A practical review of functional neurological disorder (FND) for the general physician
Open accessAbstract
We present a practical overview of functional neurological disorder (FND), its epidemiology, assessment and diagnosis, diagnostic pitfalls, treatment, aetiology and mechanism. We present an update on functional limb weakness, tremor, dystonia and other abnormal movements, dissociative seizures, functional cognitive symptoms and urinary retention, and 'scan-negative' cauda equina syndrome. The diagnosis of FND should rest on clear positive evidence, typically from a combination of physical signs on examination or the nature of seizures. In treatment of FND, clear communication of the diagnosis and the involvement of the multidisciplinary team is beneficial. We recommend that patients with FND are referred to specialists with expertise in neurological diagnosis. FND is a common presentation in emergency and acute medical settings and there are many practical elements to making a positive diagnosis and communication which are useful for all physicians to be familiar with.
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The past decades have seen significant efforts by clinicians and academics involved in the assessment and treatment of FND generally to assist colleagues in primary and secondary care to identify and manage patients with these conditions.
“The past decades have seen significant efforts by clinicians and academics involved in the assessment and treatment of FND generally to assist colleagues in primary and secondary care to identify and manage patients with these conditions (34, 35, 36).”
From A qualitative analysis of patients' day-to-day living with functional cognitive disorder (FCD). (2025) · cites this paper as [34]
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Marín‐Medina, D. S., Arenas-Vargas, P. A., Arias-Botero, J. C., Gómez-Vásquez, M., & González, C. A. S. (2024) · Acta neurológica colombiana · doi:10.22379/anc.v40i4.1888 · Cited by 8 · see citing works
Multidisciplinary Treatment for Functional Movement Disorder
Stone, J., & Carson, A. J. (2025) · CONTINUUM Lifelong Learning in Neurology · doi:10.1212/cont.0000000000001606 · Cited by 8 · see citing works
Self-citationComorbidities Across Functional Neurological Disorder Subtypes: A Comprehensive Narrative Synthesis
Mavroudis, I. A., Franekova, K., Petridis, F., Ciobica, A. S., Dăscălescu, G., Anton, E., Ilea, C. G., Papagiannopoulos, S., & Kazis, D. A. (2025) · Life · doi:10.3390/life15081322 · Cited by 11 · see citing works
“…referral cohorts, FND accounts for approximately 5–10% of new consultations, while population-based estimates in the United Kingdom suggest an annual incidence of about 12 per 100,000 individuals, equating to roughly 8000 new cases each year and a community prevalence of 50,000–100,000 people [1].”
ONOFRJ, M. C., Ajdinaj, P., Digiovanni, A., Malek, N., Martinotti, G., Ferro, F. M., Russo, M., Thomas, A., & Sensi, S. L. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1120981 · Cited by 10 · see citing works
“Several reviews and position papers (1, 21) have detailed the main reasons to separate FND into a category that can cover a welldemarcated group of patients acceptable in much wider neurology practice settings including out-patient and in-patient settings.”
BackgroundModèles de soins validés pour les patients souffrant de troubles neurologiques fonctionnels
Rauline, G., Hingray, C., Carle, G., Hubsch, C. A., El‐Hage, W., Conejero, I., Samalin, L., Garcin, B., & Gharib, A. (2023) · L Encéphale · doi:10.1016/j.encep.2023.06.005 · Cited by 8 · see citing works
The Current State of Pediatric Functional Neurological Disorder Treatment in the United States
Watson, M. M., Kreuzman, J., Zeribi, K. A., Iskander, J. M., Hopper, A., Simon, L., Chesley, G., & Fobian, A. D. (2024) · Pediatric Neurology · doi:10.1016/j.pediatrneurol.2024.06.010 · Cited by 8 · see citing works
Al‐Beltagi, M., Saeed, N. K., Bediwy, A. S., Bediwy, E. A., & Elbeltagi, R. M. (2025) · World Journal of Clinical Pediatrics · doi:10.5409/wjcp.v14.i3.105290 · Cited by 7 · see citing works
Lagrand, T. J., Gelauff, J., Brusse-Keizer, M. G. J., Lehn, A., Tijssen, M. A. J., & other individuals of the TASMAN Study Group (2024) · European Journal of Neurology · doi:10.1111/ene.16525 · Cited by 6 · see citing works
“Our results highlight that patients with FMDs are as disabled and have as impaired quality of life as patients with other movement disorders [40 ].”
