Dr. David Perez

that oftentimes the trigger can be a physical injury.

Such a brave stance and really, really important, right?

For a doctor, for a scientist to say, I see you, I hear you.

And yes, Mark Hallett put on the map this notion that maybe one of the neuroscience themes that goes awry in patients with functional tremor and functional movement disorder is an abnormality in one's sense of agency or action authorship.

We take for granted that when we move, right, closely coupled to our movement is this sense that I am the agent of that movement.

So Mark Hallett, Valerie Voon, and colleagues, they observed that there were activation abnormalities in the right temporal parietal junction.

And there were problems with how that brain area was talking to other brain areas, in particular, some basic sensory motor areas.

That tells you that

by leveraging a reflex that the basic pathways for motor control are intact.

Yeah.

And the notion here in functional neurological disorder is that the basic motor pathways are intact, but other brain networks are intruding and hijacking on those basic motor pathways.

That's the framing biologically of a functional neurological disorder.

The first step is making sure that the patient and the family members and other supports are

are really given some educational information about F&D.

And then when I think about F&D care, what it really benefits from is thinking, do you have an expert on the neurology side that's weighing in on your examination?

Do you have an expert on the mental health side that's weighing in on the context?

And are they working together?

There's an element of brain retraining and motor retraining.

And that happens through physical therapy, occupational therapy, and speech and language pathology.

And then as we think about brain retraining, that's where skills-based psychotherapy or what one form of that is called cognitive behavioral therapy, that's oftentimes coupled with physical treatments too.