Functional Neurological Disorder (FND)

FND is diagnosed when an individual experiences one or more fluctuating or persistent involuntary neurological symptoms including, but not limited to, changes in;

• sensation,

• thinking skills,

• speech,

• movement,  

• and/or muscle activity,

These changes are deemed to be caused by dysfunctional communication/signalling within the nervous system.  

​

- The diagnosis is made based on RULE IN criteria which takes into account your clinical history and 'positive signs'.  The latter are symptoms of altered voluntary motor or sensory function that are incompatible with recognised neurological or medical conditions (Aybek & Perez, 2022). For example, the type and pattern of muscle contraction, length of time, contextual influences/impact of co-contraction/distractability can be indicative of FND. 

- Symptoms can appear suddenly and progress rapidly.

- Symptoms typically fluctuate in severity, including complete remissions and sudden reoccurrences. 

- Illness or physical injury can trigger or exacerbate functional symptoms. 

A person may experience:

Functional Movement Disorder 

- Tremor, dystonia gait and balance dysfunction, jerks or myoclonus, limb weakness or paralysis. 

​

Functional Dissociative Seizures 

- Seizure episodes that resemble epilepsy or syncope. 

​

Persistent Perceptual Postural Dizziness (PPPD)

- Chronic dizziness, unsteadiness, swaying or rocking vertigo, exacerbated by movement or visually complex environments.

​

Functional Cognitive Disorders 

- Impaired cognitive function in one or more domains.

Dysfunction related to vision, speech or sensation are also possible manifestations of FND.

​

Current recommendations suggest the diagnosis should be made by a neurologist experienced in FND working in conjunction with a Psychiatrist (also experienced in FND). Allied health professionals can contribute knowledge gained from their own assessments to help formulate an appropriate diagnosis.

​

FND is thought to be influenced by a complex interaction between biological, psychological and social factors and thus benefits from a multi-disciplinary therapeutic approach. In an a quality improvement literature review conducted by our team, 12/13 studies reviewed from 2013-2023 demonstrated an improvement on outcome measures. This suggests MDT interventions can result in significant symptom improvement  in general health and well-being. Each member of the multidisciplinary team brings a unique perspective and contribution to a person's FND recovery. You can learn more about these roles below.  

​