Sireci, F., Ragucci, F., Menozzi, C., Cabboi, M. P., Picchetto, L., Bassi, M. C., Ghirotto, L., Cavallieri, F., Pedroni, C., & Valzania, F. (2024) · Journal of Neurology · doi:10.1007/s00415-024-12441-x · Cited by 5 · see citing works
“People experiencing functional neurological symptoms often suffer from comorbid anxiety and depression, either because of misdiagnosis, struggling with the symptoms, or previous adverse life experiences [93].”
Psilocybin and Motor Function: A Triple‐Blind, Dose‐Finding Study in Healthy Participants
Bhagavan, C., Kanaan, R., Carter, O. L., Nielsen, G., Berlowitz, D. J., Issak, S., Braat, S., Zaloumis, S. G., Attard, Z., Oliver, G., et al. (2024) · Psychiatric Research and Clinical Practice · doi:10.1176/appi.prcp.20240047 · Cited by 5 · see citing works
Mavroudis, I. A., Franekova, K., Petridis, F., Ciobica, A. S., Papagiannopoulos, S., & Kazis, D. A. (2025) · Brain Sciences · doi:10.3390/brainsci15090997 · Cited by 5 · see citing works
Batarseh, N., & Abdulla, F. A. (2026) · Nutritional Neuroscience · doi:10.1080/1028415x.2025.2610643 · Cited by 5 · see citing works
“The third category includes other brain conditions like migraines and sleep disorders, that do not result in structural or functional damage to the brain [2,7,8].”
Scholfield, D. W., Chandrasekharan, D. P., Bahra, A., Williams, M., & Patel, N. (2022) · The Journal of Laryngology & Otology · doi:10.1017/s0022215122001530 · Cited by 5 · see citing works
Biomarkers and Rehabilitation for Functional Neurological Disorder
Mark, V. W. (2024) · Journal of Personalized Medicine · doi:10.3390/jpm14090948 · Cited by 5 · see citing works
Lewis, E. C., Jaeger, A. H., Girn, M., Omene, E., Brendle, M., & Argento, E. (2024) · Journal of Psychopharmacology · doi:10.1177/02698811241248395 · Cited by 5 · see citing works
Panchamia, J. K., Amundson, A. W., Demirci, O., Braksick, S. A., & Wijdicks, E. F. M. (2022) · A&A Practice · doi:10.1213/xaa.0000000000001569 · Cited by 5 · see citing works
Zarotti, N., Poz, R., & Fisher, P. (2022) · Clinical Gerontologist · doi:10.1080/07317115.2022.2130124 · Cited by 5 · see citing works
“Currently, FND is estimated to represent over 15% of all referrals to neurology (Stone et al., 2010) with an annual incidence of 12 in 100,000 worldwide (Bennett et al., 2021).”
BackgroundFunctional Neurological Disorder
Butler, M., & Nicholson, T. R. (2024) · Cambridge University Press eBooks · doi:10.1017/9781911623861.018 · Cited by 5 · see citing works
Recognising and managing functional neurological disorder in the acute healthcare setting
Galenchik-Chan, A., Ren, T., Cohen, D., & Maurer, C. W. (2025) · Emergency Medicine Journal · doi:10.1136/emermed-2024-214459 · Cited by 4 · see citing works
“27 As with other neurological disorders, confirmation of the diagnosis of FND should be attained through consultation with a neurologist.”
