Functional symptoms and disorders are the second commonest reason for a neurology outpatient visit after headache.
Functional Neurological disorder includes the following symptoms:
Functional limb weakness or paralysis
Functional movement disorders like tremor, dystonia, gait disorder and jerks
Functional/Dissociative Seizures/ Attacks – events that look like epileptic seizures or syncope
Persistent Postural Perceptual Dizziness and Functional Cognitive Disorders are in a grey zone but we regard them as part of FND
FND should not be used to describe ALL functional symptoms and disorders. It doesn’t for example include Chronic pain/Fibromyalgia, persistent fatigue or Functional Gastrointestinal problems such as Irritable Bowel Syndrome. Those disorders may commonly arise through similar central mechanisms and are often present in people with FND.
Services for FND
The neurology outpatient clinic role is primarily to make the diagnosis of FND, based on positive signs of FND and exclusion of other conditions, and explain the diagnosis / provide links to websites such as neurosymptoms.org and refer patients when needed and options are available.
Neuro-physiotherapy – This is often a mainstay of management, however, neurophysiotherapy services are under significant pressure and have limited capacity; for this reason, referral for management of FND usually comes via Neurology
Speech and Language therapy –again usually after referral from neurology
FND / Neuropsychiatry service (RIE, Edinburgh): Limited to patients with refractory or complex FND following referral from Borders neurologists (approximately 12 month waiting list)
Who to refer, who not to refer, how to refer
Who to refer:
People with neurological symptoms where FND is suspected such as limb weakness, tremor or seizures should be referred to neurology
Patients with suspected Persistent Postural Perceptual Dizziness (PPPD) and Functional Cognitive Disorder can also be referred.
Who not to refer:
Patients for whom you require advice about chronic pain should be referred to the chronic pain service
Patients with other functional disorders including functional GI disorders (including swallowing issues and bowel problems) and functional bladder disorders.
Patients whose primary problem is chronic fatigue syndrome /myalgic encephalomyelitis
Patients with persistent cognitive symptoms after covid
How to refer:
Via SCI Gateway
Primary care management
Patients presenting with dissociative non-epileptic seizures or other attacks and with movement disorders should be encouraged to bring videos to the consultation
Videos are essential to the diagnosis of many of these conditions
Resources and links
neurosymptoms.org– self help website and app for people with FND and associated symptoms run by Prof Jon Stone with Scottish Government funding from 2020. Please direct patients to specific relevant pages or use the ‘recommender’ Do not use for people with functional disorders who do not have FND
Borders Ref Help Toolkit
