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..