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

In 22^nd and 29^th June 2010, I visited the Alfred Psychiatry Research Centre in preliminary sessions to fill in my personal details and provide my official diagnosis to Dr. Peter Enticott. I also filled in several questionnaires that aimed to primitively gauge my severity on the Autism Spectrum (eg the Autism Spectrum Quotient created by Simon Baron-Cohen) along with answering his questions regarding my condition, what I’m doing in life and how I cope with it etc.

After the interview, I then had to take part in a “social stories” tests (not multiple-choice) where different social scenarios were read out to me, and I had to answer questions regarding the characters’ feelings, in addition to some questions with very obvious answers as they were “controls”. I was able to answer the questions correctly IIRC, but I had to assess it intellectually and not intuitively like how most other NTs do it, I was unable to answer the questions immediately. I also had to watch several videos of these shapes moving around on a computer (laptop) screen, and I had to explain the “story” behind what the shapes were doing. I could explain some of them, based on the speed of movement and the positioning of them (eg “The big triangle is chasing after the small triangle, and the small triangle is trying to hide from the big one”), but there were others where they were just bouncing around the screen in a pattern but with insufficient substance for me to create a “social/story” description. For the pattern-bouncing ones, I just said that they were bouncing along the walls at angles which is uncorrelating to physics in real-life (hitting angle vs bouncing angle), and that I was unable to make up a story regarding them.

For a paper that involved ASD and NT individuals and the “social” comprehension of animated shapes, you can check out this paper: http://brain.oxfordjournals.org/content/125/8/1839.full

Afterwards, a demo rTMS was performed on the area of my motor cortex which controls my hand muscles. The rTMS was done to calculate the minimum (threshold) induced current required to trigger muscle twitching in my hands (more accurately my right index finger IIRC). This minimum induced current would then be used as a reference to personalize the rTMS intensity (frequency is kept the same) of my Anterior Cingulate Cortex. It felt really weird to see my right index finger twitching upon rTMS stimulation without me wanting to move it in the first place!

On 20^th July 2010, I had to undergo an fMRI prior to the rTMS treatment. The fMRI was to assess my brain activity while I performed simple cognitive tasks in the machine, to determine which side of my brain shall receive the rTMS. I was supposed to push a button when I saw a certain action in the video monitor (visible to me via various mirror positionings) such as a hand grabbing a cup, or hands waving about. I think this has something to do with the “Mirror Neuron Theory” of Autism, where there’s a disputable hypothesis that there’s an underactivation of “mirror neurons” in ASD individuals. The fMRI was VERY LOUD, even though I was wearing earplugs.

I was then allocated to the placebo or active treatment group. Either treatment group received rTMS sessions for each weekday in a 2 week period. One rTMS session was supposed to last for 30 “trains”, where one “train” lasts for 10 seconds with 50 rTMS pulses (hence the 5 Hz). There was a 20 second interval after each “train”, therefore each rTMS session was supposed to last for 900 seconds, ie 15 minutes. My rTMS intensity was first initiated at “30%” (of maximum strength), but soon increased to 46% for my remaining sessions.

My initial 2 week period was from Monday 2^nd August to Friday 13^th August 2010. In each rTMS session, I wore a blue cap on my head (same cap for all sessions), with small measuring tape measuring stuck along its mid-sagittal line. The cap was tied to my head in a tight manner and then Dr. Enticott or Ms. Peachey positioned the rTMS “helmet” above my head to target the area of my brain to be stimulated. During the rTMS “trains”, I could hear a clicking noise with each pulse, along with a tapping sensation in my head, and it wasn’t painful. The coils performing the rTMS heat up quickly, so there was an aircon continually operating within the helmet to slow down the heating. I could feel my head being cooled down a bit.

1 month after that 2 week period, I had to fill in the same questionnaires, do the same social stories test, and do the same shape animation analysis as a follow up. I gave similar answers to before, and I didn’t feel that much different in terms of cognition, although I suspected that my eye contact slightly improved, although that could be a placebo effect. It turns out that I received the placebo treatment, and was then offered the REAL “Open Label” rTMS treatment in November 2010 instead. This time, I could feel a bit more pain at the top of my head after each pulse, although I clenched my teeth and beared it.

Below is the record sheet for the REAL “Open Label” rTMS treatment (Click on image for better resolution):

I can definitely confirm that after the real “open label” rTMS treatment, my eye contact has improved dramatically, far more so than the placebo rTMS treatment; it doesn’t hurt at all to look at people in a conversation anymore, I was completely shocked. In the past, I could look at people in the eyes but always felt a piercing intrusive sensation, like they were threatening me even if I knew that they were perfectly harmless (eg old ladies). Now, I can talk at somebody and look straight at their eyes for 15 minutes straight without feeling any pain or threat at all!!! Most notable was one case, where I hated maintaining eye contact with one of my Aunts, even though she was polite and kind to me, but when I saw her several months after the treatment, I could look at her the entire time she spoke to me without flinching or cringing inside!

I find this result bizarre given that the Anterior Cingulate Cortex doesn’t seem to have much relevance to sensory processing (according to my brief literature search at least). I experienced no other improvements/changes in other areas of cognitive, sensory and emotional processing. But certainly for the eye contact, this was a significant change and I have informed Dr. Enticott about this. Having improved eye contact means that I can now spend more time comfortably looking at a Neurotypical’s face in a conversation and attempt to analyze their facial expressions while listening to their speech, even though multi-modal (of communication style) processing is still hard for me and most other ASD individuals. It has given me more motivation to study the facial expressions of these NTs, so I can try to detect subtle cues in case they try to bully me, or manipulate/stab me behind my back.

The rTMS treatment has given me drastically improved eye contact while predominantly preserving my other positive Asperger traits. My other negative Asperger traits still exist, but the removal of one undesired trait (pain in eye contact) is more than excellent for now. This will be an important tool for me to mildly improve my communication with NTs, and to help defend myself from persecution from NTs for the rest of my life. I hope my eye contact status will remain like this without ever waning. I think rTMS for selective symptomatic treatment of specific ASD traits has great potential, and I support further research into rTMS and its effects on consenting ASD adults.