rTMS Effect in Functional Psychogenic Movement Disorders Applied Alone Then Combined With Hypnotherapy

University Hospital, Toulouse18 enrolled

Overview

The management of functional psychogenic movement disorders (FNPMD) is challenging for neurologists and psychiatrists and only comprehensive multidisciplinary treatment programme can be worthwhile for these patients (Moene et al 2002). Recent functional magnetic resonance imaging studies have demonstrated abnormalities in motor control at cortical level, hyperactivity of limbic system and disturbance of connectivity between these two systems leading to a lack of self-agency, (Voon et al 2010,2011).Two recent studies suggested a possible therapeutic effect of transcranial magnetic stimulation (TMS) in FNPMD (Dakotakis 2011, Garcin, 2013). In this protocol our objectives are twofold : 1. to compare the effect of 5 consecutive daily sessions of rTMS on FNPMD in a double-blind randomized controlled study 2. to study the effect of 3 weekly hypnosis sessions combined with rTMS in FNPMD

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

TRIPLE

Enrollment

Conditions

Movement Disorders

Interventions

Eligibility

Sex: ALLMin age: 18 YearsMax age: 85 Years

Medical Language ↔ Plain English

Inclusion criteria: * Man or woman with FNPMD for at least 2 months, * diagnosed from clinical Diagnostic and Statistical Manual V conversive somatoform troubles and Gupta \& Lang (2009) and Edwards \& Bahtia 2012 neurological clinical criteria Exclusion criteria: * Severe progressive psychiatric disorders * Cardiac pace-maker * Metallic prosthesis * Cochlear implants * Previous neurosurgery * Epilepsy * Severe cardiac disease * Alcohol or toxic abuse for the last 12 months * Drugs such clozapine, bupropion, methadone or theophylline

Outcomes

Primary Outcomes

Changes of Psychogenic Movement Disorder Rating Scale (PMDRS= Hinson score between baseline and one month after rTMS treatment

Time frame: Inclusion and 1 month later

Secondary Outcomes

Clinical Global Impression-Severity scale (CGI-SEVERITY/CGI-I/CGI-S)

Time frame: inclusion, inclusion + 5 days, inclusion + 1 month, inclusion + 2 months, inclusion + 6 months, inclusion + 12 months.

Hospital Anxiety and Depression Scale (HAD/HDRS)

Time frame: inclusion, inclusion + 1 month, inclusion + 6 months, inclusion + 12 months.

Quality of Life (SF-36)

Time frame: inclusion, inclusion + 1 month, inclusion + 2 months, inclusion + 6 months, inclusion + 12 months.

Temperament and Character Inventory (TCI)

Time frame: inclusion, inclusion + 12 months.

Pain scale (VAS)

Time frame: : inclusion, inclusion + 5 days, inclusion + 1 month, inclusion + 2 months, inclusion + 6 months, inclusion + 12 months.