Double-blind, sham-controlled, pilot study of trigeminal nerve stimulation for autism spectrum disorder

TL;DR

A pilot study found that trigeminal nerve stimulation was safe and showed some potential benefits for children with autism spectrum disorder.

Contribution

This is the first double-blind, sham-controlled trial exploring trigeminal nerve stimulation for autism spectrum disorder.

Findings

Trigeminal nerve stimulation was well tolerated with no serious adverse events.

TNS showed nominal improvements in maladaptive behavior and social reciprocity compared to sham treatment.

qEEG changes correlated with improvements in social and overall functioning.

Abstract

Trigeminal nerve stimulation (TNS) is a minimal-risk, noninvasive neuromodulation method with growing evidence of efficacy across psychiatric conditions. However, its safety and potential effects in autism spectrum disorder (ASD) remain underexplored. This exploratory pilot study aimed primarily to evaluate the safety and tolerability, and secondarily to explore changes in ASD-related symptoms - including impairments in social communication and reciprocity, attention, executive functioning, emotional regulation, sleep, and sensory processing - in children with ASD, and to examine associated changes using quantitative electroencephalography (qEEG). This double-blind, sham-controlled, randomized exploratory pilot trial enrolled 29 children aged 7–12 years with ASD. The participants were randomized to receive 28 nightly sessions of active or sham TNS over 4 weeks. At baseline and week 4, we assessed safety, clinical outcomes and Clinical Global Impression scales, in addition to analyzing qEEG band power. No serious adverse events were observed, and TNS was well tolerated. Exploratory analyses showed nominal between-group differences (unadjusted) favoring the TNS group in maladaptive behavior (Vineland-II: 1.38 vs 0.08; p = .017) and social reciprocity (Social Responsiveness Scale-2: 12.07 vs −1.43; p = .025). Exploratory qEEG analyses revealed decreased gamma/high-frequency and increased alpha power in the left frontal and parietal regions, changes that significantly correlated with improvements in social (r = −0.917; p = .001) and overall (r = −0.680; p = .030) functioning. TNS was safe and showed preliminary evidence of potential benefits in improving behavioral and social functioning in children with ASD. Larger trials are required to confirm these findings. Clinical trial registration information: http://clinicaltrials.gov/; NCT06233279.

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