Effects of Non-invasive Neurostimulation on Autism Spectrum Disorder: A Systematic Review

Abstract

Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder characterized by major impairments in social communication, stereotyped and ritualistic behaviors and deficits in sensory reactivity. Recently, noninvasive brain stimulation (NIBS) methods, namely transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS), have been examined as possible new therapeutic options for modifying the pathological neuroplasticity involved in neuropsychiatric disorders including ASD. Therefore, we conducted a systematic review on the therapeutic uses of tDCS and repetitive TMS (rTMS) in ASD patients. A systematic search was performed on Scopus, Web of Science, PubMed, Cochrane and Embase. Original articles reporting the use of tDCS or rTMS to treat ASD were screened and studied by two researchers independently based on PRISMA guidelines. We found 32 eligible studies including 8 tDCS reports, 23 rTMS reports and one report with both tDCS and rTMS. These studies comprised 6 case-reports, 9 non-controlled trials and 17 controlled trials which assessed NIBS effects on the three cognitive, behavioral and biological dimensions in ASD. Existing evidence demonstrates that NIBS methods could be helpful for treating some dimensions of ASD such as repetitive behavior, sociability or some aspects of executive and cognitive functions. However, such evidence should be regarded with care because of the quality of original researches and serious publication bias as well as the heterogeneity of data. Further randomized, double-blind, sham-controlled trials with appropriate follow-up periods should be designed to assess the efficacy of NIBS methods for ASD treatment.

Keywords: Autism; Brain.; Non-invasive neurostimulation; Transcranial direct current stimulation; Transcranial magnetic stimulation.

Fig. 1

Flow diagram and process of identification, screening and assessing eligibility of studies on the noninvasive brain stimulation effects on autism spectrum disorder. tDCS, transcranial direct current stimulation; TMS, transcranial magnetic stimulation.

Fig. 2

Number of studies by age group, level of function, adminis-tration type, stimulation target and level of risk of bias. DLPFC, dorsolateral prefrontal cortex; mPFC, medial prefrontal cortex; STS, superior temporal sulcus; TPJ, tem-poroparietal junction.