Recognising and explaining functional neurological disorder

Functional disorders are conditions whose origin arises primarily from a disorder of nervous system functioning rather than clearly identifiable pathophysiological disease—such as irritable bowel syndrome, fibromyalgia, and functional neurological disorder (FND)—they are the second commonest reason for new neurology consultations.1 FND is common in emergency settings,2 stroke,3 and rehabilitation services.4 It causes considerable physical disability and distress, and often places an economic burden both on patients and health services.5 Many clinicians have had little formal clinical education on the assessment and management of these disorders, and patients are often not offered potentially effective treatments.

In practice, FND should be diagnosed by someone with specific expertise in the diagnosis of neurological conditions. Our recommendation is to refer all patients with a suspected diagnosis of FND to secondary care. However, the diagnosis may be raised as a possibility with the patient in primary care, and knowledge of how the diagnosis is confirmed greatly aids subsequent management.

In this article we offer evidence based advice to generalists on how to recognise FND, based on clinical diagnostic and prognostic studies. Although the focus of this paper is on recognising FND, we have included a short box on management to make readers aware that there are good treatments available for FND and that some patients can get better.