This 16 year old patient has, for a year and a half, presented a dystonia of the right thumb. This dystonia appeared in the first instance, after having played a prolonged session of badminton. It was a flexing dystonia that prevented her from writing. Three months before her consultation, while opening a pot of yogurt, the flexing dystonia turned into an extended dystonia, which was the case for the first phalanx of the thumb.

During this consultation, she therefore presented a very particular dystonia of the thumb (see video 1). There is no pain, but there is an important hypoesthesia of the first two fingers of both hands and of the dorsal space between the first two metacarpal bones.

The first stimulation session will include a classic wide field central transcranial magnetic stimulation and a further very high intensity stimulation (in power mode) and at a higher frequency (8 Hz) at the anesthetised area of the hand on the right side. There would be no immediate improvement. At the end of the third day, the dystonia of the right thumb disappeared (see video 2). The anesthesia persisted. I see the patient every three months in order to try and bring back sensitivity on the anesthetised areas of both hands, but for the moment without any success.

This patient presents two types of symptoms, firstly an anesthesia of the first two fingers of the hands and of the first Intermetacarpal space in a bilateral way and secondly a dystonia of the right thumb which occurred after a relatively small triggering factor. Once again we see the fragility of these connectivity disorders at the origin of functional neurological symptoms. It is likely that anesthesia was pre-dystonia. This type of anesthesia can be the base for neurological functional disorders of the type pain, dystonia or other. Even if the dystonia has disappeared, it is necessary to try to remove the anesthesia to avoid relapse by stimulating these regions at high intensity and frequency. Neither the onset date nor the triggering factor of this anesthesia are known. It should be noted that it is always necessary to seek out this type of anesthesia or hypoesthesia in neurological functional disorders because they can be ignored by the patient and may require specific treatment by stimulation.

 

This 45 year old patient has, since 10 years ago, a very severe sprain of the left ankle resulting in a severe algodystrophy that has gradually provoked significant bone destruction of the joint, a total anesthesia of the left leg with dystonia of the knee and hip, justifying the installation of orthotics to help her with walking. Subsequently, a few years later, a hypoesthesia of the left hemi-thorax and left arm appeared with a dystonia of the left hand predominantly on the last 3 fingers (see video 1).

The patient thus presents an important hypoesthesia of the left hemibody, predominantly on the leg where it is total but respecting the face. The leg is very stiff with a very altered motor drive. She is most often in a wheelchair. There is also a hypoesthesia of the left arm with dystonia very difficult to reduce manually and predominantly on the last three fingers, significantly disturbing the use of this hand.

The stimulation attempts at very high intensity and frequency resulted in no improvement to the left leg. However, it is possible, through the use of peripheral stimulation at the level of the left hand, to reduce the dystonia, by stimulating equally very strongly, with the two capacitors, at a frequency of 3 Hz (see video 2).

The clinical history of this patient perfectly demonstrates the evolutionary nature of functional neurological disorders according to a classic 'here' pattern. When the disease begins at the foot level, it will very often be associated with hypoesthesia which will diffuse upwards and can associate with motor problems at arm and hand level, or even pain. The disorder usually respects the face. Due to the significant delay between the onset of the disturbances and the first stimulation session, the oldest affected part of the body did not react to the simulation. In addition, at the level of the leg, she presents a total anesthesia and I did not manage to trigger a sensation even with a high intensity and frequency of stimulation. If I fail to trigger sensations, with an onset of pain, there can be no recovery, even partial. However, at the level of the upper left limb, where the troubles were less important and occurred later on, I was able to obtain a certain efficiency, especially at the level the dystonia of the left hand. I have to renew this stimulation every month and a half because the effect is transient and the dystonia reappears after this time.