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Can repetitive transcranial magnetic stimulation increase muscle strength in functional neurological paresis? A proof‐of‐principle study
Author(s) -
Broersma M.,
Koops E. A.,
Vroomen P. C.,
Hoeven J. H.,
Aleman A.,
Leenders K. L.,
Maurits N. M.,
Beilen M.
Publication year - 2015
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/ene.12684
Subject(s) - transcranial magnetic stimulation , paresis , medicine , placebo , physical medicine and rehabilitation , weakness , motor cortex , muscle weakness , stimulation , physical therapy , anesthesia , surgery , pathology , alternative medicine
Background and purpose Therapeutic options are limited in functional neurological paresis disorder. Earlier intervention studies did not control for a placebo effect, hampering assessment of effectivity. A proof‐of‐principle investigation was conducted into the therapeutic potential of repetitive transcranial magnetic stimulation ( rTMS ), using a single‐blind two‐period placebo‐controlled cross‐over design. Methods Eleven patients received active 15 Hz rTMS over the contralateral motor cortex (hand area), in two periods of 5 days, for 30 min once a day at 80% of resting motor threshold, with a train length of 2 s and an intertrain interval of 4 s. Eight of these eleven patients were also included in the placebo treatment condition. Primary outcome measure was change in muscle strength as measured by dynamometry after treatment. Secondary outcome measure was the subjective change in muscle strength after treatment. Results In patients who received both treatments, active rTMS induced a significantly larger median increase in objectively measured muscle strength (24%) compared to placebo rTMS (6%; P < 0.04). Subjective ratings showed no difference due to treatment, i.e. patients did not perceive these objectively measured motor improvements ( P = 0.40). Conclusions Our findings suggest that rTMS by itself can potentially improve muscle weakness in functional neurological paresis disorder. Whereas patients' muscle strength increased as measured with dynamometry, patients did not report increased functioning of the affected hand, subjectively. The results may indicate that decreased muscle strength is not the core symptom and that rTMS should be added to behavioral approaches in functional neurological paresis.