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MDS 2022 | Overlap between functional neurological disorders and PD

Alberto Espay, MD, MSc, University of Cincinnati, Cincinnati, OH, discusses the overlap between functional neurological disorders and movement disorders. The occurrence of functional disorders in Parkinson’s disease (PD) has been overlooked; however, a study on DaT scan abnormalities showed that up to 50% of people who were thought to have functional disorders had an abnormal DaT scan. Additionally, a subtype of PD in which the prodrome is a functional disorder, particularly functional tremor, has been recognized. Those findings galvanized an intriguing matter in clinical medicine. The diagnosis of functional movement disorders was considered important to distinguish them from organic neurological diseases, but there is an overlap. This suggests that, for instance, patients who meet the criteria for functional tremor but have a family history of PD might be considered for a DaT scan since they may be in a position to develop PD. Interestingly, another prodrome of Parkinson’s disease is bipolar spectrum disorder, and investigations showing that some patients had functional manifestations have led to the study of a subtype of Parkinson’s disease that starts with psychiatric or functional manifestations. This interview took place at the 2022 International Congress of Parkinson’s Disease and Movement Disorders in Madrid, Spain.

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Prof. Espay has received grant support from the NIH and the Michael J Fox Foundation; personal compensation as a consultant/scientific advisory board member for Abbvie, Neuroderm, Neurocrine, Amneal, Acadia, Acorda, Kyowa Kirin, Sunovion, Lundbeck, and USWorldMeds; honoraria from Acadia, Sunovion, Amneal, USWorldMeds; and publishing royalties from Lippincott Williams & Wilkins, Cambridge University Press, and Springer. He cofounded REGAIN Therapeutics, owner of a patent application that covers synthetic soluble non-aggregating peptide analogs as a replacement treatment in proteinopathies. He serves on the editorial boards of the Journal of Parkinson’s Disease, Journal of Alzheimer’s Disease, European Journal of Neurology, and JAMA Neurology.