Transcranial Magnetic Stimulation as a treatment for Functional (Psychogenic) Upper Limb Weakness.

Laura McWhirter, Lea Ludwig, Alan J. Carson, Robert McIntosh, Jon Stone

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: There has been a recent resurgence of interest in physical treatments for functional motor disorders (FMD) including Transcranial Magnetic Stimulation (TMS). This pilot study aimed to test the effectiveness of a single session of motor cortex TMS as a treatment for functional upper limb weakness.
Methods: Ten subjects with a diagnosis of functional upper limb weakness were randomised to immediate (n=7) or delayed (3 months) (n=3) TMS treatment. Median age was 35 (range 23-52) and median symptom duration was 2.3 years (range 5 months – 20 years). 46-70 single pulses were applied to the motor cortex at 120-150% motor threshold. We used a verbal protocol designed to standardized the effects of suggestion. Primary outcome measures were self-reported symptom severity, grip strength and tapping frequency immediately after treatment, and symptom severity and disability (SF-12 and Modified Rankin Scale (MRS)) after three months.
Results: There was a small significant reduction in symptom severity immediately after treatment, but no improvement in grip strength or tapping frequency and no change in symptom severity, SF-12 or MRS three months after treatment. Small numbers precluded comparison of immediate treatment with delayed treatment. Four of eight subjects responding to three-month follow-up reported late-onset adverse effects.
Conclusion: This pilot study suggests limited benefits for TMS as a one-off non-neuromodulatory treatment for stable chronic outpatients. TMS may still have a role alongside more intensive multidisciplinary therapy input, or in patients with severe deficits where the possibility of normal movement can be hard to demonstrate.
Trial registration: NCT02102906
Original languageEnglish
Pages (from-to)102-106
JournalJournal of Psychosomatic Research
Volume89
Early online date25 Aug 2016
DOIs
Publication statusPublished - 1 Oct 2016

Keywords

  • functional neurological disorder
  • motor conversion disorder
  • movement disorders
  • transcranial magnetic stimulation
  • treatment

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