Let’s Talk About Functional Neurological Disorder (FND)

Functional Neurological Disorder (FND) is one of the most misunderstood yet increasingly recognized conditions in both neurology and mental health. It's not imaginary or "all in your head" – but rather a disruption in how the brain sends and receives signals. Think of it like a traffic light malfunction in a busy city – the roads (nerves) are fine, but the signals are giving mixed messages. Instead of green light there is a orange or instead of red there is a green light on.

As a therapist, I learn something new from every client I speak with. Recently, someone reached out to me because she believed she was experiencing panic attacks. But as she described her episodes, something felt different. She mentioned seizure-like symptoms similar to epilepsy, yet her scans had come back clear. It was assumed to be panic—but the story didn’t sit right with me.

That moment led me to dive deeper into research, and that’s when I came across Functional Neurological Disorder (FND). During our next session, I gently shared what I had learned. The relief on her face was immediate. It gave her hope, a possible explanation, and a direction to explore. I suggested she connect with a physiotherapist who specializes in neurological issues to assess for FND while she waits for a formal neurology evaluation.

🔹 Common symptoms of FND:

• Muscle weakness or sudden movement difficulties
• Temporary vision issues like blurred vision, tunnel vision, or partial loss of sight with no detectable damage
• Speech difficulties such as sudden loss of voice, stuttering, or trouble forming words
• Tremors or spasms that change with distraction
• Functional (non-epileptic) seizures
• Speech problems, memory issues, or brain fog
• Numbness, tingling, or vision problems
• Emotional stress often linked to symptom severity

Many individuals struggling for years with symptoms that seemed neurological but had no clear cause on scans. They were often told it was just stress, panic attacks, or "all in their head." As they waited for answers, many developed anxiety, depression, and even social withdrawal out of fear of loosing control over their body. That's where FND diagnosis can come in. It's real, distressing, and frequently misdiagnosed because standard tests like MRIs, EEGs and ophthalmological exams and scans show no damage.

So how common is FND or misdiagnosis? Studies suggest that up to 1 in 6 patients referred to neurology clinics may actually have functional symptoms rather than structural brain disease. Additionally, about 20–30% of patients in epilepsy monitoring units are found to have functional seizures, not epilepsy. That means a significant number of people are living with real neurological symptoms, often without an accurate diagnosis for months—or even years.

Neurology residents’ education in functional seizures - PMC

The Diagnosis of Functional Seizures

FND seizures vs. Panic attacks – what's the difference?

While both can involve overwhelming sensations and body responses, they are not the same:

• Panic attacks are driven by a fight-or-flight response: fast heart rate, shortness of breath, fear of dying, and heightened alertness. They often build up quickly and resolve within minutes. While incredibly distressing, panic attacks usually do not involve a loss of consciousness or motor control. The person remains aware, even if overwhelmed, and there's no actual physical danger like a heart attack, seizure, or collapse, though it may feel that way in the moment.
• Functional seizures may include convulsions, loss of responsiveness, or unusual movements, but without changes in brain wave activity typical of epilepsy. These episodes are caused by a disruption in motor-sensory control, and while they may sometimes be related to emotional stress, they do not stem from fear or panic in the same way panic attacks do. 

For those who have been through countless tests without answers, learning about FND can feel like a turning point.

How can therapists differentiate between panic attacks and functional seizures during assessment?

• Awareness and memory: Clients usually remember a panic attack, even if it was overwhelming. Functional seizures often involve loss of responsiveness or partial amnesia.

• Onset and duration: Panic attacks typically build up rapidly and fade within minutes. Functional seizures may last longer and often begin without a clear trigger.

• Physical presentation: Panic attacks include hyperventilation, trembling, and a racing heart. Functional seizures may show inconsistent or non-typical movements (e.g. side-to-side head shaking or pelvic thrusting), and people often do not injure themselves during these episodes. Unlike epileptic seizures—which can lead to tongue-biting, falling with impact, or head injuries—functional seizures may involve a more controlled collapse or protective body responses, even when the person appears unresponsive.

• Response to grounding or distraction: Panic attacks can sometimes ease with grounding techniques. Functional seizures often do not respond to the same interventions in the moment.

• EEG and neurological findings: Functional seizures do not show the electrical brain patterns seen in epilepsy, which helps rule out epileptic seizures—not panic attacks directly, but this is a part of the diagnostic picture.

For some clients, dissociative processes may develop as a coping mechanism to avoid overwhelming feelings or distress. Over time, the brain may learn to automatically dissociate when triggered—sometimes even by unconscious thoughts or emotional cues. This can eventually result in sudden shutdowns or functional seizures that appear without a clear emotional build-up. 

