An introduction to functional neurological disorders in the emergency department

Functional neurological disorders (FNDs) are conditions of nervous system malfunctioning, rather than a clearly identifiable pathophysiological disease.¹ FND can present with an array of symptoms, including functional seizures, weakness and paralysis, movement disorders, speech disturbances, globus sensation, sensory complaints, visual and cognitive symptoms. These symptoms may be acute or chronic, episodic or sustained and patients often have a high rate of representation to the ED.² These factors make FND a challenge to manage within the constraints of the ED.

Previously, FND was considered a diagnosis of exclusion. Recently, FND has been described as a ‘rule-in’ diagnosis, with positive findings offering the possibility of early diagnosis and management in the ED. Shorter time from symptom onset to diagnosis is an important positive prognostic factor, leading to reduced ED utilisation and improved patient outcomes.³