Transcranial magnetic stimulation as an efficient treatment for psychogenic movement disorders
- Béatrice Garcin1,2,3,
- Emmanuel Roze1,3,
- Francine Mesrati4,
- Emmanuel Cognat1,
- Emmanuel Fournier4,
- Marie Vidailhet1,3,
- Bertrand Degos1,5
- 1Département de Neurologie, Hôpital Pitié-Salpêtrière, Centre de Référence Maladie de Parkinson, APHP, Paris, France
- 2Service de Neurologie, Hôpital Saint Antoine, APHP, Paris, France
- 3Institut du Cerveau et de la Moelle, Inserm UMR_S 975; CNRS UMR 7225, CR-ICM—UPMC, Paris, France
- 4Département de Neurophysiologie Clinique, Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France
- 5Center for Interdisciplinary Research in Biology, INSERM U-1050, Collège de France, UPMC, Paris, France
- Correspondence to Dr Bertrand Degos, Département de Neurologie, Hôpital de la Salpêtrière, 47–83 bd de l'Hôpital, Paris cedex 13 75651, France;
- Received 31 August 2012
- Revised 14 December 2012
- Accepted 9 January 2013
- Published Online First 5 February 2013
Background Management of psychogenic movement disorders (PMDs) is challenging for neurologists and, to date, there is no consensus about their treatment. Recent studies suggested a possible therapeutic effect of repeated transcranial magnetic stimulation (TMS) in psychogenic paralysis and tremor.
Objective To document the clinical impact of TMS in PMDs.
Methods We blindly video scored symptoms of consecutive patients with PMD who were recorded before and after TMS. TMS was delivered at low frequency (0.25 Hz) over the motor cortex contralateral to symptoms.
Results Twenty-four patients were included. They presented with dystonia, myoclonus, tremor, Parkinsonism or stereotypies. The median duration of symptoms before TMS was 2.8 years (6 months to 30 years). The overall score of 75% of patients improved by >50% and, furthermore, the clinical benefits were sustained upon protracted follow-up (median 19.8 months). There was no correlation between improvement and duration of symptoms before TMS.
Conclusions TMS is a therapeutic option for PMDs, including chronic PMDs.