Functional Neurological Disorder in Saudi Arabia: An Update
Tayeb, H. O. (2023) · Cureus · doi:10.7759/cureus.47607 · Cited by 4 · see citing works
Cognitive behavioural therapy for neurologists
Stanton, B. R., Chalder, T., & Carvalho, C. (2023) · Practical Neurology · doi:10.1136/pn-2023-003857 · Cited by 4 · see citing works
“Functional neurological disorder accounts for 10% of all neurological appointments 28 and it is characterised by a wide range of symptoms including motor disorders, seizures and cognitive symptoms.”
BackgroundSookdeo, A., Shaikh, Y. M., Bhattacharjee, M., Khan, J., Alvi, W. A., Arshad, M. S., Tariq, A. H., & Muzammil, M. A. (2024) · International Journal of Emergency Medicine · doi:10.1186/s12245-024-00771-6 · Cited by 4 · see citing works
“The presentation of functional dystonia is associated with pain and disability, whereas other dystonia’s are generally mobile and more variable in posture [70].”
Diagnosis of Functional Weakness and Functional Gait Disorders in Children and Adolescents
West, E., & Shah, U. H. (2022) · Seminars in Pediatric Neurology · doi:10.1016/j.spen.2022.100955 · Cited by 4 · see citing works
Functional seizures and binge eating disorder: A cross-sectional study
Mammì, A., Bova, V., Martino, I., Sammarra, I., Ferlazzo, E., Pascarella, A., Abelardo, D., Marsico, O., Torino, C., Cianci, V., et al. (2024) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2024.109943 · Cited by 5 · see citing works
“Functional seizures (FS) are paroxysmal changes, limited in time, in responsiveness, motor and sensory activity or behaviour which resemble several medical conditions, namely epileptic seizures, but are the result of complex neuropsychiatric dysfunctions [1].”
BackgroundCase report on psychogenic nonepileptic seizures: A series of unfortunate events
Udofia, A., & Rocke, T. P. (2022) · Clinical Case Reports · doi:10.1002/ccr3.6430 · Cited by 4 · see citing works
Putica, A., Agathos, J. A., & Felmingham, K. L. (2025) · Nature Reviews Psychology · doi:10.1038/s44159-025-00479-1 · Cited by 5 · see citing works
Kimata, A. R., Cameron-Burr, K. T., & Wilson, T. T. (2025) · Journal of the American College of Emergency Physicians Open · doi:10.1016/j.acepjo.2025.100220 · Cited by 3 · see citing works
“10 However, many of these established strategies for the treatment of FND are not feasible or available in the ED.”
Functional neurologic disorder (FND) in pediatrics
Baidoo, L. (2022) · The Nurse Practitioner · doi:10.1097/01.npr.0000873532.17436.85 · Cited by 3 · see citing works
“FND is two to three times more common in females and can occur at all ages, although it is rare to present before the age of 10, therefore largely affecting the adolescent population.(5,6) The symptoms of FND can be severely disabling and affect physical functioning, school attendance/activities, and socialization.”
InfluentialFunctional neurological disorder in Saudi Arabia: A retrospective study
Tayeb, H. O. (2023) · The International Journal of Psychiatry in Medicine · doi:10.1177/00912174231215908 · Cited by 3 · see citing works
“The author systematically went through pertinent elements of the clinical evaluation to diagnose FND.”
InfluentialPhysical therapy evaluation and treatment of functional movement disorders: A case series
Mowry, H., Perez, E., Stillwell, A., & Shearin, S. (2025) · Physiotherapy Theory and Practice · doi:10.1080/09593985.2025.2514126 · Cited by 3 · see citing works
“Women are about three times more likely to be diagnosed with this condition as compared to men; however, as the age of symptom onset increases, the proportion of men affected increases (Baizabal ‐ Carvallo and Jankovic, 2020; Bennett et al, 2021).”
