Use of non-invasive neurostimulation for rehabilitation in functional movement disorders.

This is a narrative review, not a systematic review, so it does not describe how studies were found or appraised. Most studies were small, open-label, or case reports, and only a few had sham controls. Sham conditions often masked sound but not scalp sensation, so participants may still have known they received active stimulation. Protocols, targets, intensities, frequencies, and outcome measures were heterogeneous, making studies hard to compare. Some studies combined stimulation with suggestion, hypnosis, or yoga, so the effect of stimulation alone cannot be separated. Functional movement disorder presentations varied widely, including tremor, dystonia, myoclonus, gait disorder, and other movements, so results may not apply to every patient.

Do not read the reported improvements in open-label rTMS studies as proof that stimulation works. In the randomized trial, rTMS was not significantly better than control stimulation, and the authors suggested improvement may reflect a cognitive-behavioral effect rather than cortical neuromodulation.