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TMS for Adults With Autism and Depression (TAD)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT02939560
Recruitment Status : Completed
First Posted : October 20, 2016
Results First Posted : October 1, 2019
Last Update Posted : October 1, 2019
Information provided by (Responsible Party):
Medical University of South Carolina

Brief Summary:
The goal of this proposal is to investigate whether a standard rTMS protocol for depression, including multiple sessions applied to left dorsolateral prefrontal cortex (DLPFC) results in reduction of depressive symptoms for adult patients with ASD and MDD (Aim 1). The secondary goal is to investigate and whether there is any beneficial reduction in the core symptoms of autism (Aim 2).

Condition or disease Intervention/treatment Phase
Autism Spectrum Disorder Depression Depressive Disorder Major Depressive Disorder Device: NeuroStar® TMS device (Neuronetics, Atlanta, GA) Not Applicable

Detailed Description:

Aim 1. Determine the safety and therapeutic efficacy of left-sided DLPFC high frequency rTMS on MDD symptoms in patients with ASD: The investigators hypothesize that patients receiving the rTMS will tolerate the treatment course without difficulty and have clinically significant reduction of depressive symptoms after receiving all 25 sessions, as compared with their symptom burden prior to initiating TMS. Depression symptom data will be collected as pre- and post-TMS scores on Hamilton Depression Rating Scale (HAM-D). Depression scores will also be monitored periodically during course of TMS with Patient Health Questionnaires (PHQ-9).

Exploratory sub-aim - Monitoring for durability of response: The investigators hypothesize that subjects receiving rTMS will demonstrate durability of response in their depression symptom reduction, as measured by HAM-D scores at 1 month and 3 months post-TMS.

Aim 2. Determine the effect of left DLPFC rTMS on core symptoms of ASD: The investigators hypothesize that subjects will experience reduction in core symptoms of ASD after completing all 25 sessions, as compared with their symptom burden prior to initiating treatment. For social and communication deficits, informant and/or self-report evaluations will be made pre- and post-TMS with the Social Responsiveness Scale (SRS), the Ritvo Autism Aspergers Diagnostic Scale-Revised (RAADS-R) and the Aberrant Behavior Checklist (ABC). Repetitive and restricted behavior will be evaluated using the Repetitive Behavior Scale-Revised (RBS-R), the ABC, and RAADS.

Exploratory sub-aim: Determine if there are changes to functional brain connectivity during face and object processing tasks via functional MRI imaging in patients with Autism who receive rTMS: The study investigators hypothesize that there will be altered brain connectivity evident in patients' baseline fMRI during cognitive processing tasks prior to TMS reflected as both hyper- and hypo-connectivity, and that there will be some level of normalization of these patterns in fMRI after completion of TMS series, particularly in the prefrontal cortex.

Exploratory sub-aim - Monitoring for durability of response: The study investigators hypothesize that subjects receiving rTMS will exhibit durability of response in their ASD symptom reduction, as measured by ABC, SRS, RAADS, AND RBR scores at 1 month and 3 months post-TMS.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 13 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Transcranial Magnetic Stimulation for Adults With Autism Spectrum Disorder and Depression
Study Start Date : September 2016
Actual Primary Completion Date : June 1, 2018
Actual Study Completion Date : September 20, 2018

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Experimental: rTMS
Participants will receive rTMS sessions according to the study protocol.
Device: NeuroStar® TMS device (Neuronetics, Atlanta, GA)
Participants in this study arm will be evaluated before and after receiving rTMS. Outcome measures will include social skills rating scales, depression rating scales and cognitive tasks while undergoing functional magnetic resonance imaging (fMRI).

Primary Outcome Measures :
  1. Change From Baseline in Hamilton Depression Rating Scale [ Time Frame: Baseline through Week 5 ]
    Hamilton Depression Rating Scale (HAM-D) with 17 questions. Minimum score = 0, maximum 53. Higher scores mean more severe depression.

  2. Change From Baseline in Aberrant Behavior Checklist [ Time Frame: Baseline, Week 5, Week 9, Week 17 ]
    Aberrant Behavior Checklist. Minimum 0, maximum 174. Higher scores indicate worse behaviors.

  3. Change From Baseline in Social Responsiveness Scale-2 [ Time Frame: Baseline, Week 5, Week 9, Week 17 ]
    Social Responsiveness Scale-2. Minimum 0, maximum 195. Higher indicates worse behaviors

  4. Change From Baseline in Ritvo Autism-Aspergers Diagnostic Scale [ Time Frame: Baseline, Week 5, Week 9, Week 17 ]
    Ritvo Autism-Aspergers Diagnostic Scale. Minimum 0, maximum 240. Higher indicates worse symptoms.

