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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 (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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Items 101–169 of 169
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Quay, A. (2024) · Emergency Medicine Australasia · doi:10.1111/1742-6723.14494 · Cited by 1
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Cornblath, D. R., Kiernan, M. C., Kimura, J., Koltzenburg, M., Lewis, R. A., Parry, G. J. G., Pollard, J. D., & Sumner, A. J. (2022) · Annals of Plastic Surgery · doi:10.1097/sap.0000000000003245 · Cited by 1
Understanding the Care Pathway in Iranian Patients with Functional Neurological Symptom DisordersPreprint
Masjedi, N., Shafaghi, L., Eybpoosh, S., Arbabi, M., Ziaa, M. J., Motamedi, A., & Yasamy, M. T. (2025) · Research Square · doi:10.21203/rs.3.rs-5461333/v1 · Cited by 1
Bhagavan, C., Carter, O. L., Nielsen, G., Berlowitz, D. J., Issak, S., Braat, S., Zaloumis, S. G., Attard, Z., Oliver, G., Mayne, D., et al. (2025) · medRxiv · doi:10.64898/2025.12.22.25342874 · Cited by 1
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Karakis, I. (2022) · Muscle & Nerve · doi:10.1002/mus.27528
“clinician to the possibility of an alternative, non-neuromuscular, organic (central nervous system or non-neurological), or functional diagnosis.(13) It can also serve for elucidation of unrevealing or equivocal results (eg, variants of uncertain significance in genetic”
BackgroundSamani, N., Burns, A., Chan, J., & Health, W. (2022) · The Neuropsychologist · doi:10.53841/bpsneur.2022.1.14.27
Diagnosis of psychogenic (functional) gait disorders
Станиславович, С. В. (2023) · Бюллетень Восточно-Сибирского научного центра Сибирского отделения Российской академии медицинских наук · doi:10.29413/abs.2023-8.1.17
Ahmadi, S., Ahmadi, F., Oghabian, M. A., & Faghihzadeh, E. (2023) · Research Square · doi:10.21203/rs.3.rs-3256726/v1
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Odobescu, S., Grosu, O., Rotaru, L., Vovc, V., & Moldovanu, I. (2023) · The Moldovan Medical Journal · doi:10.52418/moldovan-med-j.66-2.23.14
Das, A. (2024) · Neurological Sciences · doi:10.1007/s10072-024-07373-3
“A crucial aspect of an effective explanation of functional neurological disorder (FND) is to describe it in terms of its own characteristics (i.e., defining FND as “you have FND” because of the positive signs), rather than through exclusionary descriptions of what it is not [2].”
Joyce, E. M., & Bindman, D. (2024) · doi:10.1002/9781119715672.ch30
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Venturini, G., & Sarti, C. (2024) · Clinical Case Reports · doi:10.1002/ccr3.8992
Pain with and without a lesion
Jarrell, J. F. (2024) · Elsevier eBooks · doi:10.1016/b978-0-443-23994-6.00006-5
Rogers, S., Lilley, J., Raynor, G., Hodges, S., & Larson, D. T. (2024) · Military Medicine · doi:10.1093/milmed/usae382
Funktionelle Schmerzsyndrome im Rahmen von funktionellen neurologischen Störungen
Brinkers, M., Beyer, L., & Niemier, K. (2024) · Manuelle Medizin · doi:10.1007/s00337-024-01092-8
“Auf neurologischer Seite haben Popkirov et al. [3] und Bennet et al. [4] FND mit KSgleichgesetzt.”
Neural Network Analysis of MRI Scans for FND Diagnosis
Azmaien, S. (2024) · International Journal of Advanced Pharmaceutical Sciences and Research · doi:10.54105/ijapsr.a4058.04040624
Extended diagnostics for dissociative seizures
Schöne, C., Abourafia, K., & Pensel, M. C. (2024) · Clinical Epileptology · doi:10.1007/s10309-024-00726-0
“In the neurological/epilepsy setting, additional DNSD should be recorded or structural neurological disorders ruled out and, if possible, findings from confirmatory examinations should be obtained [3].”
Badran, S., Khan, H., Jerome, R., Tieu, V., Townsend, S., Randhawa, J. S., & Mohammadi, N. (2025) · Cureus · doi:10.7759/cureus.81850
“Global limb weakness selectively affecting some muscle groups correlates with FND [11].”
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Kowalska, M., Michałowska, M., & Leńska‐Mieciek, M. (2025) · Postępy Psychiatrii i Neurologii · doi:10.5114/ppn.2025.149942
“FND is frequent in neurological settings and refers to 5-15% [17, 18] of new cases in neurology clinics.”
