Transcranial magnetic stimulation and sedation as treatment for functional neurologic disorders

TY - CHAP

T1 - Transcranial magnetic stimulation and sedation as treatment for functional neurologic disorders

AU - Nicholson, T. R.J.

AU - Voon, V.

PY - 2016

Y1 - 2016

N2 - Functional neurologic disorder (FND), also known as conversion disorder, is common and often associated with a poor prognosis. It has been relatively neglected by research and as such there is a conspicuous lack of evidence-based treatments. Physical and psychologic therapies are the main treatment modalities, over and above reassurance and sensitive explanation of the diagnosis. However there are two other historic treatments that have seen a recent resurgence of interest and use. The first is electric stimulation, which was initially pioneered with direct stimulation of nerves but now used indirectly (and therefore noninvasively) in the form of transcranial magnetic stimulation (TMS). The second is (therapeutic) sedation, previously known as “abreaction,” where it was mostly used in the context of psychologic investigation and treatment, but now increasingly advocated during rehabilitation as a way to therapeutically demonstrate reversibility of symptoms. This chapter introduces the background of these treatment modalities, their evolution into their current applications before critically evaluating their current evidence base and exploring possible mechanisms of action. It also tentatively suggests when they should be considered in current practice and briefly considers their future potential. In summary there is encouraging preliminary evidence to suggest that both TMS and sedation may be effective treatments for FNDs.

AB - Functional neurologic disorder (FND), also known as conversion disorder, is common and often associated with a poor prognosis. It has been relatively neglected by research and as such there is a conspicuous lack of evidence-based treatments. Physical and psychologic therapies are the main treatment modalities, over and above reassurance and sensitive explanation of the diagnosis. However there are two other historic treatments that have seen a recent resurgence of interest and use. The first is electric stimulation, which was initially pioneered with direct stimulation of nerves but now used indirectly (and therefore noninvasively) in the form of transcranial magnetic stimulation (TMS). The second is (therapeutic) sedation, previously known as “abreaction,” where it was mostly used in the context of psychologic investigation and treatment, but now increasingly advocated during rehabilitation as a way to therapeutically demonstrate reversibility of symptoms. This chapter introduces the background of these treatment modalities, their evolution into their current applications before critically evaluating their current evidence base and exploring possible mechanisms of action. It also tentatively suggests when they should be considered in current practice and briefly considers their future potential. In summary there is encouraging preliminary evidence to suggest that both TMS and sedation may be effective treatments for FNDs.

KW - (transcranial) magnetic stimulation

KW - abreaction

KW - amytal

KW - conversion disorder

KW - dissociation

KW - functional neurologic symptoms

KW - hysteria

KW - narcoanalysis

KW - psychogenic

KW - sedation

KW - TMS

UR - http://www.scopus.com/inward/record.url?scp=85016134555&partnerID=8YFLogxK

U2 - 10.1016/B978-0-12-801772-2.00050-3

DO - 10.1016/B978-0-12-801772-2.00050-3

M3 - Chapter

C2 - 27719877

AN - SCOPUS:85016134555

VL - 139

T3 - Handbook of Clinical Neurology

SP - 619

EP - 629

BT - Handbook of Clinical Neurology

PB - Elsevier B.V.

ER -