Jul 01 2013

Transcranial Magnetic Stimulation for Autism

A clinic known as the Brain Treatment Center (BTC) is offering what they call Magnetic Resonance Therapy, or MRT™, as a treatment for autism and other disorders, including sleep disorders, schizophrenia, Alzheimer’s disease, emotional disorders, anxiety, addiction, and for athletic performance.

MRT (always be suspicious of a medical treatment that is trademarked) consists of transcranial magnetic stimulation along with other modalities:

…EEG, brain stimulation, Neurofeedback, EKG and other biometric techniques to provide a highly customized treatment personalized to how a patient’s brain takes in, processes, and communicates information.

I will discuss both the use of transcranial magnetic stimulation (TMS) for autism, and the specific claims made by BTC, starting with the latter.

BTC

The website for BTC has many signs of a dubious clinic, and offers an excellent example of the red flags that any prospective patient should watch out for when seeking treatment. I have already mentioned one – trademarking the name of a therapy, which they claim is unique to their clinic.

This is similar to the issue of patenting a medical use or technique. Medical use patents are generally considered unethical and counterproductive in the medical community, and are illegal in many countries, although still legal in the US.

Medical knowledge and treatments are, or at least should be, “open source” (as with scientific knowledge generally).  The attempt to present a clinic’s or practitioner’s treatment as unique or special is a marketing ploy, but betrays a misunderstanding of the nature of medical knowledge. Advances in medicine need to be peer reviewed, examined by the community, and replicated. By definition there is no such thing as a “unique” and simultaneously legitimate treatment.

They actually write: “With our unique knowledge of neuroscience.” How did they manage to come by this unique knowledge? The very concept is anathema to science.

The BTC website also declares:

The Brain Treatment Center offers a unique science-based approach to the treatment of autism spectrum disorder (ASD). This therapy addresses core underlying issues that contribute to behavioral and cognitive symptoms pervasive to autism spectrum disorder (ASD). It is our belief that every patient should receive personalized attention with all therapies and procedures. With our unique knowledge of neuroscience, Brain Treatment Center integrates an array of therapies and technologies to pioneer a new treatment to autism.

I don’t think they use the term “science-based” the same way that we at science-based medicine do. In addition to calling their treatment unique, there are some other red flags in the above paragraph. They claim to address underlying causes, as if that is somehow also unique to them. That is a common claim of so-called “alternative medicine” proponents – combining the unfair claim that mainstream medicine does not address underlying causes when possible with the claim that their special treatment does.

Another red flag is the claim that their treatment is “personalized.” This is another huge marketing ploy common in fringe clinics. Mainstream medicine already does personalize treatment, as much as possible, when our knowledge and the evidence supports specific personalizing factors. The question is – is BTC “personalizing” their treatments in an evidence-based fashion, or is this just marketing?  Is there personalization superficial and for show, or does it actually improve outcomes? There is no evidence on their site, references to such evidence, or anything published I can find to support these claims.

Finally, they promote their treatment with video testimonials. The use of testimonials (rather than published evidence) to promote the efficacy of treatments I consider to be dubious and unethical. Testimonials are by definition anecdotal evidence. They tend to be misleading, because they are not controlled and systematic. A legitimate clinic should use published rigorous studies to support their treatments, not testimonials.

It’s OK to use testimonials to promote the quality of service provided by a doctor or clinic – our staff are friendly, we have convenient parking, short wait times, etc. – but not the treatments themselves.

The BTC website has this disclaimer on their testimonials page:

The opinions and views represented in these videos are not necessarily those of Brain Treatment Center.

This betrays one of the reason for using testimonials – they allow a person or clinic to imply medical claims without making the claims directly themselves. The disclaimer is the cherry on top – we don’t necessarily stand by these claims, but here they are. This is similar to, “results not typical,”  or “your mileage may vary.”

