conducted under the supervision of qualied medical personnel to guarantee patient safety.
9.5 Conclusion
The mechanisms of autism spectrum disorder are believed to be associated with
neurodevelopment. Consequently, NIBS techniques, such as repetitive rTMS and
tDCS, have been utilized as alternative or adjunctive treatments targeting these
258
S.-B. Wang et al.
brain network mechanisms of ASD.However, it is important to note that NIBS
techniques are still used off-label for ASD.
rTMS and tDCS, as noninvasive brain stimulation techniques for the treatment of
ASD, have shown potential in treating the disorder. Currently, due to limited evidence, the widespread off-label use of these techniques in the ASD population is not
yet endorsed. Future research should focus on conducting larger randomized controlled trials, incorporating neuroimaging to develop biomarkers for predicting
treatment responses, and rening treatment parameters. Additionally, the safety,
efcacy, and optimal application methods of these techniques in the treatment of
ASD warrant further exploration.
Acknowledgments We thank Professor Yu Jin from Sun Yat-sen University and Professor
Hongbo He from the Guangdong Mental Health Center, Guangdong Provincial People’s Hospital
(Guangdong Academy of Medical Sciences), and Southern Medical University for their support in
drafting the manuscript.
Disclosure/Conicts of Interest The authors declare no conicts of interest in conducting this
study or preparing the manuscript.
Financial Support This study was funded by the National Center for Mental Health of China
which initiated the “Project on integrated development system of community prevention and rehabilitation of mental disorders and home care”, the National Natural Science Foundation of China
(30,600,207 and 81,171,293), the China Disabled Persons’ Federation Special Project Foundation
(2022CDPFHS-13), the Natural Science Foundation Program of Guangdong (2023A1515012442
and 2020A1515010942), the Science and Technology Planning Project of Guangdong
(2011B031800020), the Medical Scientic Research Foundation of Guangdong (A20242171), and
the Science and Technology Program of Guangzhou (2024A04J4576). The funders played no role
in the study design, data collection and analysis, the decision to publish, or the preparation of the
manuscript.
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S.-B. Wang et al.
Anxiety Disorder
WuyouBao, ShiqiYuan, PeiyingLi, andBinZhang
Abstract
Anxiety disorders rank as the ninth leading cause of health-related disability and are
characterized by high prevalence, chronicity, and comorbidity (Vos T, Abajobir AA,
Abate KH, The Lancet 390:1211–59, 2017). According to the Diagnostic and
Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), anxiety disorders
encompass generalized anxiety disorder, social anxiety disorder, panic disorder, specic phobias, and agoraphobia(Edition F, Am Psychiatric Assoc 21:591–643, 2013)
While some individuals benet from pharmacotherapy or psychotherapy, (Cuijpers
P, Cristea IA, Karyotaki E, et al., World Psychiatry 15(3):245–58, 2016; Slee A,
Nazareth I, Bondaronek P, etal., Lancet 393(10173):768–77, 2019) many individuals still suffer from treatment resistance and poor disease prognosis. Over the past
two decades, numerous clinical trials have been conducted to explore more effective
treatment options for anxiety disorders. Among these, transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) have emerged as
promising, safe, and noninvasive neuromodulation techniques. However, current
studies lack consensus on the optimal treatment protocols for TMS and tDCS.Further
research is essential to rene stimulation parameters and enhance the clinical efcacy
of these approaches for anxiety disorders. This chapter provides an overview of TMS
and tDCS as potential treatments for anxiety disorders.
10
W. Bao · P. Li
Tianjin Anding Hospital, Tianjin Medical University, Tianjin, China
S. Yuan
Brain Hospital of Guangzhou Medical University, Guangzhou, China
B. Zhang (*)
Tianjin Anding Hospital, Tianjin Medical University, Tianjin, China
Mental Health Center of Tianjin University, Tianjin, China
© The Author(s), under exclusive license to Springer Nature Singapore Pte
Ltd. 2025
W. Zheng, Y. Ning (eds.), TMS and tDCS for Psychiatric Disorders,
https://doi.org/10.1007/978-981-96-8504-2_10
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