Functional movement disorders: a paradigm shift (literature review)
Cebuc, M., Rotaru, L., Marina, S., & Grosu, O. (2025) · Bulletin of the Academy of Sciences of Moldova Medical Sciences · doi:10.52692/1857-0011.2024.3-80.08
Weissfeld, R. K. (2026) · Clinical and Translational Neuroscience · doi:10.3390/ctn10020009
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Spitzer, C., & Wülfing, P. (2025) · Trauma und Gewalt · doi:10.21706/tg-19-3-212
Functional Neurological Disorder
Keatley, E. S., & Molton, I. R. (2025) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780197525456.013.0040
Sullivan, K., & Jadhav, T. (2025) · Springer eBooks · doi:10.1007/978-981-96-7234-9_67
“Shake-Shake”: A new neurological syndrome or a functional neurological disorder?
Mpamizo, E., Musana, E., Abbo, C., & Scolding, N. J. (2025) · Journal of Interventional Epidemiology and Public Health · doi:10.37432/jieph-d-25-00122
La prise en soins des TNF en neurologie
Mhanna, E., Rumpli, D., & Garcin, B. (2025) · La Revue de l Infirmière · doi:10.1016/j.revinf.2025.07.006
Kinney, C., & Shotwell, M. (2025) · Tremor and Other Hyperkinetic Movements · doi:10.5334/tohm.1042
Miscellaneous Diseases and Normal Findings
Uher, T. (2025) · Springer eBooks · doi:10.1007/978-3-031-98945-2_12
Diagnostic labels in functional disorders
Novak, M. J. U. (2025) · Future Healthcare Journal · doi:10.1016/j.fhj.2025.100489
“Moreover, FND is not a nebulous label for uncategorisable neurological symptoms: FND has clear diagnostic criteria, 11 , 12 and common patterns of functional symptoms recur, eg typical motor, sensory, gait patterns and seizures.”
Nicholas, E., Varley, J. A., & Nicholas, R. S. (2026) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp-2025-337348
Mashuk, M. S., Lu, Y., Lai, L. Y. H., Shardlow, M., Saha, S., Williams, A. H., Lee, A., Lloyd, S., Mohanraj, R., & Basilio, D. D. (2026) · Frontiers in Digital Health · doi:10.3389/fdgth.2025.1691724
Are symptoms clustered into latent classes in pediatric functional neurological disorder?
Nishi, A., Hayakawa, I., Okubo, Y., Waugh, J. L., & Nariai, H. (2026) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2025.110876 · Cited by 1
Functional pain syndromes in the practice of a pediatric neurologist: a literature review
Zhаuniaronak, I. V., Shalkevich, L. V., Сташков, А. К., & Yakovlev, A. (2026) · Healthcare · doi:10.65249/1027-7218-2026-1-47-56
Marchica, E., Vercueil, L., & Druart, L. (2026) · Revue Neurologique · doi:10.1016/j.neurol.2026.01.268
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Hermitte, Y., & Garvin, S. (2026) · L Évolution Psychiatrique · doi:10.1016/j.evopsy.2026.01.008
Azzopardi, S., Garcin, B., Mesrati, F., Rumpli, D., Lefaucheur, J., & Tin, S. N. W. (2026) · Neurophysiologie Clinique · doi:10.1016/j.neucli.2026.103158
Na, H. S., Hwang, J.-M., Yang, H. K., & Han, S. B. (2026) · Diagnostics · doi:10.3390/diagnostics16060842
“Accurate diagnosis and clear communication at the initial encounter may play a central role in determining clinical outcomes in patients with functional neurological symptoms [15].”
Batt, I., Fong, T., Ngan, M., & Morris, L. (2026) · Disability and Rehabilitation · doi:10.1080/09638288.2026.2632934
“However, a positive diagnosis can also be supported by other functional motor signs, including tremor, dystonia, abnormal gait, and limb weakness, as well as additional features such as functional cognitive, sensory, and autonomic symptoms, and functional seizures [9,33].”
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Functional neurological disorder: a gap in the psychiatry curriculum
Mandagere, V., Fatima, O., & Bamford, J. (2026) · BJPsych Bulletin · doi:10.1192/bjb.2026.10237
Approach to the Patient with FND: Evaluation, Diagnosis, and Developing a Treatment Plan
DeDominicis, M., & Lidstone, S. C. (2026) · Seminars in Neurology · doi:10.1055/a-2835-0301
“1,39 Discussionof FNDmechanisms lays a foundation for then demonstrating the positive rule-in signs and introducing approaches to therapy (e.g., using distraction or grounding to reduce symptoms; demonstrating normal function during autonomic movements).”
