My Experience from a Repetitive-Transcranial Magnetic Stimulation (rTMS) Trial for ASD (Part 1/2)

NOTE: My blog post/s regarding my experiences with Transcranial Magnetic Stimulation (TMS) is/are way overdue, so my apologies to fellow ASD comrades (non-Communism related) and other blog readers for not posting such TMS experiences in November or December 2010. I’ve been busy with work and also procrastinating with other activities during the time since then.

I have just completed my Orientation week at my Clinical School which was very busy and stressful but will write about that in a post after the TMS ones.

(I was doing some Medical Literature search for further details about the Neuroanatomy involved in this trial. I may have made a few errors in the descriptions, so this post may be corrected in the future.)

Last year, I was 1 of 20 people to take part in a Transcranial Magnetic Stimulation trial that was conducted at the Alfred Psychiatry Research Centre that also has connections with Monash University (both located in Melbourne, Australia).

The full project title is called “The use of rTMS to Improve Theory of Mind Among Adults with Autism and Asperger’s Disorder”. I personally would’ve preferred the term “Asperger Syndrome” over “Asperger’s Disorder”, but that was how they named the condition in the title. The principle investigator was Professor Paul Fitzegerald (whom I never met in person), but the major investigators who conducted the trial that I had frequent contact with were Dr. Peter Enticott, Ms. Peachey and Ms. Rhook.

Very brief synopses of this study and others conducted by the same people can be read at www.med.monash.edu.au/spppm/research/devpsych/neuro-tms.html

www.clrsasd.org.au/documents/MAPrcASDResearchUpdateJan2011.pdf

The project aimed to see if stimulation of a certain part of the brain via rTMS (repetitive TMS) would increase the intuitive social awareness, and hence Theory of Mind in individuals on the Autism Spectrum that were verbal (especially HFA/AS people). I dunno the results for the other individuals, so I can’t say if the rTMS trial was overall successful, but I’ll be talking about my own anecdotes/results later on.

TMS is a relatively recent (primitive TMS started in the 1980’s), non-invasive technique to induce weak electrical currents in a conductor (in this case a specific area of the brain). The weak electrical currents in the neurons are created from a rapidly changing magnetic field that is a result of insulated electrical coils that are arranged in a specific style (usually coils), placed near the "conductor" and rapidly change direction in current. The rTMS involves multiple pulses in one go (in my case 50 pulses/10 seconds, ie 5 Hz), as opposed to "normal" TMS which is just single or double pulse per go. rTMS involves far more pulses, and therefore is supposed to create a longer lasting effect.

Unlike Electroconvulsive Therapy, TMS is much more selective by activating a far smaller part of the brain and has a very low chance of triggering seizures in those who don’t have a history of Epilepsy, and is far less likely to trigger memory loss.

The brain area that was targeted in this trial was supposed to be the Anterior Cingulate Cortex (even though the Participation Information states “Medial Prefrontal Cortex” which is located very close to it, I’ll have to ask Dr. Enticott for clarification). The Anterior Cingulate Cortex is located in Brodmann’s Areas 24 and 25 IIRC, and from various studies is partially involved in “empathy”, emotional processing/regulation and Executive Functions.

I chose to take part in this trial because the only other place I was aware of that was also performing rTMS trials for ASD individuals at the time was at the Beth Israel Deaconess Medical Hospital (BIDMC) in Boston, Massachusetts, so this was the perfect opportunity to take part in a potentially life-changing experience. I refuse to be completely “cured” of my Asperger Syndrome as I have numerous positive traits from it (innate drive for honesty and integrity, lack of materialism, non-judgmental towards those with non-harmful differences, strong eye for detail, hyperfocus).

I was very sure that this wouldn’t be a complete cure because I read about the accounts of John Elder Robison (famous person with Asperger Syndrome, author of autobiography titled “Look Me in the Eye”) and his friend who took part in the rTMS trials at BIDMC and reported improved intuitive ability to read facial expressions, eye contact, production of “auto-appropriate” facial expressions in response to others, and slightly improved Executive Functioning, but still retained other ASD traits like having narrower interests, stimming, seeing detail, being non-judgmental, honesty, and still having to learn most other social skills at an intellectual level and not automatically.

I felt that rTMS may offer a potential reduction in some undesired traits that make it harder for me to function in my daily living (such as intuitive difficulty reading facial expressions and body language of Neurotypicals and dislike of eye contact although I could manage it) while preserving my other positive Aspie traits that I value (as mentioned above). I thought that taking part in the rTMS trial would mean that I’d be betraying my “pure” ASD-self and the ASD Community (especially those that are vehemently “Anti-Cure” and “Pro-Neurodiversity”), but it is indeed true that for many Higher Functioning adults on the Autism Spectrum, their condition is a mixture of both beneficial and disabling traits, and that to reduce the severity of the disabling traits while maintaining the beneficial ones *WITH THEIR CONSENT*wouldn’t be immoral or unethical imo. I do acknowledge that some of the disabling traits are more a result of ASD individuals being the minority group in society, but unfortunately we will always be a neurological minority group in the world and will have to conform to a degree : (

I also acknowledge that my strong attention to detail and my hyperfocus ability is actually an indirect result of my partial Executive Dysfunction (having “normal” Executive Functioning results in “higher levels” of information processing, such as seeing the big picture and being able to rapidly switch between tasks, both which I have difficulty with), but I didn’t think that the rTMS would significantly increase my Executive Function to the extent that I wouldn’t be able to strongly see detail anymore.