Synopsis
Make a positive rule-in diagnosis of functional weakness, movement, sensory or seizure symptoms, communicate it without stigma, identify comorbid neurological disease, and organise rehabilitation around retraining and self-management.
- Functional neurological disorder causes genuine motor, sensory, seizure, speech, gait or cognitive symptoms arising from altered nervous-system functioning rather than deliberate production.
- Diagnosis is positively supported by internal inconsistency and preserved automatic function, not by normal scans, psychiatric history, unusual affect or failure to find another disease.
- Hoover sign shows weak voluntary hip extension that improves when the opposite hip flexes against resistance, demonstrating preserved automatic motor recruitment.
Key red flags
Persistent aphasia, true vascular field loss, new sphincter dysfunction, fever or objective progressive neurology requires urgent disease-specific assessment despite known FND.
Investigation priorities
Demonstrate inconsistency and preserved automatic motor capacity.
Management branches
New weakness, abnormal movement, gait or seizure-like activity presents urgently.
- Use the standard stroke, seizure, cord, metabolic or injury assessment appropriate to onset and objective findings, without allowing a previous FND label to lower safety.
- Once immediate threats are addressed, test validated inconsistency signs and document exactly what changes with automatic movement, distraction or entrainment.
Key medicines
No core FND medicineThere is no medicine dose that directly corrects functional motor or seizure mechanisms; prescribe only for a defined comorbid symptom or diagnosis.
Antiseizure medicine reviewWhen video EEG confirms only dissociative seizures, neurology designs a gradual agent-specific taper using the BNF rather than abrupt cessation.