Functional Neurological Disorders: A complete guide to understanding and treating

Is functional neurological disorder a real and reversible condition?

Functional neurological disorders cause real symptoms that may diminish or disappear in some people, with no guarantee of full recovery. Abilities and progression vary depending on symptoms, other health issues, and the care setting; no functional outcome is guaranteed. Imagine that your leg refuses to move, that your hand shakes uncontrollably, or that you lose consciousness for no apparent reason. Tests may come back normal, show abnormalities unrelated to the symptoms, or reveal another concurrent condition; the diagnosis is based on signs observed during the examination that support a functional neurological disorder (FND). Yet your symptoms are very real. You may be experiencing a functional neurological disorder (FND). FND can lead to significant limitations. Its prevalence, the groups affected, and its course depend on the definition, the population, and the presentation; no individual outcome is guaranteed. Our physical therapy guide for functional neurological disorders explains the management process.

What is Functional Neurological Disorder and how does it differ from other neurological diseases?

Functional neurological disorder (FND) causes genuine neurological symptoms and is characterized by findings on examination that do not follow the typical patterns of other neurological diseases. Changes in the functioning of certain neural networks are being studied, and another neurological disease may also coexist. ¹

A clinician makes a diagnosis of TNF based on signs observed during the examination. The presence or absence of a visible lesion on a brain image is not sufficient to confirm or rule out this diagnosis. The mechanisms underlying TNF are still being studied. Research findings from group studies do not allow us to deduce the mechanism behind an individual’s symptoms. Another neurological disorder may coexist, based on clinical evaluation. ²

The symptoms of TNF are real and may improve, stabilize, or persist. An explanation of the diagnosis helps the person understand the findings from their examination, though it does not guarantee how the condition will progress. ³

TNF is encountered in neurology clinics; its prevalence in these clinics does not reflect its prevalence in the general population. ⁴ TNF is not an uncommon condition in neurology clinics. In a Scottish study of 3,781 new patients referred to neurology, 16% of diagnoses involved functional and psychological symptoms; this proportion does not correspond to TNF alone. ⁴

The symptoms of TNF are neurological in nature. They affect movement, sensation, consciousness, or other functions controlled by the nervous system. A TNF may coexist with a neurological disorder. The diagnosis is based on positive signs rather than on an absolute distinction between function and structure. ⁵

What models are being studied to understand the symptoms of TNF?

The predictive brain is a research model used to study how expectations and sensory information might contribute to certain symptoms. It is not a single, proven cause of TNF in every person. ⁶

Some models describe perception as an interaction between expectations and sensory information. This research framework does not explain the mechanism behind TNF symptoms in a person. For example, have you ever felt your phone vibrate in your pocket even though it hadn’t moved? Perception models suggest that expectations may contribute to this type of sensation. This example illustrates that expectations can influence perception, without explaining the mechanism behind a TNF symptom. ⁷

Research models suggest that expectations and the processing of sensory information contribute to TNF symptoms. These models do not allow a person’s movement to be attributed to a single prediction error.

Functional imaging studies have observed average differences in brain activation between groups with and without TNF. These research findings do not allow for the identification of a specific mechanism in an individual or for a diagnosis to be made. The symptoms are real regardless of these images. ⁸

TNF is a recognized neurological diagnosis. The symptoms are real and involuntary; the possible presence of stress or a psychological disorder does not make them imaginary. ⁹

What is the difference between FND and malingering or a mental disorder?

TNF is diagnosed based on positive clinical signs, and the symptoms are experienced as involuntary; any potential benefit neither confirms nor rules out the diagnosis. TNF is not malingering and is not defined as a primarily psychological problem. Imaging studies show average differences in brain function between groups, but imaging alone cannot be used to diagnose TNF in an individual. ⁸

This distinction is crucial, yet it is often misunderstood, even within the medical community. Let’s start with malingering. A person who feigns symptoms consciously produces them to achieve a certain goal. This is not what happens with TNF: the symptoms occur without the person controlling them. In practice, feigning symptoms is very difficult to prove or rule out, and that is not what the physical therapist is trying to do: the diagnosis of TNF is based on positive clinical signs, not on monitoring the person. ¹⁰