Assessing the hidden burden of psychiatric disease in patients with nonepileptic seizures
Lenio, S., Baker, S., Watson, M. M., Libbon, R., Sillau, S., & Strom, L. A. (2021) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2021.108382 · Cited by 3 · see citing works
Pearce, L. N., Prindiville, P., Scroggie, C., Taylor, G., Clarke, A., Foster, A. M., & Milne, S. (2024) · Health & Social Care in the Community · doi:10.1155/2024/5547318 · Cited by 3 · see citing works
“Neurologist involvement is the frst critical step to providing successful care as they have a distinct role in communicating a FND diagnosis [27, 28] and providing ongoing education and monitoring.”
BackgroundErweiterte Diagnostik bei dissoziativen Anfällen
Schöne, C., Abourafia, K., & Pensel, M. C. (2024) · Clinical Epileptology · doi:10.1007/s10309-024-00683-8 · Cited by 3 · see citing works
Alshimemeri, S. A., Alabandi, F. A., Binabbad, R. S., Elmutawi, H., Alabdi, G., & Gilmour, G. S. (2024) · BMC Neurology · doi:10.1186/s12883-024-03810-0 · Cited by 4 · see citing works
“Considering that FND is now a “rule-in” diagnosis, positive diagnostic criteria should be utilized [13], which in turn would minimise diagnostic delays and enhance the overall management.”
BackgroundFunctional Neurological Disorder: Overview and a Case Study
Muhrer, J. C. (2021) · The Journal for Nurse Practitioners · doi:10.1016/j.nurpra.2021.08.020 · Cited by 3 · see citing works
A qualitative analysis of patients' day-to-day living with functional cognitive disorder (FCD).
Mantovani, N., Poole, N., Cope, S., Vanzan, S., Duffus, A., Williams, T., Smith, J. G., Barrett, B., Scicluna, M., Beardmore, S., et al. (2025) · Disability and Rehabilitation · doi:10.1080/09638288.2025.2460725 · Cited by 2 · see citing works
“The past decades have seen significant efforts by clinicians and academics involved in the assessment and treatment of FND generally to assist colleagues in primary and secondary care to identify and manage patients with these conditions [35,36].”
Gatherer, C., & Garip, G. (2025) · Psychological Reports · doi:10.1177/00332941251351234 · Cited by 2 · see citing works
Functional Neurological Disorders: A Comprehensive Review.
Lalitha, L., Acharya, P., Javali, M., Mehta, A., & Rangaiah, P. (2025) · Journal of Association of Physicians of India · doi:10.59556/japi.73.1051 · Cited by 1 · see citing works
Functional movement and gait disorders: A matter of age?
Kayombo, G. K., Witjas, T., Comet, C., Mira, V., Benchetrit, E., Monteiro-Dias, N., Fortanier, É., Maarouf, A., Eusébio, A., Azulay, J., et al. (2025) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2025.112471 · Cited by 2 · see citing works
Muhr, P. (2026) · Social Science & Medicine · doi:10.1016/j.socscimed.2026.119108 · Cited by 2 · see citing works
Othman, A., Cecchini, A. A., EFTAIHA, A., Nwosisi, N., & Pierce, D. M. (2022) · Cureus · doi:10.7759/cureus.26378 · Cited by 2 · see citing works
“Pharmacologic therapy currently has no direct role in the treatment of FND, but it may be used to treat coexisting psychiatric or neurological disorders [9].”
BackgroundInfluentialDevon Partnership NHS Trust, U., Russell, L. A., Butler, L., Exeter Neuro Rehabilitation Services, U., Lovegrove, C., Owens, C., Devon Partnership NHS Trust, U., Roberts, L., Yates, P., Devon Partnership NHS Trust, U., et al. (2022) · Advances in Clinical Neuroscience & Rehabilitation · doi:10.47795/kazj3546 · Cited by 2 · see citing works
Functional Neurological Disorders
Sinanović, O., Zukić, S., Banović, S., Sinanović, E., & Muftić, M. (2023) · Springer eBooks · doi:10.1007/978-3-031-33013-1_14 · Cited by 2 · see citing works
Boico, V., Humblestone, S., Moutoussis, M., & Selai, C. E. (2023) · Counselling and Psychotherapy Research · doi:10.1002/capr.12709 · Cited by 2 · see citing works
“…can range in duration from brief to persistent episodes (Petrochilos et al., 2020), including motor (e.g., jerks, weakness and tremor) and sensory symptoms (e.g., pins and needles) to impaired vision and/ or speech, dissociative events, seizures and cognitive dysfunction (Bennett et al., 2021).”
