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.

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