The diagnosis of TNF is not based on a specific personality type. Anxiety, depression, or difficult life experiences are more common in certain groups that have been studied, though they are not present in everyone. The symptoms of TNF are involuntary. ^{11, 12, 13}

The confusion with mental disorders stems in part from outdated terminology. TNF was formerly known as “conversion disorder,” which suggested that a psychological problem was manifesting as a physical symptom. TNF is a recognized neurological diagnosis based on positive clinical signs. An anxiety disorder, depressive disorder, or other disorder may coexist, but its presence is not necessary for the diagnosis. ¹⁴

Stress, anxiety, or difficult experiences may be present in some people with TNF. Their presence, absence, and timing vary; association studies do not show that they directly disrupt the nervous system to cause or maintain symptoms. ¹⁵

Anxiety or depression may precede, accompany, or follow TNF symptoms. When present, they warrant separate management and should not be used to dismiss the symptoms or to impose a single cause. ¹⁶

What are the typical symptoms of functional neurological disorder?

The neurological symptoms of TNF can affect movement, sensation, consciousness, speech, or vision. Pain may also be present and should be evaluated based on its own diagnosis.

TNF is often accompanied by other symptoms that warrant attention: pain, fatigue, dizziness, and difficulty concentrating, as well as anxiety, depression, or post-traumatic stress.

TNF can disrupt several functions, such as movement, sensation, or consciousness. The clinician interprets these symptoms in conjunction with the signs observed during the examination. ⁹

Motor symptoms may include weakness in a limb or on one side of the body. Variability depending on the task or level of attention may be observed during the examination, though it is neither consistent nor sufficient to establish a diagnosis. ¹⁷

Functional tremors are neurological symptoms. They may differ from tremors associated with other causes, such as Parkinson’s disease. A functional tremor and another neurological condition may coexist. The diagnosis is based on the complete medical history and physical examination; no single sign, test, or imaging result can confirm it on its own. During the examination, a rapid movement of the other hand may interrupt or alter a functional tremor. This reaction alone is not sufficient to establish the diagnosis. ¹⁸

Functional gait disorders may exhibit positive features such as task-dependent variability or improvement with a different gait pattern. These signs are interpreted within the context of the overall examination, and another neurological disorder may coexist. ¹⁹

How to recognize the different types of FND symptoms?

Symptoms of TNF can affect movement, sensation, memory, concentration, vision, or hearing. Dissociative episodes are involuntary episodes that can alter movement, sensation, or consciousness, with or without loss of consciousness. A person may also have epilepsy. These descriptions alone are not sufficient to make a diagnosis. ⁹

Functional motor symptoms:

Functional weakness may vary depending on the task. Hoover's sign compares voluntary and automatic hip movements; when it is positive and consistent with the rest of the examination, it may support the diagnosis without, on its own, demonstrating that muscle strength is intact or explaining the mechanism of the symptoms. ²⁰

Functional dystonia may involve sustained or intermittent postures. This description alone does not confirm either the diagnosis or its cause. The onset, distribution, and movements vary. These characteristics are interpreted in conjunction with a comprehensive examination and do not allow for an absolute distinction from all other forms of dystonia. ²¹

Functional Sensory Symptoms:

Functional sensory disturbances include numbness, tingling, or pain. The area where sensations change may vary depending on the task or may not correspond to the area typically affected by another neurological disorder. This observation contributes to the examination, but it is not sufficient on its own to distinguish TNF from all other causes and must be interpreted in conjunction with other signs. ¹⁷

Dissociative Seizures (Psychogenic Non-Epileptic Seizures, PNES):

Dissociative seizures resemble epileptic seizures, but the typical episode is not accompanied by an epileptic discharge on an electroencephalogram (EEG), a test that records the brain’s electrical activity. However, epilepsy may coexist. Some of the individuals evaluated at specialized centers for drug-resistant epilepsy actually have dissociative seizures. ^{22, 23} Seizures may include convulsions, loss of consciousness, confusion, or stiffness.

