This site is open to all, that is, patients, their families, doctors and anyone who would like information on this new major concept concerning neurology: "Functional Neurological disorders". A new type of support is offered with many illustrations in the form of videos.
1- In the drop-down menu "Functional
Neurological Disorders" you will find a text on the
generalities concerning these
disorders with a link to a site written by our British colleagues and
translated into French: "www.neurosymptoms.org" which describes in detail
all the different clinical aspects of functional neurological disorders.
There is also a text concerning the old and current
pathophysiological
assumptions about the origin of these disorders.
2- In the drop-down menu "magnetic stimulation", you will find information on the type of
stimulation used for functional neurological disorders and the supposed
mechanisms of action.
3- In the drop-down menu "patients",
you will find several examples of stimulation sessions, illustrated
alongside videos, on patients with different types of functional
neurological disorders.
An important addition to this website will be available at the beginning of
March 2019, reserved for doctors. The central and peripheral magnetic
stimulation technique will be detailed in a more precise manner, as well as
the necessary equipment. Many additional examples of patients will be given
in the various clinical areas cited in the open website to all but also in
other areas of functional neurological disorders. Neurologists are involved
in the foreground but also rheumatologists (central neuropathic pain,
fibromyalgia e.g.), orthopaedic surgeons (functional neurological disorders
consequences of an orthopedic lesion or surgery), and ENT (Dyskinesia of
vocal chords). With this data, a doctor familiar with this type of pathology
could easily be introduced to this form of treatment.
Docteur Dominique PARAIN.
Since 1995, I have been caring for patients with functional neurological
disorders such as paralysis, sensory disorders, abnormal movements (tremors,
dystonia), non-epileptic seizures or pain. These patients are addressed to me
either by their neurologist, or their rheumatologist. All present complementary
examinations (imaging, biological checkup, neurophysiological examinations),
eliminating any classical organic condition.
Neurological functional disorders represent the second reason for external
consultation with a neurologist. It is now known that these symptoms are related
to disorders of cerebral connectivity (fragility of the connection between
neurons) which are the result of a genetic predisposition and/or emotional
factors and/or physical trauma on parts of the body. We cannot, at present,
identify these disorders using conventional imaging, but this is now possible in
some research labs. Essentially, these patients have neurological disorders. But
very often they are wrongly diagnosed as patients with psychiatric problems,
which more often aggravates their distress. The overall prognosis of functional
neurological disorders is considered to be unfavourable despite the proposed
treatments which are often limited to analgesic-targeted prescriptions,
physiotherapy (for motor problems), hypnosis or behavioural therapy (when it is
accessible).
In this website, I explain how and why, since 1995, I have been led to develop
the management of these patients, using a particular type of transcranial
magnetic stimulation called "Large Field", coupled with peripheral magnetic
stimulation, on other parts of the body. We know that the nervous system works
through chemical and electrical phenomena. Magnetic stimulation is able to act
by transforming itself into electric current deep inside the brain at the level
of peripheral sensory nets.
In most University hospitals, another type of Transcrâniennne magnetic
stimulation is used, called "focal length", and only acts on 1 to 2 cm² of
cerebral cortex with almost exclusive indication of depression. This technique
does not work in neurological functional disorders in view of the complexity of
the networks involved (explanations in the site).
The method I use, is technically simpler than the focal method. To learn more
about the procedure and the necessary material (link with magnetic stimulation
on the site).
This type of treatment has become central to the management of my patients,
including when I associate other therapeutic approaches. In this mode of
stimulation, the pain threshold is never exceeded and there are no significant
side effects. I was able to significantly improve many of my patients (about two
out of three).
To objectively identify the evolution of the symptoms and to measure the
effectiveness of the stimulation, I often filmed my patients, especially those
with motor manifestations.
To help you better understand the effect of this stimulation, you can view
several of these videos (some are anonymised) available on this website: see
menu "patients"
This technique has been the subject of several scientific publications emanating
from the CHU in Rouen, where I worked in the Department of Neurology, and from
the Department of Neurology of the hospital of the Salpêtrière in Paris which,
for about ten years now, has been using the same technique obtaining similar
results in paralysis as well as in abnormal functional movements. A multicentric,
controlled study, coordinated by the Department of Neurophysiology in the CHU
Rouen, on functional paralysis, comparing a central magnetic stimulation to a
placebo stimulation, is currently being drafted. It clearly shows that the
results are significantly better with active stimulation when it is performed
early, i.e. in the first few months after the onset of symptoms. When the
stimulation is performed later, the results are not as significant. I would like
to clarify that in my practice the addition of peripheral magnetic stimulation
significantly improves any results. A recent study shows, moreover, that
peripheral magnetic stimulation modifies the excitability of the motor cortex in
a retrograde way. This technique therefore has a true effect of cerebral
neuromodulation.
One of the key points, which I would therefore like to point out, is the need
to propose this type of treatment as quickly as possible in order to prevent the
patient from settling in their pathology for too long, therefore becoming
resistant to this treatment. Even when the situation is worsening, neurological
functional disorders often have an evolutionary character.
In view of the results obtained, after years of practice on a considerable
number of patients sometimes coming from all over France and in view of the data
of the literature (even if they could be considered insufficient), this type of
treatment appears to have a real place in the therapeutic arsenal for these
patients. Other arguments may support this indication: the safety of the
technique; its low cost; The often severe handicap presented by these patients
and the current weakness of any therapeutic proposals.
Certainly a third of the patients will not respond to the technique. For others,
the benefit can be extremely important. Very often, just one stimulation session
may not enough. The effect is sometimes partly transient. You have to be able to
repeat the sessions when and as much as necessary. This is a real support..