Garcin Béatrice, Mesrati Francine, Hubsch Cécile, Mauras Thomas, Iliescu Iulia, Naccache Lionel, Vidailhet Marie, Roze Emmanuel, Degos Bertrand
Neurology Department, Parkinson's Disease Expert Centre, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.
Institut du Cerveau et de la Moelle épinière (ICM), UPMC UMRS 1127, INSERM U 1127, CNRS UMR 7225, Paris, France.
Front Neurol. 2017 Jul 19;8:338. doi: 10.3389/fneur.2017.00338. eCollection 2017.
Recent studies suggest that repeated transcranial magnetic stimulation (TMS) improves functional movement disorders (FMDs), but the underlying mechanisms are unclear. The objective was to determine whether the beneficial action of TMS in patients with FMDs is due to cortical neuromodulation or rather to a cognitive-behavioral effect.
Consecutive patients with FMDs underwent repeated low-frequency (0.25 Hz) magnetic stimulation over the cortex contralateral to the symptoms or over the spinal roots [root magnetic stimulation (RMS)] homolateral to the symptoms. The patients were randomized into two groups: group 1 received RMS on day 1 and TMS on day 2, while group 2 received the same treatments in reverse order. We blindly assessed the severity of movement disorders before and after each stimulation session.
We studied 33 patients with FMDs (dystonia, tremor, myoclonus, Parkinsonism, or stereotypies). The median symptom duration was 2.9 years. The magnetic stimulation sessions led to a significant improvement (>50%) in 22 patients (66%). We found no difference between TMS and RMS.
We suggest that the therapeutic benefit of TMS in patients with FMDs is due more to a cognitive-behavioral effect than to cortical neuromodulation.
近期研究表明，重复经颅磁刺激（TMS）可改善功能性运动障碍（FMDs），但其潜在机制尚不清楚。目的是确定TMS对FMDs患者的有益作用是由于皮质神经调节还是认知行为效应。
连续的FMDs患者在症状对侧皮质或症状同侧脊髓神经根[神经根磁刺激（RMS）]上接受重复低频（0.25Hz）磁刺激。患者被随机分为两组：第1组在第1天接受RMS，第2天接受TMS，而第2组接受相反顺序的相同治疗。我们在每次刺激前后盲目评估运动障碍的严重程度。
我们研究了33例FMDs患者（肌张力障碍、震颤、肌阵挛、帕金森症或刻板动作）。症状持续时间的中位数为2.9年。磁刺激疗程使22例患者（66%）有显著改善（>50%）。我们发现TMS和RMS之间没有差异。
我们认为，TMS对FMDs患者的治疗益处更多地归因于认知行为效应而非皮质神经调节。
