In this episode, we speak with Dr. Mark Hallett about functional neurological disorders (FNDs). We cover the history, epidemiology, symptomatology, and pathophysiology of FNDs. We touch on the issue of “lumping versus splitting,” controversies in the literature, the need for better training on FNDs in medicine and psychology, and currently available treatments, among other topics.
A pdf of the transcript for this episode is available here.
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Dr. Hallett is an NIH Distinguished Investigator Emeritus having recently retired as the Chief of the Human Motor Control Section, NINDS, NIH, Bethesda. He obtained his MD at Harvard Medical School, had a medical internship at the Peter Bent Brigham Hospital, and a residency in Neurology at the Massachusetts General Hospital. He had fellowships in biophysics at the NIH and clinical neurophysiology at the Institute of Psychiatry in London. From 1976 to 1984, Dr. Hallett was the Chief of the Clinical Neurophysiology Laboratory at the Peter Bent Brigham Hospital, which became the Brigham and Women’s Hospital. He progressed at Harvard Medical School to Associate Professor of Neurology, and then in 1984, Dr. Hallett went to NINDS. He is currently the immediate Past-President of the Functional Neurological Disorder Society. Dr. Hallett is also remote past President of the International Parkinson and Movement Disorder Society and the International Federation of Clinical Neurophysiology and past Editor-in-Chief of Clinical Neurophysiology. He has won many awards including, in October 2019, the World Federation of Neurology Medal for Contributions to Neuroscience. His work mainly deals with principles of motor control and the pathophysiology of movement disorders. Recently, a focus of his work has been Functional Neurological Disorders.
Baizabal-Carvallo, J. F., Hallett, M., & Jankovic, J. (2019). Pathogenesis and pathophysiology of functional (psychogenic) movement disorders. Neurobiology of disease, 127, 32-44.
Ball, H. A., McWhirter, L., Ballard, C., Bhome, R., Blackburn, D. J., Edwards, M. J., … & Carson, A. J. (2020). Functional cognitive disorder: dementia’s blind spot. Brain, 143(10), 2895-2903.
Butler, M., Coebergh, J., Safavi, F., Carson, A., Hallett, M., Michael, B., … & Coronerve Studies Group. (2021). Functional neurological disorder after SARS-CoV-2 vaccines: two case reports and discussion of potential public health implications. The Journal of neuropsychiatry and clinical neurosciences, 33(4), 345-348.
Chung, D. S., Wettroth, C., Hallett, M., & Maurer, C. W. (2018). Functional speech and voice disorders: case series and literature review. Movement disorders clinical practice, 5(3), 312-316.
Drane, D. L., Fani, N., Hallett, M., Khalsa, S. S., Perez, D. L., & Roberts, N. A. (2021). A framework for understanding the pathophysiology of functional neurological disorder. CNS spectrums, 26(6), 555-561.
Espay, A. J., Aybek, S., Carson, A., Edwards, M. J., Goldstein, L. H., Hallett, M., … & Morgante, F. (2018). Current concepts in diagnosis and treatment of functional neurological disorders. JAMA neurology, 75(9), 1132-1141.
Gelauff, J., & Stone, J. (2016). Prognosis of functional neurologic disorders. Handbook of clinical neurology, 139, 523-541.
Hallett, M. (2018). Patients with Parkinson disease are prone to functional neurological disorders. Journal of Neurology, Neurosurgery & Psychiatry, 89(6), 557-557.
Hallett, M., Aybek, S., Dworetzky, B. A., McWhirter, L., Staab, J. P., & Stone, J. (2022). Functional neurological disorder: new subtypes and shared mechanisms. The Lancet Neurology.
Hanakawa, T., Goldfine, A. M., & Hallett, M. (2017). A common function of basal ganglia-cortical circuits subserving speed in both motor and cognitive domains. Eneuro, 4(6).
Kemp, S., Kapur, N., Graham, C. D., & Reuber, M. (2022). Functional Cognitive Disorder: Differential Diagnosis of Common Clinical Presentations. Archives of Clinical Neuropsychology.
Kletenik, I., Sillau, S. H., Isfahani, S. A., LaFaver, K., Hallett, M., & Berman, B. D. (2020). Gender as a risk factor for functional movement disorders: the role of sexual abuse. Movement disorders clinical practice, 7(2), 177-181.
LaFaver, K., LaFrance, W. C., Price, M. E., Rosen, P. B., & Rapaport, M. (2021). Treatment of functional neurological disorder: current state, future directions, and a research agenda. CNS spectrums, 26(6), 607-613.
Lehn, A., Navaratnam, D., Broughton, M., Cheah, V., Fenton, A., Harm, K., … & Pun, P. (2020). Functional neurological disorders: effective teaching for health professionals. BMJ neurology open, 2(1).
