Expectations and tolerance of transcranial magnetic stimulation in patients with functional neurological disorder

In patients with functional neurological disorder (FND), transcranial magnetic stimulation (TMS) can be used for either diagnostic or therapeutic purpose. This study aimed to determine patients' expectations and tolerance of TMS techniques.

Data were collected prospectively using a standardized questionnaire before, immediately after, and 14 days after a session combining TMS for diagnosis and treatment (based on repeated single-pulse TMS).

32 patients with FND were included. Most patients (79%) had received little or no information about TMS methods before the session. However, the majority of patients felt neither anxiety (78%) nor fear (69%) regarding this technique. With TMS, patients hoped more for a diagnosis (91%) than for even partial improvement of their symptoms (59%). Most patients (69%) rated the TMS experience as positive, although adverse events were frequent after the session (75%), but generally very mild. The occurrence of adverse events was associated with greater prior knowledge of TMS techniques and higher patients' expectations of treatment efficacy. Finally, an improvement in at least one of the initial symptoms was reported by 45% of patients during an interview conducted 14 days after the TMS session.

This work fills a significant clinical gap in our understanding of the expectations of patients with FND regarding the applications of TMS, and their relationship to tolerance and short-term outcomes. Patients' initial knowledge of TMS did not alter their expectations, which were higher regarding its diagnostic than therapeutic value. An important finding of this study is that it demonstrates, for the first time, that the therapeutic efficacy of TMS is not related to patients' expectations or their initial level of information distinguishing this technique from a placebo.