Transcranial magnetic stimulation as an efficient treatment for psychogenic movement disorders

Background Management of psychogenic movement disorders (PMDs) is challenging for neurologists and, to date, there is no consensus about their treatment. Recent studies suggested a possible therapeutic effect of repeated transcranial magnetic stimulation (TMS) in psychogenic paralysis and tremor. Objective To document the clinical impact of TMS in PMDs. Methods We blindly video scored symptoms of consecutive patients with PMD who were recorded before and after TMS. TMS was delivered at low frequency (0.25Hz) over the motor cortex contralateral to symptoms. Results Twenty-four patients were included. They presented with dystonia, myoclonus, tremor, Parkinsonism or stereotypies. The median duration of symptoms before TMS was 2.8years (6months to 30years). The overall score of 75% of patients improved by >50% and, furthermore, the clinical benefits were sustained upon protracted follow-up (median 19.8months). There was no correlation between improvement and duration of symptoms before TMS. Conclusions TMS is a therapeutic option for PMDs, including chronic PMDs.