Transcranial magnetic stimulation in the reversal of motor conversion disorder

Background. There is no agreement on the most effective therapy for motor conversion symptoms. Functional electric stimulation has been successfully used to reverse conversion paralysis. We tested the therapeutic potential of high-frequency repetitive transcranial magnetic stimulation (rTMS) in a 20-year-old patient suffering from a conversion paralysis of the right arm. Method rTMS was applied to the contralateral motor cortex. Stimulations were performed on working days at a frequency of 15 Hz (train length 2 s; inter-train interval 4 s) yielding 4,000 pulses/day. Results: Within 12 weeks, motor function, hyposensibility and muscle bulk were completely restored. Conclusions: The patient recovered completely during rTMS treatment. In addition to possible psychological effects, rTMS may have had a causal therapeutic effect by strengthening corticocortical connections and thereby priming voluntary movements. Further controlled studies are needed. Copyright (C) 2003 S. Karger AG, Basel.