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Neuropsychiatry
Review
Neuromodulation for the treatment of functional neurological disorder and somatic symptom disorder: a systematic review
  1. Chika Oriuwa1,2,
  2. Adriano Mollica1,2,
  3. Anthony Feinstein1,3,
  4. Peter Giacobbe1,2,3,
  5. Nir Lipsman2,3,4,
  6. David L Perez5,6,
  7. Matthew J Burke1,2,3,7,8
  1. 1 Neuropsychiatry Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
  2. 2 Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, Ontario, Canada
  3. 3 Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
  4. 4 Division of Neurosurgery, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
  5. 5 Department of Neurology, Cognitive Behavioural Neurology Division, Functional Neurological Disorder Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
  6. 6 Department of Psychiatry, Neuropsychiatry Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
  7. 7 Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
  8. 8 Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Dr Matthew J Burke, Neuropsychiatry Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; matt.burke{at}utoronto.ca

Abstract

Functional neurological disorder and somatic symptom disorder are complex neuropsychiatric conditions that have been linked to circuit-based dysfunction of brain networks. Neuromodulation is a novel therapeutic strategy capable of modulating relevant brain networks, making it a promising potential candidate for the treatment of these patient populations. We conducted a systematic review of Medline, Embase and PsycINFO up to 4 March 2021. Trials investigating neuromodulation devices for the treatment of functional neurological disorder or somatic symptom disorder were selected. Extracted variables included study design, demographic and clinical characteristics, psychiatric comorbidity, neurostimulation protocols, clinical outcome measures and results. 404 studies were identified with 12 meeting inclusion criteria. 221 patients were treated in the included studies with mean study sample size of 18 (4–70). Five studies were randomised clinical trials. Functional motor symptoms (six weakness, four movement disorders) were the most studied subpopulations. Transcranial magnetic stimulation (TMS) was the most frequently used device (10 studies), followed by electroconvulsive therapy (one study) and direct-current stimulation (one study). Treatment protocols varied in intended therapeutic mechanism(s): eight studies aimed to modulate underlying network dysfunction, five aimed to demonstrate movement (one also leveraged the former) and three boosted their primary mechanism with enhanced suggestion/expectation. All but one study reported positive results; however, methodological/outcome heterogeneity, mixed study quality and small sample sizes precluded quantitative meta-analysis. Neuromodulation, particularly TMS for the treatment of functional motor symptoms, shows preliminary promise in a growing line of research. Larger, sham-controlled studies are needed to further establish efficacy and better understand therapeutic mechanisms.

  • functional neurological disorder
  • somatisation disorder
  • neuropsychiatry
  • magnetic stimulation
  • electrical stimulation

http://dx.doi.org/10.1136/jnnp-2021-327025

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    Footnotes

    • CO and AM contributed equally.

    • Contributors Concept and design: MJB, CO and AM. Data collection and processing: MJB, CO and AM. Drafting of the manuscript: CO, AM and MJB. Critical revision of the manuscript: MJB, AM, CO, DLP, AF, PG and NL.

    • Funding This study was supported by funding from the Liu Fu Yu Charity Foundation.

    • Competing interests DLP has received honoraria for continuing medical education lectures on functional neurological disorder and is on the editorial board of Epilepsy & Behavior.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.