Certain characteristics related to duration, movements, eye movements, responsiveness, and recovery can guide the assessment of a seizure. None of these characteristics alone confirms the diagnosis; recording a typical event and clinical interpretation in conjunction with an EEG are often necessary. ²⁴

Functional Cognitive Symptoms:

Memory or concentration difficulties may accompany TNF. Their variability or their association with fatigue, stress, or attention is not sufficient to rule out another cause. ²⁵

Functional Sensory Symptoms:

Visual or auditory symptoms may be reported. Any observed variability contributes to the evaluation but does not, on its own, reveal their nature or rule out another cause. ⁹

Why do FND symptoms fluctuate so much from day to day?

The symptoms of TNF can vary depending on the task, the time of day, and the context. Attention, stress, or fatigue may contribute to these fluctuations in some people, but they do not reveal the cause of these changes in an individual. ²⁶

Symptoms can change from one day to the next, making it difficult to plan activities. An improvement does not mean that previous symptoms were made up. ⁹

Attention and conscious effort can alter certain movements in some people. Their effect varies depending on the task and context; this observation alone is not sufficient to determine the mechanism underlying the symptoms. ²⁷

Stress and anxiety can coexist with fluctuations in symptoms, but their effect varies depending on the individual and the context. Their presence does not prove that they are the cause of the symptoms. ⁹

Fatigue may accompany TNF and warrants an assessment of its possible causes and effects on daily activities. ²⁸

Walking may vary across tasks and contexts. This observation does not demonstrate either a simulation or a causal mechanism specific to attention or the environment. ²⁹

How is a Functional Neurological Disorder diagnosed?

The diagnosis of TNF is based on positive clinical signs—that is, observations made during the physical examination that support the diagnosis, such as certain signs of weakness or tremor. Additional tests are selected based on the symptoms and clinical context; they are not limited to seeking normal results or ruling out all other diseases. ¹⁷

The diagnosis of TNF is now based on positive clinical signs rather than solely on the exclusion of other diseases. Delays of several years have been reported, particularly for dissociative episodes, but their duration does not apply to all forms of TNF. ^{23, 30}

Positive clinical signs consistent with TNF can support the diagnosis. Their interpretation takes into account the patient’s history, the overall physical examination, and any coexisting conditions. Positive signs are interpreted in conjunction with the medical history and physical examination by a trained clinician; the ability of a sign to distinguish TNF from other causes varies depending on the test and the context. The absence of a sign does not necessarily rule out the diagnosis, as that sign is not present in all individuals with TNF. ¹¹

What are the clinical signs used to identify FND?

Positive clinical signs may include Hoover's sign, a change in the tremor during a rhythmic task, or test-related variability. These signs are interpreted in conjunction with one another and with the rest of the examination; none on its own is sufficient to rule out another neurological disorder. ¹⁷

The diagnosis is based on the complete history and physical examination; no single sign, test, or imaging result can confirm it on its own. You are lying on your back. The clinician compares the pressure on your heels as you push each leg against the bed. The clinician then asks you to lift the less-affected leg against resistance and observes the pressure automatically produced by the heel of the affected leg. They may also compare the pressure in the opposite heel when you attempt to lift the weaker leg. A difference between these tasks may support the diagnosis when it is consistent with other signs; its absence does not rule it out. This test compares the force generated during two tasks; it is not sufficient on its own to explain why movements are difficult. ²⁰

The tremor may change rhythm during a test. The clinician may ask you to follow a rhythm with your less-affected hand and observe whether the tremor in the other hand follows that rhythm. This observation contributes to the examination but does not, on its own, confirm the diagnosis. ¹⁸

Variability in symptoms across different tests can aid in diagnosis when it is reproducible and consistent with other signs. For example, a person may exhibit marked weakness during a direct strength test but demonstrate normal strength during a functional movement that has not been formally tested (such as regaining balance after a simulated loss of balance). ¹¹

The findings observed during the examination can help the clinician make a diagnosis, but none of these examples alone is sufficient to confirm TNF or rule out another condition.

