Recognising and explaining functional neurological disorderBMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m3745 (Published 21 October 2020) Cite this as: BMJ 2020;371:m3745
- Jon Stone, professor of neurology1,
- Chris Burton, professor of primary care2,
- Alan Carson, professor of neuropsychiatry1
- 1Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK
- 2Academic Unit of Primary Medical Care, University of Sheffield, Sheffield S5 7AU, UK
- Correspondence to: J Stone .
What you need to know
Functional neurological disorder (FND) is associated with considerable distress and disability. The symptoms are not faked
Diagnose FND positively on the basis of typical clinical features. It is not a diagnosis of exclusion
FND can be diagnosed and treated in presence of comorbid, pathophysiologically defined disease
Psychological stressors are important risk factors but are neither necessary nor sufficient for the diagnosis
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.
Sources and selection criteria
We conducted a PubMed search of evidence for diagnosis of functional neurological disorder (FND) until June 2020, especially systematic reviews.14 …