Psychogenic Paralysis Clinical Trial
Psychogenic paralysis presents a real treatment challenge. Despite psychotherapy,
physiotherapy, antidepressants, acupuncture or hypnosis, the outcome is not always
satisfactory with persistent symptoms after long-term follow-up. In a preliminary
retrospective study on 70 patients with psychogenic paralysis (44F/26M, mean age : 24.7 ±
16.6 ys), repetitive transcranial magnetic stimulation (rTMS) delivered over the motor
cortex at low frequency was effective in 89% of cases (recovery: n=53, improvement: n=9),
with an immediate or quasi-immediate recovery in 73% of patients (n=51).
We suggest that the dramatic improvement of psychogenic paralysis after rTMS could be due to
the restoration of an appropriate cerebral connectivity by activating a suppressed motor
cortex. Nevertheless, the possibility of a placebo effect cannot be ruled out.
A prospective multicentric (Rouen, Caen) randomized controlled trial versus placebo will be
done for 94 patients with psychogenic paralysis, 1- to evaluate rTMS efficacy for paralysis
at short and long term follow-up, and 2- to confirm rTMS safety. Two rTMS sessions will be
performed at D0 and D1 (120 pulses over 2 days, delivered over the motor cortex at 2 Hz)
with an active or a sham coil. Post-rTMS assessment will evaluate 1- the degree of the
paralysis at D2 (quantified by a videotape) and D60 (quantified by an interview and a
standardized examination), 2- the number and gravity of side effects.
If psychogenic paralysis improvement by motor cortex rTMS is confirmed, rTMS could be
considered a useful early therapeutic option.
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Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Investigator, Outcomes Assessor), Primary Purpose: Treatment