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Abnormal transcranial magnetic stimulation in a patient with presumed psychogenic paralysis
  1. R Geraldes1,
  2. M Coelho1,
  3. M M Rosa1,
  4. L Severino2,
  5. J Castro3,
  6. M de Carvalho1,3
  1. 1
    Department of Neurology, Hospital de Santa Maria, Lisbon, Portugal
  2. 2
    Department of Psychiatry, Hospital de Santa Maria, Lisbon, Portugal
  3. 3
    Neuromuscular Unit, Institute for Molecular Medicine, Faculdade de Medicina de Lisboa, Portugal
  1. Professor M de Carvalho, Department of Neurology, Hospital de Santa Maria, Av. Prof. Egas Moniz, 1649 Lisbon, Portugal; mamedemg{at}

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Conversion disorders (CD) are frequently related to the locomotor system (paresis, abnormal movements) but also to the somatosensory system (positive and negative symptoms) or visual system (tunnel vision, blindness).1 2 CD is classified within the group of “somatoform disorders” in the Diagnostic and Statistical Manual of Mental Disorders-IV and its definition implies that the patient has no voluntary control over the production of symptoms (unlike factitious disorder or malingering). The reported rate of misdiagnosis of conversion symptoms has, on average, been 4% since 1970.1 Psychogenic paralysis (PP) is generally a diagnostic challenge for the neurologist, usually leading to an expensive work-up to exclude organic lesions.

There are several theories explaining CD. There are, however, few methods that are able to highlight the mechanisms underlying this disorder.1 2 Some reports suggest that functional brain imaging3 and neurophysiological studies may prove to be a useful approach. We report a case of PP where changes in transcranial magnetic stimulation (TMS) were found.

A 25-year-old married healthy woman was referred to the neurology department with a 3 …

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  • Competing interests: None.