Psychogenic paralysis and recovery after motor cortex transcranial magnetic stimulation.
Psychogenic paralysis presents a real treatment challenge. Despite psychotherapy, physiotherapy, antidepressants, acupuncture, or hypnosis, the outcome is not always satisfactory with persistent symptoms after long-term follow-up. We conducted a retrospective study to assess clinical features and to propose an alternative treatment based on repetitive transcranial magnetic stimulation (rTMS). Seventy patients (44 F/26 M, mean age: 24.7 +/- 16.6 years) experienced paraparesis (57%), monoparesis (37%), tetraparesis (3%), or hemiparesis (3%). A precipitating event was observed in 42 patients, primarily as a psychosocial event or a physical injury. An average of 30 stimuli over the motor cortex contralateral to the corresponding paralysis was delivered at low frequency with a circular coil. The rTMS was effective in 89% of cases, with a significantly better outcome for acute rather than chronic symptoms. In conclusion, motor cortex rTMS seem to be very effective in patients with psychogenic paralysis and could be considered a useful therapeutic option.
Chastan
Nathalie
N
Department of Neurophysiology, Rouen University Hospital, Rouen, France. nathalie.chastan@chu-rouen.fr
Parain
Dominique
D
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000502:physiology*; D010243:Paralysis / Q000473:pathology / Q000523:psychology / Q000628:therapy; D020127:Recovery of Function / Q000502:physiology*; D012189:Retrospective Studies; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D055815:Young Adult