Psychogenic paralysis and recovery after motor cortex transcranial magnetic stimulation

Authors

  • Nathalie Chastan MD, PhD,

    Corresponding author
    1. Department of Neurophysiology, Rouen University Hospital, Rouen, France
    • CHU de Rouen—Hôpital Charles Nicolle, Service de Neurophysiologie, 1 rue de Germont, 76031 Rouen Cedex, France

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    • Potential conflict of interest: The authors confirm that there was no conflict of interest. The authors have no financial disclosures or additional information to disclose.

  • Dominique Parain MD, PhD

    1. Department of Neurophysiology, Rouen University Hospital, Rouen, France
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    • Potential conflict of interest: The authors confirm that there was no conflict of interest. The authors have no financial disclosures or additional information to disclose.


Abstract

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. © 2010 Movement Disorder Society

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