Psychiatry Investig.  2018 Apr;15(4):428-431. 10.30773/pi.2017.10.16.2.

Chasing the Chameleon: Psychogenic Paraparesis Responding to Non-Invasive Brain Stimulation

• Portaro S
• Milardi D
• Naro A
• Chillura A
• Corallo F
• Quartarone A
• Calabrò R

• KMID: 2411398
• DOI: http://doi.org/10.30773/pi.2017.10.16.2

Abstract

Neurologic symptoms that develop unconsciously and are incompatible with known pathophysiologic mechanisms or anatomic pathways belong to Conversion Disorder (CD). CD diagnosis is based on the clinical history and the exclusion of physical disorders causing significant distress or social and occupational impairment. In a subgroup of CD, called functional weakness (FW), symptoms affecting limbs may be persistent, thus causing a permanent or transient loss of limb function. Physiotherapy, pharmacotherapy, hypnotherapy and repetitive transcranial magnetic stimulation (rTMS) have been proposed as treatment strategies for FW-CD. Herein, we report a 30 year-old male, presenting with lower limb functional paraparesis, having obtained positive, objectively, and stable effects from a prolonged r-TMS protocol associated to a multidisciplinary approach, including psychological and sexuological counseling, and monitored by gait analysis. We postulate that our rTMS protocol, combined with a multidisciplinary approach may be the proper treatment strategy to improve FW-CD.

Keyword

Functional weakness; Conversion disorder; Repetitive Transcranial Magnetic Stimulation (r-TMS); Multidisciplinary approach; Treatment strategies

MeSH Terms

Brain*
Conversion Disorder
Counseling
Diagnosis
Drug Therapy
Extremities
Gait
Humans
Hypnosis
Lower Extremity
Male
Neurologic Manifestations
Paraparesis*
Transcranial Magnetic Stimulation