The benefits of treating autism, dementia and ADHD with TMS
Currently, there are very few good options for the treatment of autism, and TMS represents a bright star of hope for the families of autistic kids. One of the interesting and puzzling aspects of the research done on autism is that the four major groups who are doing research are using different parts of the brain. They’re using different frequencies of stimulation but they’re all achieving some results. The rationale for the different locations and frequencies varies among the groups. For example, the DMPFC – which we’ve seen how it’s used in Canada for depression – can be stimulated as shown by the Kentucky Group with Cassanova and colleagues, with a 1 Hertz stimulation – a very slow stimulation. They do it once per week. When you have a once-per-week stimulation for autistic kids, you remove that enormous barrier of the daily five days a week, trying to get your autistic child in the car and to the clinic. Once a week stimulation represents an exciting possibility for autism and hopefully for other kinds of conditions in the future as well.
Dementia is going to be a very important indication. Sooner or later, government and private funding organizations will come to the conclusion that medications might not be the best option for dementia. Brain stimulation is known to increase BDNF, it’s known to increase cortical activity, it’s known to increase cortical thickness. The idea of using TMS for dementia is an obvious and very intuitive idea. One of the advantages of using TMS in dementia is the infinite nature of parameter space because there are many different areas of the brain and there are many different ways to stimulate in terms of frequency, in terms of trains on and pauses off.
Because there’s so many different possibilities, one never has the problem of having exhausted the different options. One can stimulate in a different place, one can stimulate over a greater period of time. One can combine stimulation with cognitive activities during the session, before the session, after the session. One can do the same thing with physical exercise, physical exercise before TMS, probably not during TMS but maybe after TMS. So dementia is a fertile ground for the application of TMS devices and technology. As the population ages, the need for treatment of dementia is going to increase more and more.
The use of TMS for the treatment of ADHD?
Attention deficit hyperactivity disorder is, to me, a surprise with TMS because when I saw patients with comorbid ADHD and depression, it didn’t surprise me that the depression got better, but the level of response to the symptoms was extraordinary. People who were squirming and hyperactive in the chair the first session would come back for the second session and be just completely still and content to not move during the entire session. Patients who had previously been getting C’s in their college courses reported to me that they had been getting A’s. When I asked, “Is that because you’re studying so much harder now, that you have better self-control?”, one of them said, “No, it’s because once I’m exposed to something during a lecture, it comes back to me immediately on the exam”, which means that the retention and the efficiency of cognitive activity have been improved.
TMS for ADHD, I think, is an extraordinary opportunity and there are many parents who don’t want their children on stimulants, that they don’t the lifelong commitment that they foresee, even though it’s not necessarily lifelong. There are many parents who would like a definitive treatment that doesn’t obligate their child to go to a psychiatrist every month or two months, even when they go off to college or in their career.
TMS is directed instead of systemic, it goes to one part of the brain. It’s definitive instead of ongoing, you do it and you’re done. In terms of cost-effectiveness, over the long haul, it is cost-effective because it relieves the person of the burden of having to think about the condition that they have – it can make it go away. Many patients find complete remission from their symptoms.