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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This episode’s guest is Dr. Sarah Cope, DClinPsy. Dr. Cope is a Consultant Clinical Psychologist at St. Georges University Hospitals NHS Foundation Trust as well as South West London & St. Georges Mental Health NHS Trust. She is an accredited EMDR & CBT Therapist.

We discuss her pathway into FND, the basics of EMDR therapy (protocols, mechanisms, targets), the use of EMDR in FND, specifically her MODIFI trial, funded by the National Institute for Health and Care Research (NIHR) under its Research for Patient Benefit Programme (Grant Reference Number 202277).

Links for the discussed articles – MODIFI: protocol for randomised feasibility study of eye-movement desensitisation and reprocessing therapy (EMDR) for functional neurological disorder (FND): MODIFI EMDR

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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This is a 3 part panel series, exploring FND across the international arena. Part 1 includes FND diagnosis, access, and discussion of treatment landscapes, Part 2 including FND culturally relevant factors within the biopsychosocialspiritual model, and Part 3 covers FND research, funding, and international collaborations.

My gracious guests include: Lucia Tesolin a neurologist in charge of the Functional Neurological Disorders Clinic at the Civil Hospital of Bolzano, Italy, and researcher at the Center for Research in Complementary Medicine, EsSalud Social Health Insurance, Peru; Sonja Rutten from Amsterdam University Medical Center, the Netherlands (providing input on the Dutch and FND); Takamichi Kanbayashi, from Tokyo and Teikyo University School of Medicine (presently learning FND in Edinburg, UK); Lucas D’Andrea – at University of São Paulo Brazil; Chrisma Pretorius at Stellenbosch University in South Africa; and Sanjay Pandey, presently in Delhi, India at Amrita Institute of Medical Sciences.

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This is a 3 part panel series, exploring FND across the international arena. Part 1 includes FND diagnosis, access, and discussion of treatment landscapes, Part 2 including FND culturally relevant factors within the biopsychosocialspiritual model, and Part 3 covers FND research, funding, and international collaborations.

My gracious guests include: Lucia Tesolin a neurologist in charge of the Functional Neurological Disorders Clinic at the Civil Hospital of Bolzano, Italy, and researcher at the Center for Research in Complementary Medicine, EsSalud Social Health Insurance, Peru; Sonja Rutten from Amsterdam University Medical Center, the Netherlands (providing input on the Dutch and FND); Takamichi Kanbayashi, from Tokyo and Teikyo University School of Medicine (presently learning FND in Edinburg, UK); Lucas D’Andrea – at University of São Paulo Brazil; Chrisma Pretorius at Stellenbosch University in South Africa; and Sanjay Pandey, presently in Delhi, India at Amrita Institute of Medical Sciences.

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Multi-Cultural Podcast Series: Part 1 FND Diagnosis, Access, & Treatment Landscapes

This is a 3 part panel series, exploring FND across the international arena. Part 1 includes FND diagnosis, access, and discussion of treatment landscapes, Part 2 including FND culturally relevant factors within the biopsychosocialspiritual model, and Part 3 covers FND research, funding, and international collaborations.

My gracious guests include: Lucia Tesolin a neurologist in charge of the Functional Neurological Disorders Clinic at the Civil Hospital of Bolzano, Italy, and researcher at the Center for Research in Complementary Medicine, EsSalud Social Health Insurance, Peru; Sonja Rutten from Amsterdam University Medical Center, the Netherlands (providing input on the Dutch and FND); Takamichi Kanbayashi, from Tokyo and Teikyo University School of Medicine (presently learning FND in Edinburg, UK); Lucas D’Andrea – at University of São Paulo Brazil; Chrisma Pretorius at Stellenbosch University in South Africa; and Sanjay Pandey, presently in Delhi, India at Amrita Institute of Medical Sciences.

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In this episode we have two guests, both esteemed board-certified neuropsychologists. Dr. Noah Silverberg is an associate professor at the University of British Columbia, and Dr. Ryan Van Patten is an assistant professor at Brown University.

In this conversation, we discuss neuropsychological educational pathways, and current training needs as it relates to FND, neuropsychologist’s role across FND in both clinical and research contexts, and a topic near and dear to my heart, functional cognitive disorders and the role neuropsychologists can play in advancing the diagnostic understanding and treatment of FCD and FND more broadly.

Links for the discussed articles – Cognitive performance in functional seizures compared with epilepsy and healthy controls: a systematic review and meta analysis: https://pubmed.ncbi.nlm.nih.gov/38879275/ and Neuropsychological evaluation of functional cognitive disorder: a narrative review: https://pubmed.ncbi.nlm.nih.gov/37369579/

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

Support the show