Scheurich, J. A., Klaas, K. M., Sim, L. A., Weiss, K., Case, H. F., & Harbeck‐Weber, C. (2024) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2024.109689 · Cited by 2 · see citing works
Leochico, C. F. D., Mitchell, S. B., Levitt, S. E., Tam, A. K. H., & Guo, M. (2024) · Journal of the International Society of Physical and Rehabilitation Medicine · doi:10.1097/ph9.0000000000000029 · Cited by 2 · see citing works
Leandertz, M., & Ala-Ruona, E. (2024) · Approaches An Interdisciplinary Journal of Music Therapy · doi:10.56883/aijmt.2024.395 · Cited by 2 · see citing works
Funktionelle neurologische Störungen in der Neurorehabilitation
Schmidt, R., van Husen, D. K., Gegusch, M., & Schmid, D. A. (2024) · Springer eBooks · doi:10.1007/978-3-662-66957-0_38 · Cited by 2 · see citing works
A Measure of Swallow Effort Using the Borg Category Ratio 10 Perceived Exertion Scale
Cortez-Aoyagi, M., Gufstason, E., Murphy, A. M., & van Mersbergen, M. (2023) · American Journal of Speech-Language Pathology · doi:10.1044/2023_ajslp-23-00090 · Cited by 2 · see citing works
Varley, D., Scorer, L., Bramley, S., & Feltz-Cornelis, C. M. V. D. (2024) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2024.04.008 · Cited by 2 · see citing works
Functional neurological disorder: a review
Dusara, K., Davies, S., & Lee, Y. (2023) · BDJ · doi:10.1038/s41415-023-6054-8 · Cited by 1 · see citing works
Işık, N. A., Grager, B., Neugebauer, J., & Pauli, J. D. (2024) · Psychiatria Danubina · doi:10.24869/psyd.2024.118 · Cited by 1 · see citing works
Optimizing the Team Approach: Designing a Clinical Care Pathway for Functional Neurological Disorder
Brown, L., Norwood, M., & Thompson, L. G. (2024) · Journal for Healthcare Quality · doi:10.1097/jhq.0000000000000445 · Cited by 1 · see citing works
Psychological assessment and support in functional neurological disorder: a longitudinal study
Radin, Y., Bulfon, M., Caruso, P., Barbi, E., Manganotti, P., & Clarici, A. (2025) · Frontiers in Psychology · doi:10.3389/fpsyg.2025.1506069 · Cited by 1 · see citing works
Assessment of emergency department physician perspectives on people with functional seizures
Moore, M., Watson, M. M., & Strom, L. A. (2025) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2025.110494 · Cited by 1 · see citing works
Prevalence of somatic symptom and related disorders at a tertiary neuroimmunology clinic
Sarin, S., Borthwick, K. G., Kumar, P., Shrestha, R., & Abboud, H. (2025) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2025.106588 · Cited by 1 · see citing works
Maassen, L., Fox, N., & Stiller, K. R. (2025) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2025.123671 · Cited by 1 · see citing works
Davies, S., Rafi, D., Rifkin-Zybutz, R. P., Heyland, S., & Jadhakhan, F. (2025) · BMJ Open · doi:10.1136/bmjopen-2025-101122 · Cited by 1 · see citing works
Raffman, E. S., Sorets, T. R., Golding, D., Finley, J. A., Carson, A. J., & Cotton, E. (2025) · Journal of Neuropsychiatry · doi:10.1176/appi.neuropsych.20250097 · Cited by 1 · see citing works
Self-citationPlacebo in Functional Neurological Disorders: Promise and Controversy
Szejko, N., Abusrair, A. H., Pasierski, T., Schmitt, S., Cramer, C., Pietrzykowski, T., Dunalska, A., Saramak, K., Śmiłowska, K., Serranová, T., et al. (2025) · Healthcare · doi:10.3390/healthcare13222863 · Cited by 1 · see citing works
“Although incongruity or incompatibility with recognized neurological disease remains in the diagnostic criteria, this is increasingly viewed as a problematic exclusion criterion, as not all disease patterns are fully understood [6].”
