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McLoughlin C, Hoeritzauer I, Cabreira V, Aybek S, Adams C, Alty J, Ball HA, Baker J, Bullock K, Burness C, Dworetzky BA, Finkelstein S, Garcin B, Gelauff J, Goldstein LH, Jordbru A, Huys ACM, Laffan A, Lidstone SC, Linden SC, Ludwig L, Maggio J, Morgante F, Mallam E, Nicholson C, O'Neal M, O'Sullivan S, Pareés I, Petrochilos P, Pick S, Phillips W, Roelofs K, Newby R, Stanton B, Gray C, Joyce EM, Tijssen MA, Chalder T, McCormick M, Gardiner P, Bègue I, Tuttle MC, Williams I, McRae S, Voon V, McWhirter L. Functional neurological disorder is a feminist issue. J Neurol Neurosurg Psychiatry 2023; 94:855-862. [PMID: 36977553 PMCID: PMC10511956 DOI: 10.1136/jnnp-2022-330192] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 02/26/2023] [Indexed: 03/30/2023]
Abstract
Functional neurological disorder (FND) is a common and disabling disorder, often misunderstood by clinicians. Although viewed sceptically by some, FND is a diagnosis that can be made accurately, based on positive clinical signs, with clinical features that have remained stable for over 100 years. Despite some progress in the last decade, people with FND continue to suffer subtle and overt forms of discrimination by clinicians, researchers and the public. There is abundant evidence that disorders perceived as primarily affecting women are neglected in healthcare and medical research, and the course of FND mirrors this neglect. We outline the reasons why FND is a feminist issue, incorporating historical and contemporary clinical, research and social perspectives. We call for parity for FND in medical education, research and clinical service development so that people affected by FND can receive the care they need.
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Affiliation(s)
- Caoimhe McLoughlin
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Ingrid Hoeritzauer
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Verónica Cabreira
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Neurology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Selma Aybek
- Department of Clinical Neuroscience, Hopitaux Universitaires de Geneve, Geneva, Switzerland
- Department of Clinical Neuroscience, Inselspital Universitatsspital Bern Universitatsklinik fur Neurologie, Bern, Switzerland
| | - Caitlin Adams
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jane Alty
- College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
- Neurology, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Harriet A Ball
- Bristol Medical School, University of Bristol Faculty of Health Sciences, Bristol, UK
- Neurology, North Bristol NHS Trust, Westbury on Trym, UK
| | - Janet Baker
- Randwick Specialist Centre, Private Practice, Randwick, New South Wales, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Kim Bullock
- Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, Stanford, California, USA
| | | | - Barbara A Dworetzky
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sara Finkelstein
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Jeannette Gelauff
- Department of Neurology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Laura H Goldstein
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Anika Jordbru
- Faculty of Humanities, Sport and Educational Science, University of South-Eastern Norway, Kongsberg, Norway
| | - Anne-Catherine Ml Huys
- Department of Neurology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Aoife Laffan
- Neurology, St. James's Hospital, Dublin, Ireland
| | - Sarah C Lidstone
- University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - Stefanie Caroline Linden
- Department of Health, Ethics and Society, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Lea Ludwig
- Department of Clinical Psychology and Psychotherapy, University of Hamburg, Hamburg, Germany
| | - Julie Maggio
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Physical Therapy and Functional Neurological Disorder Unit and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Francesca Morgante
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University Hospitals NHS Foundation Trust, London, UK
- Department of Experimental and Clinical Medicine, University of Messina, Messina, Italy
| | - Elizabeth Mallam
- The Rosa Burden Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Clare Nicholson
- Therapy Services, National Hospital for Neurology & Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Mary O'Neal
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Isabel Pareés
- Movement Disorders Program, Neurology Deparment Hospital Ruber Internacional, Madrid, Spain
- Movement Disorders Unit, Neurology Department, Hospital Ramón y Cajal, Madrid, Spain
| | | | - Susannah Pick
- Section of Cognitive Neuropsychiatry, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Wendy Phillips
- Department of Neurology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Karin Roelofs
- Donders Institute for Brain Cognition and Behaviour: Donders Centre for Cognitive Neuroimaging, Radboud University Nijmegen, Nijmegen, The Netherlands