All of this requires gentle, trauma-informed questioning and collaboration with neurologists or FND-informed teams. Listening to the full story is key,  because trauma and dissociation often play a role in the development of functional symptoms. Past emotional overwhelm or unresolved stress can leave a 'footprint' on the nervous system, leading to disconnects between thoughts, emotions, and bodily reactions. 

Therapeutic approaches like hypnosis can be helpful here: identifying those hidden triggers, challenging unhelpful beliefs, and practicing emotional acceptance in a safe, guided way. Through imaginal exercises or hypnotic reprocessing, the brain can learn new responses to stress and form healthier, more integrated patterns of coping. This is the support that neurologist of physiotherapist are not trained for and unfortunately neither have a time for. 

Treatment & Hope:

The emotional triggers can be complex or even unconscious, and the brain responds with functional symptoms rather than the typical panic response. Both can be responses to stress, but they involve different brain circuits and require different support strategies.

FND is highly treatable. The most effective approaches focus on retraining the brain and restoring nervous system regulation, often with:

• Physical therapy
• Cognitive Behavioural Therapy (CBT)
• Speech and occupational therapy
• Education and support
• Mindfulness & emotional regulation
• Cognitive Behavioural Hypnotherapy (CBH)

CBH can play a unique role by helping clients identify and shift unconscious patterns that contribute to symptoms. Through structured hypnotic techniques, individuals can rehearse new responses to stress, reframe unhelpful beliefs, and reduce dissociation. Imaginal exposure, guided emotional processing, and future-oriented mental rehearsal under hypnosis can create a safe space for rewiring how the body and brain react to triggers.

Emerging research supports this too. A review published in Neuroscience & Biobehavioral Reviews found that hypnosis and suggestion-based therapies can reduce FND symptoms—especially when integrated with other treatments. A pilot study in Movement Disorders Clinical Practice also showed that behavioural therapy incorporating hypnosis led to greater symptom reduction compared to standard care.
🔗 Study 3 | Study 4

 

 Clinical tests used in diagnosis:

FND is diagnosed by neurologists using positive clinical signs like observable patterns that suggest the issue lies in how the brain functions, not in structural damage. These include inconsistent symptoms, variability with attention, and specific signs such as Hoover’s Sign or tremor entrainment. These tests help confirm FND, rather than ruling out other conditions.

Not everyone is familiar with FND, so if standard scans are clear and symptoms persist, it may help to mention FND as a possibility. A respectful question like:

“I’ve been reading about Functional Neurological Disorder and my symptoms seem similar. Could this be something we consider?”  This can help open the conversation.

Due to long wait times, some clients first see a physiotherapist trained in neurological conditions. These professionals may recognize functional symptoms and suggest further assessment. While not all physiotherapists are trained in FND, those with experience in neurological rehab may offer valuable early insights.

• Tremor Entrainment Test – When asked to tap a rhythm with the other hand, tremors may change or stop.
• Hoover’s Sign – A test to detect functional leg weakness. When lying down, the person may appear unable to lift one leg. But when asked to lift the other, the 'weak' leg pushes down automatically—indicating strength is present.
• Gait analysis – Some people walk more steadily when not focusing on walking.

Where Can I Get Diagnosed in Czech Republic?

If you suspect FND, seek specialists at: 📌 Brno University Hospital – Center for Functional Neurological Disorders 📌 General Faculty Hospital, Prague – Neurological diagnostics & movement disorder specialists 📌 Thomayer University Hospital, Prague – Functional movement evaluations

 

Success Rate of FND Treatment

Studies show that multidisciplinary treatment (including physiotherapy, cognitive-behavioral therapy (CBT), and psychoeducation) leads to significant improvement in most patients:

• Inpatient rehabilitation: A study found that 83% of patients with severe FND showed global improvement in mobility, mood, and quality of life after intensive inpatient treatment.
• Outpatient therapy: An 8-week multidisciplinary program led to statistically significant improvements in anxiety, depression, and functional mobility, with continued progress at the 3-month follow-up.

How Long Does It Take to Feel Better?

Recovery time varies based on symptom severity, treatment approach, and individual response, but general trends show:

• Short-term improvement: Many patients report noticeable symptom relief within 8 weeks of structured therapy.
• Long-term recovery: With consistent treatment, functional mobility, emotional regulation, and symptom management continue to improve over several months to a year.
• Key factor for success: Patient confidence in treatment is a strong predictor of positive outcomes.

Final Encouragement for Clients

 FND is treatable, and most patients see significant improvement with the right therapy. Recovery takes time, but structured treatment can lead to better mobility, reduced anxiety, and improved quality of life. You are not alone—specialists understand FND better than ever, and support is available!

If you or someone you care about has unexplained neurological symptoms, there is hope. FND is real and diagnosable. FND is treatable, and most patients see significant improvement with the right therapy. 

Studies show significant improvement is possible, especially with multidisciplinary support. 

Feel free to message me if you're curious or want to learn more.