Unseen struggles: The psychosocial toll of raising a child with functional neurological disorder
Ahmad, W., Dastagir, M., Azhar, I. A., Ahmad, S., & Batool, S. (2025) · Journal of Shalamar Medical & Dental College - JSHMDC · doi:10.53685/jshmdc.v6i2.337 · Cited by 1 · see citing works
Chappidi, R., Serafin, J., & Barnett, K. M. (2026) · A&A Practice · doi:10.1213/xaa.0000000000002159 · Cited by 1 · see citing works
Hjiej, G., Sikkal, A., Khattab, H., Haddouali, K., Bellakhdar, S., Otmani, H. E., Moutawakil, B. E., & Rafai, M. A. (2026) · Journal of Clinical Neuroscience · doi:10.1016/j.jocn.2026.111913 · Cited by 1 · see citing works
Building a Functional Neurological Disorder Program: Finding Solutions to Common Obstacles
López, M. R., & LaFrance, W. C., Jr. (2026) · Seminars in Neurology · doi:10.1055/a-2796-7123 · Cited by 1 · see citing works
A guide to functional disease for a trauma conscious generation
Whitfield, A. (2021) · Clinical Medicine · doi:10.7861/clinmed.2020-1023 · Cited by 1 · see citing works
Morisetty, H., Wallace, N., & Ugorji, U. (2021) · Frontiers in Medical Case Reports · doi:10.47746/fmcr.2021.2506 · Cited by 1 · see citing works
“Studies indicate FND can occur in all age groups, although rarer in patients under 10 years of age (Bennett et al., 2021).”
BackgroundInfluentialFunctional Neurological Disorders in Children and Adolescents – A Long-Overdue Renaissance
Albert, D. V. F. (2022) · Seminars in Pediatric Neurology · doi:10.1016/j.spen.2022.100954 · Cited by 1 · see citing works
Considerations in the Management of Functional Neurological Disorders in Patients with Hearing Loss
Libdeh, A. A., Alkalbani, L., Freedman, D., Quezada, J., & Nyp, S. S. (2023) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/dbp.0000000000001170 · Cited by 1 · see citing works
- Authors
- Bennett, K., Diamond, C., Hoeritzauer, I., Gardiner, P., McWhirter, L., Carson, A., & Stone, J.
- Affiliations
- Edinburgh Royal Infirmary (GB)
- University of Edinburgh (GB)
- Venue
- Clinical Medicine
- Publisher
- Elsevier BV
- Published
- 2021-01
- Volume
- 21
- Issue
- 1
- Pages
- 28-36
- ISSN
- 1470-2118 (ISSN-L)
- PMC
- PMC7850207
- OpenAlex
- W3123764886
- Cited by
- 169
- References
- 52
- Citations by year
- 2026: 40 · 2025: 37 · 2024: 43 · 2023: 27 · 2022: 14 · 2021: 8
- FWCI
- 4.10
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Clinical Medicine (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Keywords
- conversion disorder, functional tremor, functional dystonia, psychogenic non-epileptic seizures, urinary retention, cauda equina syndrome, diagnostic pitfalls, etiology, multidisciplinary management, emergency medicine
- MeSH terms
- Conversion Disorder, Emergency Service, Hospital, Humans, Nervous System Diseases, Seizures, Tremor, General Practitioners
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