Practical strategies for caring for patients with functional neurological disorder in the ED

Abstract

Functional Neurological Disorder (FND) presents unique challenges in the emergency department (ED), where patients often arrive with varied and vague symptoms that can be difficult to address. This article provides practical strategies for effectively managing and supporting FND patients in the ED, emphasizing a compassionate, systematic approach, tailored treatments, appropriate use of investigations, and ensuring continuity of care. Key principles include clear communication of the diagnosis, preventing iatrogenic harm, and facilitating appropriate referrals for follow-up care. Consistent and respectful language is important when managing patients with FND. Creating a calm environment reduced stress and symptom exacerbation. Thorough history taking and examination can help build the patient's confidence in their diagnosis. Validating symptoms and providing a clear explanation of the diagnosis are important. FND presentations, such as functional weakness and seizures, require tailored interventions with early involvement of physiotherapy and/or psychological support. A low threshold for investigating potential comorbid neurological conditions should be maintained when patients present to ED, especially in cases of unclear diagnoses or acute presentations, while avoiding repetitive testing that may reinforce illness behaviour. Managing FND in the ED requires a patient-centered, multidisciplinary approach. By adopting these strategies, health professionals can improve outcomes and support patients in managing their condition effectively.