[Augmented psychotherapy with rTMS in functional neurological disorder]

H Bottemanne; K Imadache; L Pernet; T de La Forest Divonne; I English; E Barron; B Millet

doi:10.1016/j.encep.2021.02.017

[Augmented psychotherapy with rTMS in functional neurological disorder]

Encephale. 2022 Feb;48(1):110-113. doi: 10.1016/j.encep.2021.02.017. Epub 2021 Jun 5.

[Article in French]

Authors

H Bottemanne¹, K Imadache², L Pernet², T de La Forest Divonne², I English², E Barron², B Millet³

Affiliations

¹ Sorbonne University, Department of Psychiatry, Pitié-Salpêtrière hospital, DMU Neuroscience, Assistance Publique-Hôpitaux de Paris (AP-HP), 47, boulevard de l'Hôpital, 75013 Paris, France; Paris Brain Institute-Institut du Cerveau (ICM), UMR 7225/UMRS 1127, Sorbonne University/CNRS/INSERM, 47, boulevard de l'Hôpital, 75013 Paris, France; Sorbonne University, Department of Philosophy, SND Research Unit, UMR 8011/FRE 3593, 1 rue Victor Cousin, 75005 Paris, France. Electronic address: hugo.bottemanne@gmail.com.
² Sorbonne University, Department of Psychiatry, Pitié-Salpêtrière hospital, DMU Neuroscience, Assistance Publique-Hôpitaux de Paris (AP-HP), 47, boulevard de l'Hôpital, 75013 Paris, France.
³ Sorbonne University, Department of Psychiatry, Pitié-Salpêtrière hospital, DMU Neuroscience, Assistance Publique-Hôpitaux de Paris (AP-HP), 47, boulevard de l'Hôpital, 75013 Paris, France; Paris Brain Institute-Institut du Cerveau (ICM), UMR 7225/UMRS 1127, Sorbonne University/CNRS/INSERM, 47, boulevard de l'Hôpital, 75013 Paris, France.

PMID: 34099244
DOI: 10.1016/j.encep.2021.02.017

Abstract

Background: We report the observation of a 47-year-old woman with functional neurological disorder (tetraparesis, mixed tremors and non-epileptic seizures) treated with a protocol of augmented psychotherapy in combination with repeated transcranial magnetic stimulation (rTMS).

Intervention: We carried out a biofeedback psychotherapy protocol with rTMS (twenty sessions, two sessions per day for ten days; 1Hz, 150% of the motor threshold, twenty minute sessions, 300 pulses per session) in which the patient visualized the motor activity of her upper limbs during stimulation of the primary motor area (PMA). The evolution of neurological symptoms was assessed using the Medical Research Council Scale for Muscle Strength (MRC).

Results: Symptoms were improved between the 4th and 6th days of treatment (8th and 12th sessions) with first a relief of paresis, then a secondary cascade improvement of other functional symptoms. At two months the patient no longer presented any functional neurological symptoms.

Discussion & conclusion: We propose several hypotheses concerning the effectiveness of this type of biofeedback protocol using rTMS. We also suggest that this type of protocol should be systematically associated with psychotherapeutic support on biographical elements for holistic management. This observation underlines the interest of potentiating cognitive-behavioral therapies using the principle of operant conditioning with the aid of brain stimulation in functional neurological disorders, and motivates the realization of future studies.

Keywords: Augmented psychotherapy; Conversion Weakness; Crise psychogène non épileptique; Functional Paralysis; Functional movement disorder; Functional neurologic disorder; Functional neurological symptom; Paralysie fonctionnelle; Psychogenic movement disorder; Psychogenic paralysis; Psychogenic tremor; Psychothérapie augmentée; Repetitive transcranial magnetic stimulation; Stimulation magnétique transcranienne; Symptôme neurologique fonctionnel; Trouble moteur fonctionnel; Trouble neurologique fonctionnel; rTMS.

Publication types

Case Reports

MeSH terms

Conversion Disorder* / therapy
Female
Humans
Middle Aged
Paresis
Psychotherapy
Transcranial Magnetic Stimulation*
Treatment Outcome