Treating dissociative post-traumatic stress disorder presenting as a functional movement disorder with transcranial magnetic stimulation targeting the cingulate gyrus

Abstract

A 29-year-old woman presented with head and neck dystonia, as well as functional seizures. The patient was an active military service member with a history of combat-related trauma. Resting blood oxygen level dependent (BOLD) functional MRI (fMRI) scans of the brain demonstrated an increased anterior cingulate component of the salience network and hyper-connectivity between the insula and cingulate. Following neurological and psychiatric evaluation, she was diagnosed with dissociative post-traumatic stress disorder, partially presenting as a functional movement disorder. Inhibitory repetitive transcranial magnetic stimulation (rTMS) was prescribed with the anterior cingulate as the primary target, and supplementary motor and premotor cortices as secondary targets. The treatment was intended to suppress tremors both directly and indirectly. Thirty-six sessions later, her symptoms were in remission, and she returned to active duty. This case demonstrates the potential efficacy of fMRI-guided rTMS in the treatment of dissociative PTSD.

Keywords: Anterior cingulate; Dissociative PTSD; Functional movement disorder; TMS.