Session Information
Date: Thursday, June 23, 2016
Session Title: Parkinson's Disease: Clinical Trials II and Non-PD Clinical Trials
Session Time: 12:00pm-1:30pm
Objective: To determine whether the beneficial effect of repeated transcranial magnetic stimulation (rTMS) in psychogenic movement disorders (PMDs) is the consequence of a cortical functioning effect or a combination of suggestion/cognitive-behavioral effect. In this purpose, we compared the therapeutic effect of repeated root magnetic stimulation (rRMS) and rTMS in PMDs.
Background: PMDs account for 3% of all patients seen in movement disorder clinics. The outcome is often poor, and there is an overall lack of consensus about the treatment of PMDs. Recent studies suggest an effect of low frequency rTMS [1]. However, it remains unclear whether this effect is the consequence of a cortical modulation.
Methods: We conducted a prospective crossover study, with 2 different repeated magnetic stimulations: 1) rTMS: An average of 20 consecutive stimuli was delivered at low frequency over the motor cortex contralateral to PMDs and 2) rRMS: Stimulation was delivered over cervical (for upper limbs) or lumbar (for lower limbs) spinal nerves. Patients were randomly assigned either to group 1 with rRMS on day one and rTMS on day 2 or group 2 in which the order of treatment was inversed. Clinical and paraclinical features of patients were collected, and blinded scorings of PMDs were performed before, between and after the sessions of magnetic stimulation.
Results: Thirty three patients (26 F/7M, mean age 43.1 +/- 17.1) were included, presenting with tremor/myoclonus in 48.5%, dystonic tremor in 33% and dystonia in 18.2%. The mean duration of symptoms before magnetic stimulations was 7.4 years. Patients from group 1 (n=16) and group 2 (n=17) did not statistically differ on age, sex, duration, presentation or severity. Mean improvement on PMDs scores was 40.7% after the first session, and 60.6 % after both sessions, with no statistical difference between rTMS and rRMS
| Group 1 (rRMS first) | Group 2 (rTMS first) | Statistics | |
| Number of patients | 16 | 17 | |
| Age | 42.8 | 43.2 | T-test, p=0.94 |
| Gender | 14F 2M | 12F 5M | Fisher’s test, p=0.4 |
| Symptom duration in months (mean) | 7.7 | 7.1 | T-test, p=0.85 |
| Clinical presentation | Chi-square, p=0.9 | ||
| Tremor/myoclonus | n=8 (50%) | n=8 (47%) | |
| Dystonic tremor | n=5 (31%) | n=6 (35%) | |
| Dystonia | n=3 (19%) | n=3 (18%) | |
| PMDs score (/41, mean) | 21.7 | 18.4 | T-test, p=0.26 |
| Improvement after first magnetic stimulation | 34.2% | 46.8% | T-test, p=0.33 |
| Improvement after both magnetic stimulations | 58.3% | 62.8% | T-test, p=0.75 |
Conclusions: Repeated magnetic stimulation seems to be an effective treatment for chronic and resistant PMDs. rRMS is as efficient as rTMS. This suggests an important contribution of suggestion and cognitive-behavioral effect induced by the alteration of the movement disorder during rTMS, rather than an effect on cortical functioning.
To cite this abstract in AMA style:
B. Garcin, C. Hubsch, L. Lliescu, L. Naccache, M. Vidailhet, E. Fournier, F. Mesrati, E. Roze, B. Degos. Transcranial versus root repeated magnetic stimulation as a treatment of psychogenic movement disorders [abstract]. Mov Disord. 2016; 31 (suppl 2). https://www.mdsabstracts.org/abstract/transcranial-versus-root-repeated-magnetic-stimulation-as-a-treatment-of-psychogenic-movement-disorders/. Accessed November 24, 2024.« Back to 2016 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/transcranial-versus-root-repeated-magnetic-stimulation-as-a-treatment-of-psychogenic-movement-disorders/