Abstracts

Rationale: Patients with NES have a higher level at the somatization score compare with patients with epileptic seizures (1). So, NES may be associated with FP. These two functional symptoms may be due to a dysfunction of near the same neuronal network. As for functional movement disorders, a hypothesis arising from functional imaging study is that emotionally arousing events might trigger movement controlled by the supplementary motor area that is functionally disconnected from top-down control by the dorsolateral prefrontal cortex (2). In a previous study, we have shown that multi pulseTMS with circular coil on midline central and frontal area was effective in 89% of 70 patients with FP (3). A controlled study is ongoing with the agreement of ethic committee (paralystim: ClinicalTrials.gov identifier: NCT01352910). We propose the same, well tolerated and easy to do therapy for patients with very disabling NES associated with FP. Methods: On a population of sixty patients with EEG video recorded NES in our unit, eigth patients had disabling (out of job or school) NES and recurrent or persistent FP. For TMS, a 10cm diameter coil was placed without neuronavigation, on the head midline, the posterior border the coil on the motor cortex. This coil was located upon the motor cortex, the supplementary motor area, the premotor prefrontal dorsolateral and anterior cingular cortex. A TMS session consisted of 60 pulses at motor threshold at about 0.3 hz. The sessions were repeated eventually each week, during 2 months and after, every 2 months, according to the evolution of NES frequency. We compare the baseline NES frequency during the month before the first TMS session and at 6 months. Results: At 6 months, compared to baseline month, 5 patients had no NES, 1 patient had 90% and 2 patient 80% reduction in NES frequency. All patients had no FP and had reintegrated school or job. No adverse effect had been observed except transient headache after 1 session for 2 patients Conclusions: In this short open trial, multi shocks TMS with circular coil seem efficient to control NES associated with FP. Controlled study is mandatory to confirm the efficacy of this type of TMS in NES. 1) Predicting psychogenic nonepileptic seizures with the Personality Assessment Inventory and seizure variables. Stacy W. H., Shawn D. G. Epilepsy Behavior 2011 (22) 255-260 2)Aberrant supplementary motor complex and limbic activity during motor preparation in motor conversion disorder. Voon V, Brezing C, Gallea C, Hallett M. Mov Disord. 2011(13):2396-403. 3) Psychogenic paralysis and recovery after motor cortex transcranial magnetic stimulation. Chastan N., Parain D. Mov Disord. 2010; 25(10):1501-4.