Effects of Repetitive Transcranial Magnetic Stimulation Combined with Action-Observation-Execution on Social Interaction and Communication in Autism Spectrum Disorder: Preliminary Study

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Abstract
Objective: To investigate the effects of high-frequency rTMS (HF-rTMS) with action observation and execution (AOE) on social interaction and communication and in children with Autistic Spectrum Disorder (ASD). Materials and methods: Fifteen children underwent 10 sessions of 5-Hz HF-rTMS on the right inferior frontal gyrus combined with AOE. An experimental group received the real HF-rTMS while the control group received the sham one. For the AOE protocol, they were instructed to watch and imitate a video showing the procedure, including reaching and grasping tasks, gustatory tasks, and facial expressions. Their behavioural outcomes were evaluated using the Vineland Adaptive Behaviour Scale (VABS) and electroencephalograms (EEGs) recorded at three time points: baseline, immediately after each treatment, and at the 1-week follow-up after the 10th treatment. Results: There was a reduction in the VABS subitem scores of the experimental group, including the receptive, expressive, domestic, and community scores but no such reductions were observed in the control group. For the EEG, the beta rhythm at C3 and C4 increased in the experimental group. Additionally, positive correlations were observed between changes in the scores for the expressive subitem and changes in the beta rhythm on the C4 electrode at baseline and immediately after treatment in the experimental group. The control group showed no significant differences in any items for both observation and imitation times. Conclusion: Ten sessions of HF-rTMS combined with AOE had immediate and persistent effects after 1 week on the subitems of communication and daily living skills domain in children aged 7-12 years with ASD. This improvement may be partly attributable to increased cortical activity, as evidenced by beta rhythms.