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, Netherlands
| | - Rachel Newby
- Neurology, Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Cordelia Gray
- Neurology Psychotherapy Service, Sheffield Teaching Hospital, Academic Neurology Unit, The University of Sheffield, Sheffield, UK
| | - Eileen M Joyce
- Neuropsychiatry, UCL Queen Square Institute of Neurology, London, UK
| | - Marina Aj Tijssen
- Expertise Center Movement Disorders Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Trudie Chalder
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Maxanne McCormick
- Physician assistant/patient with FND, FNDRecovery.com, -, Monument CO, USA
| | - Paula Gardiner
- Psychological Therapy in Primary Care, University of Dundee, Dundee, UK
- enhance-cbt.com therapist, NeuroSpecialist Physiotherapist, Stirling, UK
| | - Indrit Bègue
- Department of Psychiatry, Geneva University Hospitals, Geneve, Switzerland
| | - Margaret C Tuttle
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Functional Neurological Disorder Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Isobel Williams
- Neuropsychology, Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK
| | - Sarah McRae
- Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK
| | - Valerie Voon
- Psychiatry, University of Cambridge, Cambridge, UK
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Laura McWhirter
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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9
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Perez DL, Aybek S, Popkirov S, Kozlowska K, Stephen CD, Anderson J, Shura R, Ducharme S, Carson A, Hallett M, Nicholson TR, Stone J, LaFrance WC, Voon V. A Review and Expert Opinion on the Neuropsychiatric Assessment of Motor Functional Neurological Disorders. J Neuropsychiatry Clin Neurosci 2021; 33:14-26. [PMID: 32778007 DOI: 10.1176/appi.neuropsych.19120357] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Functional neurological (conversion) disorder (FND) is a prevalent and disabling condition at the intersection of neurology and psychiatry. Advances have been made in elucidating an emerging pathophysiology for motor FND, as well as in identifying evidenced-based physiotherapy and psychotherapy treatments. Despite these gains, important elements of the initial neuropsychiatric assessment of functional movement disorders (FND-movt) and functional limb weakness/paresis (FND-par) have yet to be established. This is an important gap from both diagnostic and treatment planning perspectives. In this article, the authors performed a narrative review to characterize clinically relevant variables across FND-movt and FND-par cohorts, including time course and symptom evolution, precipitating factors, medical and family histories, psychiatric comorbidities, psychosocial factors, physical examination signs, and adjunctive diagnostic tests. Thereafter, the authors propose a preliminary set of clinical content that should be assessed during early-phase patient encounters, in addition to identifying physical signs informing diagnosis and potential use of adjunctive tests for challenging cases. Although clinical history should not be used to make a FND diagnosis, characteristics such as acute onset, precipitating events (e.g., injury and surgery), and a waxing and waning course (including spontaneous remissions) are commonly reported. Active psychiatric symptoms (e.g., depression and anxiety) and ongoing psychosocial stressors also warrant evaluation. Positive physical examination signs (e.g., Hoover's sign and tremor entrainment) are key findings, as one of the DSM-5 diagnostic criteria. The neuropsychiatric assessment proposed emphasizes diagnosing FND by using "rule-in" physical signs while also considering psychiatric and psychosocial factors to aid in the development of a patient-centered treatment plan.
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Affiliation(s)
- David L Perez
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Selma Aybek
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Stoyan Popkirov
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Kasia Kozlowska
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Christopher D Stephen
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Jordan Anderson
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Robert Shura
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Simon Ducharme
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Alan Carson
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Mark Hallett
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Timothy R Nicholson
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Jon Stone
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - W Curt LaFrance
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Valerie Voon
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
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- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
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