Lidstone, S. C., Bayley, M., & Lang, A. E. (2020). The evidence for multidisciplinary care in Parkinson’s disease. Expert Review of Neurotherapeutics, 20(6), 539-549.
Lidstone, S. C., Costa-Parke, M., Robinson, E. J., Ercoli, T., & Stone, J. (2022). Functional movement disorder gender, age and phenotype study: a systematic review and individual patient meta-analysis of 4905 cases. Journal of Neurology, Neurosurgery & Psychiatry, 93(6), 609-616.
Lidstone, S. C., MacGillivray, L., & Lang, A. E. (2020). Integrated therapy for functional movement disorders: time for a change. Movement disorders clinical practice, 7(2), 169-174.
Maurer, C. W., LaFaver, K., Limachia, G. S., Capitan, G., Ameli, R., Sinclair, S., … & Horovitz, S. G. (2018). Gray matter differences in patients with functional movement disorders. Neurology, 91(20), e1870-e1879.
Perez, D. L., Edwards, M. J., Nielsen, G., Kozlowska, K., Hallett, M., & LaFrance Jr, W. C. (2021). Decade of progress in motor functional neurological disorder: continuing the momentum. Journal of Neurology, Neurosurgery & Psychiatry, 92(6), 668-677.
Perez, D. L., Nicholson, T. R., Asadi-Pooya, A. A., Bègue, I., Butler, M., Carson, A. J., … & Aybek, S. (2021). Neuroimaging in functional neurological disorder: state of the field and research agenda. NeuroImage: Clinical, 30, 102623.
Pick, S., Anderson, D. G., Asadi-Pooya, A. A., Aybek, S., Baslet, G., Bloem, B. R., … & Nicholson, T. R. (2020). Outcome measurement in functional neurological disorder: a systematic review and recommendations. Journal of Neurology, Neurosurgery & Psychiatry, 91(6), 638-649.
Popkirov, S., Nicholson, T. R., Bloem, B. R., Cock, H. R., Derry, C. P., Duncan, R., … & Stone, J. (2019). Hiding in plain sight: functional neurological disorders in the news. The Journal of neuropsychiatry and clinical neurosciences, 31(4), 361-367.
Shin, H. W., Cho, H. J., Lee, S. W., Shitara, H., & Hallett, M. (2021). Sensory tricks in cervical dystonia correlate with enhanced brain activity during motor preparation. Parkinsonism & related disorders, 84, 135-138.
Spagnolo, P. A., Parker, J., Horovitz, S., & Hallett, M. (2021). Corticolimbic modulation via intermittent theta burst stimulation as a novel treatment for functional movement disorder: a proof-of-concept study. Brain sciences, 11(6), 791.
Spagnolo, P. A., Norato, G., Maurer, C. W., Goldman, D., Hodgkinson, C., Horovitz, S., & Hallett, M. (2020). Effects of TPH2 gene variation and childhood trauma on the clinical and circuit-level phenotype of functional movement disorders. Journal of Neurology, Neurosurgery & Psychiatry, 91(8), 814-821.
Spagnolo, P. A., Garvey, M., & Hallett, M. (2021). A dimensional approach to functional movement disorders: Heresy or opportunity. Neuroscience & Biobehavioral Reviews, 127, 25-36.
Tinazzi, M., Morgante, F., Marcuzzo, E., Erro, R., Barone, P., Ceravolo, R., … & Geroin, C. (2020). Clinical correlates of functional motor disorders: an Italian multicenter study. Movement disorders clinical practice, 7(8), 920-929.
Tinazzi, M., Geroin, C., Erro, R., Marcuzzo, E., Cuoco, S., Ceravolo, R., … & Morgante, F. (2021). Functional motor disorders associated with other neurological diseases: beyond the boundaries of “organic” neurology. European journal of neurology, 28(5), 1752-1758.
Tinazzi, M., Geroin, C., Marcuzzo, E., Cuoco, S., Ceravolo, R., Mazzucchi, S., … & Erro, R. (2021). Functional motor phenotypes: to lump or to split?. Journal of neurology, 268(12), 4737-4743.
Waugh, R. E., Parker, J. A., Hallett, M., & Horovitz, S. G. (2022). Classification of Functional Movement Disorders with Resting-State Functional Magnetic Resonance Imaging. Brain Connectivity.
Wissel, B. D., Dwivedi, A. K., Merola, A., Chin, D., Jacob, C., Duker, A. P., … & Espay, A. J. (2018). Functional neurological disorders in Parkinson disease. Journal of Neurology, Neurosurgery & Psychiatry, 89(6), 566-571.
Xie, X. Y., Lin, G. Z., Huang, Q., Li, C. B., Hallett, M., Voon, V., … & Wang, G. (2021). Opinions and clinical practice of functional movement disorders: a nationwide survey of clinicians in China. BMC neurology, 21(1), 1-10.