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December 2020; 10 (6) Commentary

Cautionary notes on diagnosing functional neurologic disorder as a neurologist-in-training

View ORCID ProfileDavid L. Perez, Ann Hunt, Nutan Sharma, Alice Flaherty, David Caplan, Jeremy D. Schmahmann
First published December 4, 2019, DOI: https://doi.org/10.1212/CPJ.0000000000000779
David L. Perez
Departments of Neurology and Psychiatry (DLP), Functional Neurology Research Group, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School; Department of Neurology (AH, NS, AF), Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School; Department of Neurology (DC), Cognitive Behavioral Neurology Unit, Massachusetts General Hospital, Harvard Medical School; and Department of Neurology (JDS), Ataxia Unit, Cognitive Behavioral Neurology Unit, Laboratory for Neuroanatomy and Cerebellar Neurobiology, Massachusetts General Hospital, Harvard Medical School, Boston.
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  • ORCID record for David L. Perez
Ann Hunt
Departments of Neurology and Psychiatry (DLP), Functional Neurology Research Group, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School; Department of Neurology (AH, NS, AF), Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School; Department of Neurology (DC), Cognitive Behavioral Neurology Unit, Massachusetts General Hospital, Harvard Medical School; and Department of Neurology (JDS), Ataxia Unit, Cognitive Behavioral Neurology Unit, Laboratory for Neuroanatomy and Cerebellar Neurobiology, Massachusetts General Hospital, Harvard Medical School, Boston.
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Nutan Sharma
Departments of Neurology and Psychiatry (DLP), Functional Neurology Research Group, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School; Department of Neurology (AH, NS, AF), Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School; Department of Neurology (DC), Cognitive Behavioral Neurology Unit, Massachusetts General Hospital, Harvard Medical School; and Department of Neurology (JDS), Ataxia Unit, Cognitive Behavioral Neurology Unit, Laboratory for Neuroanatomy and Cerebellar Neurobiology, Massachusetts General Hospital, Harvard Medical School, Boston.
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Alice Flaherty
Departments of Neurology and Psychiatry (DLP), Functional Neurology Research Group, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School; Department of Neurology (AH, NS, AF), Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School; Department of Neurology (DC), Cognitive Behavioral Neurology Unit, Massachusetts General Hospital, Harvard Medical School; and Department of Neurology (JDS), Ataxia Unit, Cognitive Behavioral Neurology Unit, Laboratory for Neuroanatomy and Cerebellar Neurobiology, Massachusetts General Hospital, Harvard Medical School, Boston.
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David Caplan
Departments of Neurology and Psychiatry (DLP), Functional Neurology Research Group, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School; Department of Neurology (AH, NS, AF), Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School; Department of Neurology (DC), Cognitive Behavioral Neurology Unit, Massachusetts General Hospital, Harvard Medical School; and Department of Neurology (JDS), Ataxia Unit, Cognitive Behavioral Neurology Unit, Laboratory for Neuroanatomy and Cerebellar Neurobiology, Massachusetts General Hospital, Harvard Medical School, Boston.
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Jeremy D. Schmahmann
Departments of Neurology and Psychiatry (DLP), Functional Neurology Research Group, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School; Department of Neurology (AH, NS, AF), Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School; Department of Neurology (DC), Cognitive Behavioral Neurology Unit, Massachusetts General Hospital, Harvard Medical School; and Department of Neurology (JDS), Ataxia Unit, Cognitive Behavioral Neurology Unit, Laboratory for Neuroanatomy and Cerebellar Neurobiology, Massachusetts General Hospital, Harvard Medical School, Boston.
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Citation
Cautionary notes on diagnosing functional neurologic disorder as a neurologist-in-training
David L. Perez, Ann Hunt, Nutan Sharma, Alice Flaherty, David Caplan, Jeremy D. Schmahmann
Neurol Clin Pract Dec 2020, 10 (6) 484-487; DOI: 10.1212/CPJ.0000000000000779

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Abstract

Functional neurologic disorder (FND), although neglected for much of the 20th century, is among the most common conditions encountered by neurologists across clinical settings. High prevalence rates and limited provider expertise in FND have created a considerable need to develop educational initiatives and practical suggestions to guide neurologists in training working with this population. To help avoid diagnostic errors, trainees should keep in mind that (1) marginally positive functional examination signs have low specificity; (2) FND can coexist with other neurologic comorbidities; and (3) bizarre, not previously encountered, neurologic presentations should not be mistakenly diagnosed as FND. Furthermore, trainees should be encouraged to longitudinally follow in their clinics a subset of patients with FND to develop the interview, diagnostic, and neuropsychiatric skills needed to effectively care for this population. As the landscape of neurologic care evolves, neurologists with expertise in FND should advise on shaping elements of the educational curriculum for neurology residents.

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  • Funding information and disclosures are provided at the end of the article. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.

  • Editorial, page 471

  • Received September 6, 2019.
  • Accepted October 17, 2019.
  • © 2019 American Academy of Neurology
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