TMS for Autism

Transcranial magnetic stimulation is a legitimate, cutting edge treatment modality. Is uses low-powered magnetic fields to alter the firing of neurons in one part of the brain, and can be tuned to a specific brain region and to either increase or decrease activity. It is very useful in research for identifying the neuroanatomical correlates of brain function. As a treatment modality, however, it is very new and existing research is therefore scant.

The best researched indication for TMS is depression. Other brain stimulation treatments, like electroconvulsive therapy, are well established. TMS is new, and the research so far shows promise but is insufficient to conclude that it definitely works. Existing research shows a statistically significant positive effect, but is limited by small effect size and lack or rigorous methodology – and this is the best current case for therapeutic use of TMS.

There are many other possible indications being investigated: migraine, Parkinson’s disease, insomnia, tinnitus, and others. However, none have been adequately researched to establish TMS as clearly effective.

The same is true of autism – there are some preliminary reports, but nothing compelling. In an interview for NOVA, TMS expert Mark George gave this summary:

There have been only a few small studies with TMS in autism, with inconclusive results. We really do not know which part of the brain is not working in autism, or how it is not working. We do not have the roadmap yet to know how to even think about using TMS to treat it. More research is needed, and maybe someday…

Not only is there insufficient evidence to conclude that TMS works for autism, we haven’t even done enough basic research to design an adequate treatment. TMS is not one treatment – it is a treatment approach. You need to know what frequencies to use on which part of the brain in order to apply the treatment effectively.

How does BTC deal with this lack of knowledge? They appear to just make it up. They give low level “subthreshold” TMS to the whole brain. They are not even properly using TMS.

Conclusion

TMS is an exciting research tool, and a potential new treatment modality for a variety of neurological conditions. However, a great deal of research needs to be done before it can be established as an accepted safe and effective treatment. So far there is only one indication for which TMS is close to being an accepted treatment, depression, and that is controversial.

TMS is not a scientifically established treatment for autism. This is a possible future application, but much more research needs to be done.

There is a tendency, however, for some dubious clinics to latch onto emerging therapies and then offer them to their patients for a long list of indications, supported only by preliminary evidence and testimonials. They can easily make themselves sound scientific, and cloak their clinic in the trappings of cutting edge science, but this is ultimately a deception – little more than clever marketing.

This is harmful on many levels, not least of which it may taint with pseudoscience a potential emerging therapy.

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13 responses so far

13 Responses to “Transcranial Magnetic Stimulation for Autism”

  1. DOYLEon 01 Jul 2013 at 2:06 pm

    Has there been specific exploration of any link between mirror neuron activity and autism.If so would tms be able to improve mirror neuron response.

  2. SARAon 01 Jul 2013 at 2:40 pm

    I guess I’ve been reading you too long. Because it didn’t sound science based, it sounded marketing based to me.

    The whole tone sounds like they are advertising a new face cream or shampoo to me.

    But I suppose when you are desperate, you latch onto anything that supports your hope and that is why they will probably be very successful. There are lots of desperate people and just enough cretins to feed on them.

  3. Mlemaon 01 Jul 2013 at 11:24 pm

    “Transcranial magnetic stimulation is a legitimate, cutting edge treatment modality.”

    I think that may be a typo, and you probably meant “diagnostic modality”.

    I don’t see the promise for TMS in treating depression, based on the research. Looks like wishful thinking to me. :)

    Also, regarding ECT, I’m wondering what’s the science behind referring to ECT as “brain stimulation treatments”.

  4. rocken1844on 01 Jul 2013 at 11:26 pm

    So some groups can bypass, as you specify, ” Advances in medicine need to be peer reviewed, examined by the community, and replicated.”, by receiving a medical-use-patent?

  5. skeplankeron 02 Jul 2013 at 2:21 am

    This is their old website, for some reason not linked to anymore: http://autism.braintreatmentcenter.com/

    The entire “MRT” protocol page (http://autism.braintreatmentcenter.com/MRT_Protocol.php) seems to have been written by a random buzzword generator.

