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David L. Perez

Possible papers associated with this exact author name in Arrow. This page groups case-insensitive exact name matches and is not a full identity disambiguation profile.

5 papers

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YNICL Journal 2026 Journal Article

Relationships between brain functional connectivity and resting cardiac autonomic profiles in functional neurological disorder: A pilot study

Cristina Bleier
Andrew J. Guthrie
Jessica Ranford
Julie MacLean
Ellen Godena
Julie Maggio
Sara A. Finkelstein
Ibai Diez

BACKGROUND: Functional neurological disorder (FND) is associated with alterations in functional brain networks, yet relationships between peripheral autonomic physiology and brain architecture remain poorly characterized. This pilot study examined associations between cardiac autonomic metrics and resting-state functional connectivity (rsFC) in FND. METHODS: Twenty females with FND and 23 age-matched female psychiatric controls (PCs) completed questionnaires, 10-min resting photoplethysmography recordings, and same-day resting-state fMRI. Interbeat interval (IBI) and heart rate variability (HRV) metrics were extracted. Whole-brain rsFC was quantified using weighted-degree [centrality]. Within-group analyses tested associations between cardiac autonomic metrics and weighted-degree rsFC separately in FND and PC cohorts, adjusting for age, head motion, and antidepressant/β-blocker use - while applying a cluster-wise correction. RESULTS: Cardiac (IBI and HRV) metrics did not differ between FND and PC cohorts, and these metrics did not correlate with FND symptom severity, somatic symptom burden, affective symptoms, or childhood trauma. In FND, shorter IBI (i.e., faster resting heart rate) correlated with higher weighted-degree rsFC in bilateral supplementary motor area (SMA) and right precentral/superior frontal regions, whereas lower HRV primarily correlated with higher weighted-degree rsFC in the bilateral SMA, mid-cingulate cortex, and right amygdala, anterior insula, and lateral orbitofrontal cortex. In PCs, autonomic-rsFC associations were more spatially restricted to the bilateral anterior/mid-cingulate and SMA. CONCLUSION: In FND, individual differences in resting autonomic physiology related to the centrality of brain areas that are part of the central autonomic, salience, and allostatic-interoceptive networks. These findings suggest that the relationship between autonomic physiology and network architecture may be important in FND.

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YNICL Journal 2026 Journal Article

Structural brain alterations and predictors of clinical improvement in functional cognitive disorder after concussion

Christiana Westlin
Mathilde Rioux
Jaqueline Lee
William Panenka
Daniela J. Palombo
Rebecca M. Todd
Noah D. Silverberg
David L. Perez

Functional cognitive disorder (FCD) is an under-studied yet likely prevalent subtype of functional neurological disorder (FND), with neural mechanisms that remain poorly understood. While studies of other FND subtypes have revealed structural and functional brain alterations across several large-scale brain networks, no study to date has investigated neural alterations in FCD. Here, we examined structural grey matter brain differences as measured from magnetic resonance imaging in 37 adults with FCD after concussion compared to 25 post-concussion controls. We compared FreeSurfer-based cortical thickness and subcortical volumes between groups and investigated associations between structural measures and memory symptoms. A subset of participants with FCD (n = 24) participated in a randomized controlled trial of cognitive-behavioral therapy vs. cognitive rehabilitation, and relationships between baseline structural measures and treatment outcomes were evaluated. All primary analyses were adjusted for age, sex, estimated IQ, and loss of consciousness, and corrected for multiple comparisons. No significant between-group differences in cortical thickness or subcortical volume were observed. However, across all participants, greater functional memory symptom severity was associated with larger right amygdala volume, which remained significant adjusting for depression scores, anxiety scores, and psychotropic medication use. Post-hoc analyses identified that this observation was driven by differences in lateral, basal, and paralaminar amygdalar nuclei. Additionally, greater improvement in memory symptoms following treatment was associated with increased pre-treatment cortical thickness in the right inferior frontal gyrus. These findings provide initial insights into the structural neurobiology of FCD and its associations with symptom severity and clinical trajectories.

