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Treating FND Patients During COVID-19

In This Video

  • Functional neurological disorder (FND) is a condition that sits between neurology and psychiatry, and is the second most common reason that patients receive outpatient neurology consultations
  • The coronavirus has presented challenges in treating and studying FND. Still, the COVID-19 pandemic has helped streamline access to patient care
  • Those with FND can receive consultations through telemedicine and physical therapy. Occupational therapy and psychotherapy can be accessed through virtual technologies
  • Patients enrolled as research participants can consent virtually and participate in the full battery of psychometric measures from the comfort of their own home

David L. Perez, MD, MMSc, director of the Functional Neurological Disorder (FND) Treatment Program in the Departments of Neurology and Psychiatry at Massachusetts General Hospital, talks about the treatment of FND during the COVD-19 pandemic. Dr. Perez discusses how consultation and treatment for FND, a condition that sits between neurology and psychiatry, can be accessed through telemedicine and virtual technologies.


At Mass General, I am quite proud that I'm affiliated with both the Department of Neurology and the Department of Psychiatry. Functional neurological disorder, which I will abbreviate as FND, is now recognized as the second most common reason to see an outpatient neurologist. One of the issues that has become increasingly apparent based on epidemiology research is that functional neurological disorder is medicine's silent epidemic. It's also been called psychiatry's blind spots and this speaks to the fact that it is highly prevalent and yet it's been neglected by both neurology and psychiatry in part because it falls at the borderland of both disciplines.

At Massachusetts General Hospital, I direct the neuroimaging-focused research program. And the main aim of our research program is to study biomarkers of symptom severity, disease risks and prognosis. It's certainly been a trying time with COVID-19. I imagine this is true for clinicians and researchers across the board. I will say that there have been some positives with COVID-19. On the clinical side, we've adapted our clinical program to be largely virtual. We can deliver our consultations through telemedicine and our treatment pathways in physical therapy, occupational therapy and psychotherapy have also adopted virtual technology. On the research side, we've actually streamlined our data collection protocol so that patients can consent virtually as well as participate in our full battery of psychometric measures while in the comfort of their own homes. For our brain imaging, obviously, patients are still coming in and we're taking precautions to ensure that all the appropriate safety measures around COVID-19 are followed very carefully, but we are able to minimize contact with patients to preserve their safety and ours by really focusing on the virtual collection of data apart from brain scans itself.

So, in summary, I think as it pertains to the challenges that we face with COVID-19, there are many challenges that remain but there are some bright spots. And I think the bright spots have been catalyzed by some of the technology that we are able to leverage here at Massachusetts General Hospital. I think that largely pertains to the ability to perform telemedicine consultations not just at the physician level but across all aspects of clinicians and we've taken this telemedicine opportunity to also collect data remotely. This has streamlined our ability to do research. It has also increased our catchment area so that patients who live quite far away are also able to participate in our research program and we hope to expand this as we move forward.

Learn more about the Functional Neurological Disorders (FND) Treatment Program

Learn more about research in the Department of Neurology

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In the first study to evaluate white matter in mixed motor subtypes of functional neurological disorder, microstructural differences were observed in brain regions implicated in emotion/salience, pain modulation and stress responses, and certain differences correlated with clinical findings.


David L. Perez, MD, MMSc, director of the Functional Neurological Disorder (FND) Treatment Program in the Departments of Neurology and Psychiatry at Massachusetts General Hospital, discusses FND.