This episode is jointly hosted with the International League Against Epilepsy Sharp Waves podcast. My cohost is Dr. Ayushe Sharma a Postdoctoral Fellow in the Blumenfeld Lab in Neurology at Yale School of Medicine.

Our guests this episode are Dr. Barbara Dworetzky and Dr. Dara Albert. Dr. Barbara Dworetzky is the A.J. Trustey Endowed Chair in Neurology, Professor of Neurology at Harvard Medical School, Chief of the Division of Epilepsy and Clinical Neurophysiology at Brigham and Women’s Hospital, and the President of the Functional Neurological Disorders Society. Dr. Dara Albert, is a pediatric neurologist and epileptologist. She is the medical director of the multi-disciplinary Functional Seizure Clinic in the Pediatric Epilepsy Center at Nationwide Children's Hospital and The Ohio State University. The goal of that clinic is to help patients and families understand their diagnosis and move to effective treatment and improving outcomes. She has a passion and scholarly interest in medical education and serves as the Associate Program Director of the Child Neurology Residency Program.

We discuss population similarities and differences among adults and pediatric functional seizures, key outpatient differential diagnostic considerations, and some of the challenges for functional seizure management within the emergency department setting. I really enjoyed this recording and sharing the hosting role.

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Dr. Julia Doss is the owner and director of Doss Clinic of Health Psychology. The clinic is focused on providing care for patients with Psychogenic Nonepileptic Seizures (PNES) and other forms of Functional Neurological Disorder (FND). She is a clinical psychologist with a pediatric specialization. In practice she has focused the majority of her 20 year career on assisting in diagnosis and treatment of patients and their families struggling with PNES. She has published her research in scientific journals, she has authored professional book chapters, and presents in meetings across the US and abroad. She has been a chair of the Pediatric Non-epileptic Seizure SIG at the American Epilepsy Society. She is currently a steward for the NINDS/NIH task force for comorbidities in epilepsy for the past 5 years, from which recommendations were presented to congress to assist in determining funding for research in this area. She was involved in the first pediatric multisite study of youth with psychogenic non-epileptic seizures. She has co-authored two books, one in 2017 “Pediatric Psychogenic NonEpileptic Seizures: A Guide” and more recently “The Psychogenic Non-epileptic Seizure Pocketbook” in 2023 with co-author Dr. Lorna Myers.

Dr Doss has been a training director of psychology fellows while practicing at the Children’s Hospitals and Clinics of Minnesota. She is experienced in pediatric hypnosis and uses a variety of modalities when approaching the treatment of PNES.

Dr Doss has trained a number of post-graduate clinicians in the treatment of PNES/Functional Disorders and enjoys disseminating information to clinicians. She and Dr. Myers have recently launched an online training program aimed at teaching clinicians methods for managing PNES in youth and adults.

We discussed her pathway into FND, her views about FND subtypes, similarities and divergences between adults and pediatric. FND, the role of the family in pediatric FND, her views on terminology, and the role of psychological service access and treatment models and structures, and how that can be best approached and considered by treating clinicians. It was a very enjoyable conversation with such a skilled and seasoned FND clinician.

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This week our guest is Dr. Jeff Waugh. Dr. Waugh is an Associate Professor of Pediatrics and Neuroscience at the University of Texas, Southwestern, in Dallas. He founded and directs the Pediatric Movement Disorders Program and founded and co-directs the Pediatric Functional Neurological Disorders Clinic. His research centers on neuropsychiatric disorders of the striatum, a brain area that sorts and regulates input from every part of the human cortex. His lab studies the interacting and competing functions of two sub-compartments of the striatum, the striosome and matrix, and how imbalances between the compartments contribute to human diseases. His research articles, case series, reviews, chapters, and editorials have been cited by peers more than 1500 times.

In this episode, Dr. Waugh and I discuss elements specific to pediatric FND including the role of the family and treatment models, a survey of pediatric providers regarding FND documentation, communication, and experiences, the role of medical systems in supporting good communication and provider / patient experience, and lastly FND and the gender spectrum. It was a great discussion about brilliant work, and a very enjoyable conversation.

Relevant Articles:

When neurologists diagnose functional neurological disorder, why don’t they code for it?: https://pubmed.ncbi.nlm.nih.gov/34521502/

Functional Neurologic Disorder Among Sexual and Gender Minority People:https://pubmed.ncbi.nlm.nih.gov/37775203/

Lastly, we invite providers to participate in a brief survey examining driving recommendations for patients with functional seizures. Developed by a dedicated study group, this survey seeks to capture the current opinions of physicians worldwide on this topic. Please take a moment to share your expertise: https://survey.alchemer.com/s3/8065625/functional-dissociative-seizures-and-driving

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