    In particular, the “music” part of the treatment (http://autism.braintreatmentcenter.com/Autism_Treatment_Procedure.php) is firmly based in magical thinking, with prior plausibility approaching 1/G, with G = Graham’s number.

  6. steve12on 02 Jul 2013 at 2:54 pm

    This makes me think of Daniel Amen – they guy who does the informercial on PBS. Take legitimate neuroscience / imaging technologies to make things seem “cutting edge”, misrepresent their clinical applications via some nonsense proprietary “method” and voila! cash. Lots of cash.

  7. Bruce Woodwardon 03 Jul 2013 at 3:43 am

    How do magnets work though?!

  8. daedalus2uon 03 Jul 2013 at 8:58 am

    TMS actually uses very high strength magnetic fields, with a high time derivative such that currents and voltages are induced in the brain across a quite large air-gap.

    The degree of prior plausibility for using TMS for anything is small. It can’t stimulate specific brain regions, the current loops are necessarily large and the magnetic fields and field gradients are inches away from the regions being stimulated.

    Any mechanism of action is probably similar to ECT, electroconvulsive therapy, which also doesn’t treat specific brain regions.

  9. steve12on 03 Jul 2013 at 11:44 am

    “It can’t stimulate specific brain regions”

    Actually – guided by previously recorded fMRI activations TMS can be fairly precise. Precise enough to induce only your index finger to twitch by exposing the corresponding contralateral motor strip to the field.

    It’s currently used in research in a knock out sort of way to show causal (as opposed to simply looking at neural correlates) relationships between given brain regions and certain cognitive functions. Pretty cool stuff.

  10. rogeron 05 Nov 2013 at 3:08 pm

    Hi I read this and looked into it. I found this article that was accepted for publication last month, Oct 2013:

    A double-blind, randomized trial of deep repetitive transcranial magnetic stimulation (rTMS) for autism spectrum disorder

    http://www.sciencedirect.com/science/article/pii/S1935861X13002994

    Results

    Participants in the active condition showed a near significant reduction in self-reported social relating symptoms from pre-treatment to one month follow-up, and a significant reduction in social relating symptoms (relative to sham participants) for both post-treatment assessments. Those in the active condition also showed a reduction in self-oriented anxiety during difficult and emotional social situations from pre-treatment to one month follow-up. There were no changes for those in the sham condition.

    Conclusion

    Deep rTMS to bilateral dorsomedial prefrontal cortex yielded a reduction in social relating impairment and socially-related anxiety. Further research in this area should employ extended rTMS protocols that approximate those used in depression in an attempt to replicate and amplify the clinical response.

  11. C.Jon 25 Dec 2013 at 10:24 pm

    Unbelievable! This is the first and only promising treatment for autism in about a two decades, and this guy can only think of the negative things to say about it.

    Not surprising, the medical community just wants people to keep paying for “treatments” which don’t actually work. Things like therapy and special education. That’s why parents and patients are getting fed up, and trying their luck with anything, including going overseas for stem cell treatment.

    There is enough proof that TMS works, so far. There have been a few studies published on this, like the one roger mentioned above. Also, look up John Elder Robison talks about TMS on Youtube.

  12. C.Jon 26 Dec 2013 at 1:14 am

    And another thing, he even goes on to say that TMS for depression is “unethical”. Really? By whose standards?

    There are plenty of people who have given their opinions on the internet who have claimed to have tried it and said that it works. But nah, I guess that’s just unethical.

    Why is it that whenever there’s a new treatment out that is shown to work, those in medical research are always quick to jump on it and criticize it and find the negatives?

  13. C.Jon 27 Dec 2013 at 1:34 am

    Check this study out, which was conducted in Melbourne, and published 2013.

    http://www.newscientist.com/article/mg22029414.000-brain-stimulation-boosts-social-skills-in-autism.html#.Ur0eLnaM6Sp

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