Mark Hallett, MD, leader in functional neurological research… : Neurology Today

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79-year-old Dr. Mark Hallett looks back on his life’s work as he retires after an illustrious career that climbed to the head of the Human Motor Control Division at the National Institute of Neurological Disorders and Stroke.

In the 19th century, Jean-Martin Charcot called it “hysteria.” Then, in the early 20th century, Sigmund Freud called it “conversion disorder.” And Mark Hallett, MD, who has played a key role in redefining and revolutionizing our understanding of what we call functional movement disorders, which is included in a broader disease called functional neuropathy (FND), in the 21st century. FAAN has appeared.

Scientists from around the world gather on the campus of the National Institutes of Health (NIH) on December 12 to celebrate the extraordinary career of Dr. Hallett, who served for decades as director of the Division of Human Movement Control at the National Institute of Neurological Disorders. celebrated and stroke (NINDS).

in an interview with Neurology TodayDr. Hallett said what the field needs most right now is not another clinical trial or preclinical experiment (although they are certainly welcome).

“The most important issue is education,” he said Neurology Today 1 hour interview. “There’s a lot we know at the moment, but the information isn’t widespread enough. Ignorance is a big problem.”

A second need is to increase the availability of treatment programs.

“In the United States and around the world, treatment by well-trained people is very limited,” Dr. Hallett said. “So often, we get a diagnosis here, but we can’t find anyone who wants treatment. Approximately 75% of patients can benefit if treated in the manner recommended.”

Despite the current challenges, the field is far from where it was when Dr. Hallett opened a movement disorder clinic at NINDS in the mid-1980s.

“We had a diagnosis of what was then called psychogenic movement disorder in 30% of the patients that came to our clinic,” he recalled. “I started thinking about the situation and realized this was a big problem. First, it wasn’t an uncommon disease. And research was not advanced, neurologists and psychiatrists were not very interested in the problem, there was no good treatment and the prognosis was poor.”

As such, in 2006 he published an editorial, Psychogenic Movement Disorders: A Neurological Crisis. Since then, Dr. Hallett and other researchers have documented dozens that his movement-related FND is associated with alterations in imaging of the limbic system in general, the amygdala in particular, and the right temporoparietal junction. have shown in the paper. The temporoparietal junction, which he and others have discovered, is a key node in the experience of voluntary or involuntary movements.

storied career

Dr. Hallett’s first glimpse of his future career came in high school when he chose to write a paper on Freud for his psychology class.

“Freud was a neurologist who became concerned with what was called hysteria at the time,” said Dr. Hallett. “He ended up calling it conversion disorder, but now he calls it functional neuropathy.”

After earning a medical degree from Harvard University, training in neurology at Massachusetts General Hospital, and a fellowship in London, Dr. Hallett joined the staff of what was then called Peter Bent Brigham Hospital. There he served eight years before moving to the NIH in 1984. He has served as president of the International Society of Parkinson and Movement Disorders, vice president of the AAN, and editor-in-chief of the journal. clinical neurophysiology, most recently serving as the first president of the Japanese Society for Functional Neuropathy. Among the members of the new society are not only neurologists, but also psychologists, psychiatrists, social workers, physical and occupational therapists.

“There are very few places where a neurologist and a psychiatrist can discuss the same issues in the same room,” he said. “People think neurology and psychiatry are completely separate fields. But it really isn’t. It’s all about the brain.”

According to Dr. Hallett, before he and others coined the term FND, many patients resented being told they had a “psychogenic” movement disorder.

“That’s part of the reason we changed the name,” he said. “When it was called psychogenic, things got even worse. There’s a reason for it, and there’s a way to deal with it, so they can accept it.”

NINDS Director Walter Koroshetz, MD, FAAN said of Dr. Hallett: He has trained so many people around the world who are currently making a difference in neurology.People from India, Japan, Germany, Thailand and Switzerland have joined the program. For NINDS, Dr. Hallett is a role model for the special kind of clinical research career that can be obtained through Bethesda’s NINDS Intramural Research Program. “

Avindra Nath, MD, FAAN, now serving as Dr. Hallett’s former clinical director of NINDS, said in studying how voluntary movements are initiated in the brain: I’m here. Hallett actually explored the electrophysiology of free will. He is his seventh most cited person in neuroscience. He trained hundreds of people and founded many associations over the years. “

One of the many international speakers at the day-long conference celebrating Dr. Hallett’s career was Dr. John Stone, Emeritus Professor of Neurology at the University of Edinburgh, who specializes in the research and treatment of FND. Appearing remotely after a scheduled flight out of the UK was canceled due to weather, he said directly to Dr. Hallett: FND and Neuropsychiatry is currently he one of 18 core his topics every neurologist should know. This is something he would have been relatively unthinkable twenty years ago and will largely depend on your leadership and the work of others. “

However, Dr. Hallett says: Doctors don’t know how to talk to patients about it. Our treatment is still suboptimal. We still need to learn more about exactly how limbic dysfunction occurs. ’” He paused, adding: I am 79 years old. “

and he laughed.