| Objective: To observe the clinical efficacy of repetitive transcranial magnetic stimulation(r TMS)at different frequencies with autism spectrum disorder(ASD),to measure the functional connectivity strength and to explore the neural mechanism of action using near infrared functional brain imaging(f NIRS).Methods: Sixty children with autism spectrum disorder who met the criteria and were treated at Jinan Weizhong Children’s Rehabilitation Medical Center from December 2021 to November 2022 were selected.A random number table method was used to divide them into a low frequency group(1Hz),a high frequency group(5Hz)and a control group,with 20 cases in each group.All three groups received conventional rehabilitation and other treatments.The low-frequency and high-frequency groups were treated with r TMS at 1Hz and 5Hz,respectively,1 time/day for 2 hours/time,5 times/week for 8 weeks.The children were evaluated by ABC,CARS and ATEC scales before and after the treatment,while changes in blood oxygen concentration in the eight cortical regions of interest(ROI)were measured using the f NIRS technique before and after treatment in the three groups for comparison of the strength of functional brain connections.Results: A total of four patients were moved during the study,three to the high-frequency group and one to the low-frequency group,and finally56 patients were completed and enrolled in the experiment.Before treatment:The general data,ABC,CARS,ATEC scale scores and whole brain functional connectivity strength of the three groups were compared,and the differences were not statistically significant(P>0.05).After treatment:(1)Patients in all three groups had lower ABC,CARS,and ATEC scale scores than before treatment in the group,and the difference was statistically significant(P<0.05);compared between groups,the high-frequency group scored significantly lower than the low-frequency group and the control group on each scale(P<0.05),the low-frequency group scored lower than the control group in sensory,motor,physical activity,object use,and nonverbal communication,and the difference in change was greater than the high-frequency group(P<0.05),and the high-frequency group improved better than the control and low-frequency groups in language,social interaction,interpersonal relationships,imitation,emotional response,and anxiety(P<0.05).(2)The whole-brain functional connectivity intensity was higher in all three groups than before treatment,and the connectivity intensity in the high-frequency group was significantly higher than that in the low-frequency group and the control group,with statistically significant differences(P<0.05);The connection strengths in the RPFC,RPL,and ROL zones were significantly higher in the low-frequency group after treatment compared with the control group,and the differences in changes were greater than those in the high-frequency group(P<0.01),while the changes in the remaining ROI zones were not statistically significant(P>0.05).The connection strengths in LPFC,RPFC,LPL,RPL,and LTL areas were significantly higher in the high-frequency group compared with the control group,but there were significant differences in LPFC and LTL areas compared with the low-frequency group(P<0.01).Conclusion:1.Combined r TMS treatment was superior to conventional rehabilitation training,and different frequencies of r TMS could improve the functional impairment and enhance the therapeutic effect of children with ASD,and high-frequency stimulation was more effective than low-frequency stimulation.2.The treatment effects of r TMS with different frequencies were further compared.Low-frequency r TMS was more effective in improving children’s sensory,somatic motor,and irritability,while high-frequency r TMS was more effective in improving children’s social interaction,language,imitation,emotional response,and anxiety disorders3.The functional connection between the parietal lobe,temporal lobe and other low-functioning brain regions and the frontal lobe of the brain of autistic patients is lower than that of normal individuals,the impact of low-frequency r TMS with ASD is mainly by acting on the right prefrontal lobe area,the right parietal cortex area and the right occipital cortex area,high-frequency r TMS mainly acts on the left prefrontal region and the left temporal lobe area,with the r TMS stimulation treatment,the E/I balance between the cerebral cortex is restored,and the strength of the functional connection between the corresponding brain regions of the child gradually increases,and the functional connectivity becomes better.So as to promote the improvement of various functional disorders in children. |
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