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YNICL Journal 2024 Journal Article

Response to the Letter Concerning the Publication: Neuroimaging in Functional Neurological Disorder: State of the Field and Research Agenda. Perez DL et al. Neuroimage Clin. 2021;30:102623

David L. Perez
Timothy R. Nicholson
Ali A. Asadi-Pooya
Matthew Butler
Alan J. Carson
Anthony S. David
Quinton Deeley
Ibai Diez

In their letter, Tuller and colleagues raise concerns regarding the following introductory phrase and the linked Stone et al (2010) reference: "this renewed interest parallels recognition that FND [functional neurological disorder] is the 2nd most common outpatient neurologic diagnosis."While we appreciate there is complexity to epidemiological considerations in FND, we do not agree with the concerns raised.We share our perspective on this matter with the following four points:

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YNICL Journal 2021 Journal Article

Neuroimaging in Functional Neurological Disorder: State of the Field and Research Agenda

David L. Perez
Timothy R. Nicholson
Ali A. Asadi-Pooya
Indrit Bègue
Matthew Butler
Alan J. Carson
Anthony S. David
Quinton Deeley

Functional neurological disorder (FND) was of great interest to early clinical neuroscience leaders. During the 20th century, neurology and psychiatry grew apart - leaving FND a borderland condition. Fortunately, a renaissance has occurred in the last two decades, fostered by increased recognition that FND is prevalent and diagnosed using "rule-in" examination signs. The parallel use of scientific tools to bridge brain structure - function relationships has helped refine an integrated biopsychosocial framework through which to conceptualize FND. In particular, a growing number of quality neuroimaging studies using a variety of methodologies have shed light on the emerging pathophysiology of FND. This renewed scientific interest has occurred in parallel with enhanced interdisciplinary collaborations, as illustrated by new care models combining psychological and physical therapies and the creation of a new multidisciplinary FND society supporting knowledge dissemination in the field. Within this context, this article summarizes the output of the first International FND Neuroimaging Workgroup meeting, held virtually, on June 17th, 2020 to appraise the state of neuroimaging research in the field and to catalyze large-scale collaborations. We first briefly summarize neural circuit models of FND, and then detail the research approaches used to date in FND within core content areas: cohort characterization; control group considerations; task-based functional neuroimaging; resting-state networks; structural neuroimaging; biomarkers of symptom severity and risk of illness; and predictors of treatment response and prognosis. Lastly, we outline a neuroimaging-focused research agenda to elucidate the pathophysiology of FND and aid the development of novel biologically and psychologically-informed treatments.

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YNICL Journal 2019 Journal Article

Structural alterations in functional neurological disorder and related conditions: a software and hardware problem?

Indrit Bègue
Caitlin Adams
Jon Stone
David L. Perez

Functional neurological (conversion) disorder (FND) is a condition at the interface of neurology and psychiatry. A "software" vs. "hardware" analogy describes abnormal neurobiological mechanisms occurring in the context of intact macroscopic brain structure. While useful for explanatory and treatment models, this framework may require more nuanced considerations in the context of quantitative structural neuroimaging findings in FND. Moreover, high co-occurrence of FND and somatic symptom disorders (SSD) as defined in DSM-IV (somatization disorder, somatoform pain disorder, and undifferentiated somatoform disorder; referred to as SSD for brevity in this article) raises the possibility of a partially overlapping pathophysiology. In this systematic review, we use a transdiagnostic approach to review and appraise the structural neuroimaging literature in FND and SSD. While larger sample size studies are needed for definitive characterization, this article highlights that individuals with FND and SSD may exhibit sensorimotor, prefrontal, striatal-thalamic, paralimbic, and limbic structural alterations. The structural neuroimaging literature is contextualized within the neurobiology of stress-related neuroplasticity, gender differences, psychiatric comorbidities, and the greater spectrum of functional somatic disorders. Future directions that could accelerate the characterization of the pathophysiology of FND and DSM-5 SSD are outlined, including "disease staging" discussions to contextualize subgroups with or without structural changes. Emerging neuroimaging evidence suggests that some individuals with FND and SSD may have a "software" and "hardware" problem, although if structural alterations are present the neural mechanisms of functional disorders remain distinct from lesional neurological conditions. Furthermore, it remains unclear whether structural alterations relate to predisposing vulnerabilities or consequences of the disorder.

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