  5. Change From Baseline in Repetitive Behavior Scale-Revised [ Time Frame: Baseline, Week 5, Week 9, Week 17 ]
    Repetitive Behavior Scale-Revised Global Impression. Minimum 0, maximum 100. Higher indicates worse behaviors

Secondary Outcome Measures :
  1. Change From Baseline in Functional MRI Scanning During Cognitive Processing Tasks [ Time Frame: Baseline, Week 5 ]
    Functional MRI data during cognitive processing tasks

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.

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Ages Eligible for Study:   18 Years to 65 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes

Inclusion Criteria:

  • Diagnosis of Autism Spectrum Disorder and active depressive symptoms.

Exclusion Criteria:

  • List specific contraindicationsUncontrolled and/or untreated seizure disorder as defined by any incidence of seizure within the past 6 months. Patients with diagnosed epilepsy, or prior seizures, will be allowed in the study if they are taking an anticonvulsant medication, or have not had a seizure in the past year off medications.
  • Moderate to severe intellectual disability (ID) as defined by IQ < 60, determined by prior IQ testing or Wechsler Abbreviated Scale of Intelligence (WASC-II) if no prior test results available
  • Other psychiatric or neurodevelopmental illness that is the primary area of clinical focus (including but not limited to primary psychotic disorder, substance abuse disorder, and ASD or ID which are secondary to genetic syndromes)
  • Active suicidal ideation or suicide attempt in the 90 days prior to initial assessment
  • Presence of any metal implants or devices in the head or neck (e.g. metal plates or screws)
  • No participants who are pregnant or who are planning to become pregnant
  • Exclusion criteria for fMRI scanning:

    • have metal pins, plates or clips in the body or have orthodontics
    • have surgical implants such as pacemakers or cochlear implants
    • have permanent makeup or tattoos near the face or head
    • have metal fragments in the body (from welding, shrapnel, BB guns) or suspect that they have fragments
    • are claustrophobic
    • are pregnant
    • have ever suffered a closed head injury or concussion
    • are currently under the influence of alcohol or other recreational drugs
    • are a smoker
    • are currently enrolled in a course in which the PI or co-I's are instructors
    • cannot understand the task instructions
    • cannot lay still in the mock scanner for a period of 6 minutes
  • Inability or unwillingness of participant or legal guardian/representative to give informed consent
  • There will be no discrimination or exclusions based on race, gender, sexual orientation, or other socioeconomic factors. Of note, while both male and female participants will be actively and equally recruited using the same methods. The natural distribution of autism in the population skews towards significant towards male gender, with male prevalence being 4-5 times that of female prevalence. Our study will therefore likely have more male participants than female due to this trend in prevalence.
  • Children (age <18) are being excluded from this study for several reasons. While autism is a pediatric neurodevelopmental disorder with symptom onset as young as one year of age, it is also one that is chronic throughout adulthood. Both children with autism and neurotypical children undergo periods of rapid change in brain size, structure, and organization as they age, and the interaction between a full rTMS series and brains that are still involved in periods of very active development and whom may also be at different points along their own developmental timelines may skew or alter the data that is collected. Additionally, due to both brain growth and increases in skull thickness, children of different ages may have significantly different "scalp to cortex" distances, which can result in very different patterns of cortical stimulation despite uniform coil positioning. This will be an added, unnecessary variable which would compromise the attempt at performing a standardized protocol. Finally, while high frequency rTMS is an FDA approved treatment for depression in adults, it has not yet been FDA approved in children and adolescents.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT02939560

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United States, South Carolina
Medical University of South Carolina
Charleston, South Carolina, United States, 29425
Sponsors and Collaborators
Medical University of South Carolina
  Study Documents (Full-Text)

Documents provided by Medical University of South Carolina:
Additional Information:
Publications of Results:
Other Publications:
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Responsible Party: Medical University of South Carolina Identifier: NCT02939560    
Other Study ID Numbers: Pro00056546
First Posted: October 20, 2016    Key Record Dates
Results First Posted: October 1, 2019
Last Update Posted: October 1, 2019
Last Verified: September 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No
Plan Description: Individual participant data will not be shared.
Keywords provided by Medical University of South Carolina:
Autism Spectrum Disorder
Additional relevant MeSH terms:
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Depressive Disorder
Depressive Disorder, Major
Autistic Disorder
Autism Spectrum Disorder
Child Development Disorders, Pervasive
Pathologic Processes
Behavioral Symptoms
Mood Disorders
Mental Disorders
Neurodevelopmental Disorders