Objective: St Vincent’s Hospital Sydney has been offering Transcranial Magnetic Stimulation (TMS) to adult patients with a diagnosis of Functional Movement Disorders (FMD) since 2020. The aim of this single-centre retrospective audit was to examine our practices and outcomes in TMS for FMD and compare this to published studies.

Background: FMD represents a significant proportion of presentations to neurology acute care and is disabling for patients and burdensome on healthcare resources. TMS has recently emerged as a novel treatment, offering a non-invasive, non-pharmacological therapeutic option which is relatively fast and cost-effective.

Method: 12 patients with FMD were treated with TMS at St Vincent’s Hospital Sydney from 2020 to July 2024. Data was collected at a single time point in July 2024 via structured phone interview and review of records. A systematic literature search using PubMed identified publications using single pulse or repetitive TMS as treatment for FMD and protocols at our centre were qualitatively compared to published literature. Outcomes included patient reported Clinical Global Impression of Improvement (CGI-I) in symptoms after TMS, modified Rankin Scale (mRS), employment status and use of disability services.

Results: There is heterogeneity amongst published literature with regards to TMS parameters used, particularly number of pulses delivered and number of treatment sessions. Site of stimulation, frequency and intensity were consistent over most studies. In our cohort of 12, patient reported CGI-I after treatment varied: 3 patients reported much improvement (CGI-2), 1 patient reported minimal improvement (CGI-I 3), 6 patients reported no change (CGI-I 4) and 2 patients reported minimal worsening (CGI-I 5). Most patients remained functionally impaired with 4 patients with mRS of 0-1, 6 patients with mRS of 2-3 and 2 patients with mRS of 4. 3 patients were working or studying.

Conclusion: Our current treatment practices are comparable to published literature, but the number of sessions delivered to each patient was variable and the interval between consecutive treatments was long. Outcomes in our group were mixed with 50% of patients reporting no change in symptoms and most patients remaining functionally disabled, though outcome assessments were limited to patient recalled retrospective data, subjective to bias.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/transcranial-magnetic-stimulation-as-treatment-for-functional-movement-disorders-experiences-from-a-single-centre-retrospective-audit/