Impaired intracortical inhibition in functional gait disorders: a pilot study
Banerjee, S., Choudhury, S., Majumdar, S., Sarkar, S., Das, K., Mukherjee, D., Bayen, A. B., Kumar, P., Chakroborty, S., Mukherjee, S., et al. (2026) · Annals of Movement Disorders · doi:10.4103/aomd.aomd_54_25
Callanan, L., O’Keeffe, F. M., & Burke, T. (2026) · Journal of Neurology · doi:10.1007/s00415-026-13817-x
“Pain is frequently overlooked in FND care, where attention often centres on core neurological symptoms [62, 99, 124].”
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Roldan, A., Shulman, J., Singh, R., Dayon, E., Abdou, A., Hartnett, J., & Trovato, E. L. (2026) · Journal of Clinical Medicine · doi:10.3390/jcm15093501
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Tolmacheva, V. A., Parfenov, V. A., Romanov, D. V., Дмитриевна, С. Е., Альбертовна, В. Б., & Владимировна, С. Е. (2026) · Journal of Clinical Medicine · doi:10.3390/jcm15093544
“The prevalence of FMD is quite high, from 80 to 140 per 100,000 people [6–8], and they are the second most common cause of a neurological outpatient visit after headache [9–12].”
Moss, R. S. L., Lennon, M. J., Anne, S., Swift, E., Lo, J., Walpola, I. C., Connors, M. H., Sachdev, P. S., & Mohan, A. (2026) · BJPsych Open · doi:10.1192/bjo.2026.11038
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“From a neurological viewpoint, functional neurological disorders are characterized by authentically experienced motor and sensory symptoms originating from dysfunctional activity of the nervous system instead of structural damage that leads to disability [ 8 ].”
Prolonged Functional Flaccid Paraplegia With Rapid Reversibility During Sensorimotor Facilitation
Mahmood, Q. (2026) · Journal of Clinical Neurology · doi:10.3988/jcn.2025.0758
Okazaki, M., Adachi, N., Sunaga, A., Watanabe, S., Ikegaya, N., Iwasaki, M., Hara, K., Ito, M., Kato, M., & Onuma, T. (2026) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2026.111163
Mavroudis, I. A., Petridis, F., Ciobica, A. S., Ionescu, C., Kamar, A. E., Cojocariu, R. O., Kazis, D. A., Gheban, D., Morosan, C., Gurzu, B., et al. (2026) · Frontiers in Molecular Neuroscience · doi:10.3389/fnmol.2026.1816644
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Anne, S., Lennon, M. J., Swift, E., Jervis, N., Harris, W., Gow, K., Walpola, I. C., Connors, M. H., Moss, R. S. L., Crawford, J. D., et al. (2026) · Neurology Clinical Practice · doi:10.1212/cpj.0000000000200638
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“Motor FND, for example, is characterised by motor symptoms, such as abnormal gait, weakness or tremor, that are considered incompatible with other neurological disorders [67], and expert consensus recommends psychologically informed physiotherapy as part of a multidisciplinary approach [68].”
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Wall, S., Singhal, S., Povey, J., Hopewell, E., & Jack, K. (2026) · British Journal of Neuroscience Nursing · doi:10.12968/bjnn.2025.0099
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Diagnóstico diferencial entre crisis funcionales/disociativas y crisis epilépticas frontales
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“Las personas con CEF y CFD pueden consultar tanto a servicios de Urgencias, Neurología y Medicina General (9); y es clave que durante la valoración se rea - lice una anamnesis detallada que incluya, de forma completa, síntomas y signos clínicos, que se pueda realizar un adecuado diagnóstico y se…”
Neuroscience-informed psychoeducation in functional neurological disorders
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Maggio, J., Salon, H., & Hershberg, J. (2026) · Neurology Report · doi:10.1097/npt.0000000000000583
Sloan, M. A., Leschziner, G. D., Arunasalam, A., D’Cruz, D. P., Calderwood, L., Harwood, R., Kaul, A., Bosley, M., Pitkänen, M., Gnanapavan, S., et al. (2026) · Rheumatology International · doi:10.1007/s00296-026-06296-w
“The converse is also true for functional symptoms mimicking symptoms requiring immunosuppression or antiseizure medication [ 28].”
Metadata
- 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 › Cardiology and Cardiovascular Medicine › 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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