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December 2020; 10 (6) Commentary

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
First published December 4, 2019, DOI: https://doi.org/10.1212/CPJ.0000000000000779
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Article Information

vol. 10 no. 6 484-487
DOI: 
https://doi.org/10.1212/CPJ.0000000000000779
Published By: 
Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology
Print ISSN: 
2163-0402
Online ISSN: 
2163-0933
History: 
  • Received September 6, 2019
  • Accepted October 17, 2019
  • First Published December 4, 2019.

Article Versions

Copyright & Usage: 
© 2019 American Academy of Neurology

Author Disclosures

    1. David L. Perez, MD, MMSc,
    2. Ann Hunt, DO,
    3. Nutan Sharma, MD, PhD,
    4. Alice Flaherty, MD, PhD,
    5. David Caplan, MD, PhD and
    6. Jeremy D. Schmahmann, MD
  1. David L. Perez, MD, MMSc,
    2. Scientific Advisory Boards:

    1. NONE

    Gifts:

    1. NONE

    Funding for Travel or Speaker Honoraria:

    1. NONE

    Editorial Boards:

    1. NONE

    Patents:

    1. NONE

    Publishing Royalties:

    1. NONE

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. NONE

    Speakers' Bureaus:

    1. NONE

    Other Activities:

    1. NONE

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. NONE

    Research Support, Government Entities:

    1. National Institute of Mental Health (NIMH), 1K23MH111983- 01A1, PI, 9/2017-8/2022 Please note: the above funding did not support this manuscript

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. Sidney R. Baer Jr. Foundation Please note: the above funding did not support this manuscript

    Stock/Stock Options/Board of Directors Compensation:

    1. NONE

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  2. Ann Hunt, DO,
    3. Scientific Advisory Boards:

    1. NONE

    Gifts:

    1. NONE

    Funding for Travel or Speaker Honoraria:

    1. NONE

    Editorial Boards:

    1. NONE

    Patents:

    1. NONE

    Publishing Royalties:

    1. NONE

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. NONE

    Speakers' Bureaus:

    1. NONE

    Other Activities:

    1. NONE

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. NONE

    Research Support, Government Entities:

    1. NONE

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. NONE

    Stock/Stock Options/Board of Directors Compensation:

    1. NONE

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  3. Nutan Sharma, MD, PhD,
    4. Scientific Advisory Boards:

    1. NONE

    Gifts:

    1. NONE

    Funding for Travel or Speaker Honoraria:

    1. NONE

    Editorial Boards:

    1. Brain and Behavior, Associate Editor, 2016 - 2018 Brain and Behavior, Editor in Chief, 2019

    Patents:

    1. NONE

    Publishing Royalties:

    1. NONE

    Employment, Commercial Entity:

    1. Employed full-time by the Massachusetts General Hospital Physicians Organization.

    Consultancies:

    1. NONE

    Speakers' Bureaus:

    1. NONE

    Other Activities:

    1. NONE

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. NONE

    Research Support, Government Entities:

    1. NIH , P01 NS087997, PI of clinical core 2015-present

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. NONE

    Stock/Stock Options/Board of Directors Compensation:

    1. NONE

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  4. Alice Flaherty, MD, PhD,
    5. Scientific Advisory Boards:

    1. NONE

    Gifts:

    1. NONE

    Funding for Travel or Speaker Honoraria:

    1. NONE

    Editorial Boards:

    1. NONE

    Patents:

    1. NONE

    Publishing Royalties:

    1. The Massachusetts General Hospital Handbook of Neurology, 2nd edition, 2007

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. NONE

    Speakers' Bureaus:

    1. NONE

    Other Activities:

    1. NONE

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. NONE

    Research Support, Government Entities:

    1. NONE

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. NONE

    Stock/Stock Options/Board of Directors Compensation:

    1. NONE

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  5. David Caplan, MD, PhD and
    6. Scientific Advisory Boards:

    1. NONE

    Gifts:

    1. NONE

    Funding for Travel or Speaker Honoraria:

    1. NONE

    Editorial Boards:

    1. Language and Cognitive Processes, 2008, 2009

    Patents:

    1. NONE

    Publishing Royalties:

    1. NONE

    Employment, Commercial Entity:

    1. Behavioral Neurology CME course on Dementia, Co-organizer and speaker, 2008, 2009

    Consultancies:

    1. NONE

    Speakers' Bureaus:

    1. NONE

    Other activities:

    1. I have acted as an expert witness in several legal cases involving mild closed head injury. This is unrelated to the ms

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. NONE

    Research Support, Government Entities:

    1. CAPLAN, D. AActive: P50DC012283 Subcontract from Northwestern 04/01/13-03/31/18 3.00 Calendar Months. NIH $177,644 The Neurobiology of recovery of naming impairments Goals: To identify BOLD signal correlates of recovery and effects of treatment of language disorders after stroke and the neural, cognitive, and biological determinants of these effects Role: PI 5R01DC011032-03 (Caplan) 06/01/10-05/31/13 2.40 Cal months NIH/NIDCD $143,990 Spatiotemporal Neuroimaging of Situated Sentence Comprehension This grant will use MEG to study the neural basis of aspects of sentence comprehension Role: PI R305G050083 (PI: Waters, BU) 04/01/10–3/31/14 3.00 cal. months IES/DoE $400,000 Assessment of Comprehension Skills in Older Struggling Readers The major goal of this is the development an assessment battery for skills required for efficient reading for use in middle and high school. Role: Investigator Completed: 4R33DC010461-03 (Kiran, BU) 09/01/10-08/31/14 3.20 Cal. Months NIH-NIDCD $78,204 Theoretically-Based Treatment of Syntactic Comprehension Deficits in Aphasia The major goals of this project are the creation of sentences and pictures to be used in assessing and training patients, anc of paragraphs that test patients’ acquisition of the skills that have been taught.) Role: PI of MGH subcontract 5R01DC003108-14 (Gow) 09/18/09–08/31/14 1.80 Cal months NIH-NIDCD $214,625 Neural Dynamics of Spoken Word Recognition The major goals of this project are to determine the neural dynamics of the regions that underlie categorical, phonotactic and semantic effects on speech perception, and the functional integration these regions in recovery from aphasia. Role: Co-Investigator

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. NONE

    Stock/Stock Options/Board of Directors Compensation:

    1. NONE

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  6. Jeremy D. Schmahmann, MD
    7. Scientific Advisory Boards:

    1. Cadent Therapeutics

    Gifts:

    1. NONE

    Funding for Travel or Speaker Honoraria:

    1. NONE

    Editorial Boards:

    1. The Cerebellum, Editorial Board,1999 - Cerebellum and Ataxias

    Patents:

    1. NONE

    Publishing Royalties:

    1. 1. Schmahmann JD. (Editor). The Cerebellum and Cognition. International Review of Neurobiology. Volume 47. San Diego, Academic Press. 1997. 2. Schmahmann JD, Doyon J, Toga A, Petrides M, Evans A. MRI Atlas of the Human Cerebellum. San Diego, Academic Press. 2000. http://www.ebooks.com/ebooks/book_display.asp?IID=428486 3. Schmahmann JD, Pandya DN. Fiber Pathways of the Brain. New York, Oxford University Press. 2006. http://www.ebooks.com/ebooks/book_display.asp?IID=431410 4. Boltshauser E, Schmahmann JD. (Editors). Cerebellar Disorders in Children. Clinics in Developmental Medicine No. 191 – 192. London, MacKeith Press. 2012. 5. Manto M, Gruol D, Schmahmann JD, Koibuchi N, Rossi F. (Editors). Handbook of the Cerebellum and Cerebellar Disorders. New York, Springer. 2012. 6. Manto M, Gruol D, Schmahmann JD, Koibuchi N, Rossi F. (Editors). Essentials of the Handbook of the Cerebellum and Cerebellar Disorders. New York, Springer. 2016.

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. (1) Cadent Therapeutics (2) Triplet Therapeutics (3) Celgene

    Speakers' Bureaus:

    1. NONE

    Other activities:

    1. (1) Site PI for Biohaven clinical Trials in ataxia and multiple system atrophy

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. (1) Biohaven Pharma support of clinical trials

    Research Support, Government Entities:

    1. (1) Department of Defense, 2016-20, co-PI

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. (1) National Ataxia Foundation, 2019, PI

    Stock/Stock Options/Board of Directors Compensation:

    1. Ataxion / Cadent Therapeutics

    License fee payments, Technology or Inventions:

    1. (1) Brief Ataxia Rating Scale. The General Hospital Corporation (2) Cerebellar Cognitive Affective / Schmahmann syndrome Scale. The General Hospital Corporation (3) Patient Reported Outcome Measure for Ataxia

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  1. 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.
  1. Correspondence
    Dr. Perez dlperez{at}partners.org
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