Which tests are necessary and which are not?

The diagnosis is based on positive clinical signs. Additional tests depend on the symptoms and are used to rule out other conditions that may coexist. For seizures, a video recording with an EEG of a typical episode often serves as the gold standard. Magnetic resonance imaging (MRI), which produces detailed images of the brain, may be indicated to rule out certain conditions but is not routinely necessary once the clinical diagnosis has been established. ³¹

A clinical neurological examination, along with the patient’s history and consistent positive findings, contributes to the diagnosis. No single test or level of experience can guarantee universal diagnostic certainty.

Video EEG may be indicated when a typical seizure needs to be characterized. Its role depends on the clinical presentation and the diagnostic question. ³¹ When a seizure occurs, it is recorded on video, and the brain’s electrical activity is recorded simultaneously. Video EEG helps confirm a dissociative seizure when a typical seizure is recorded and its clinical presentation, along with the EEG, is not consistent with an epileptic seizure.

A brain MRI, or magnetic resonance imaging, is a test that produces detailed images of the brain. Its use depends on the symptoms and clinical context; a normal or abnormal MRI result alone neither confirms nor rules out a TNF. ³²

The choice of additional tests depends on the symptoms, their progression, previous findings, and clinical judgment; normal imaging results alone do not confirm a TNF. Repeated testing may reinforce the idea that there is an underlying disease, delaying acceptance of the diagnosis and the start of treatment. ³³

How is a diagnosis of a functional neurological disorder explained?

The diagnosis of TNF is based on positive clinical signs that indicate an alteration in neurological function. The 3P model can then classify the so-called predisposing, precipitating, and perpetuating factors—that is, factors present before symptoms appear, around the time of their onset, or while they persist—without determining the cause in an individual and without requiring any one of these factors for the diagnosis. ³⁴

A person with TNF may also ask themselves, “Why me? What triggered these symptoms?” The answer is rarely simple or straightforward. Several factors are being studied, but their presence alone does not explain the cause of a person’s symptoms.

The 3P model categorizes possible factors into three categories. It is used to structure the clinical interview, without proving that each category contributes to a person’s symptoms. ³⁵

What factors increase the risk of developing FND?

Certain groups of people with TNF are more likely to experience anxiety, depression, or a difficult past than the groups with which they are compared. Migraine may also be present. These associated problems are not required for diagnosis and are evaluated as needed. ^{11, 13, 36}

Certain characteristics may be more common in some groups with TNF, but they are neither necessary nor sufficient. These associations do not indicate a mechanism of prediction error in an individual. ³⁷

A migraine may occur alongside TNF. This coexistence does not prove that one condition causes the other and is not sufficient to make a diagnosis. ³⁶

L’anxiété et la dépression préexistantes sont rapportées plus souvent dans certains groupes, sans permettre d’attribuer une cause individuelle au TNF.

Personality traits are not used to diagnose TNF. Psychological characteristics may be discussed when they are relevant to the individual, but they should not be used as a causal explanation. ^{12, 13}

A history of physical, emotional, or sexual trauma has been reported in certain groups, though this does not allow for the identification of an individual cause of TNF. Only a portion of people with TNF report difficult life experiences, such as childhood abuse. ¹⁵ The presence of this history alone does not predict the severity of a person’s symptoms. ¹³ These experiences may be relevant to care when a person wishes to discuss them, but they are not necessary for diagnosis nor do they prove a lasting brain mechanism.

What events or circumstances might precede the symptoms?

The diagnosis therefore no longer depends on identifying a trigger. ³⁸

A physical event may precede certain TBI cases in specialized cohorts. This association does not allow for the identification of an individual cause or the prediction of symptom severity. See the guide on concussions. See the guide on whiplash.

Several factors may be associated with the onset or persistence of symptoms. Their presence alone is not sufficient to determine the cause of a person’s symptoms.

Le stress peut précéder, accompagner ou suivre les symptômes chez certaines personnes. Sa présence ne permet pas d’en faire la cause du TNF.

Une intervention, une infection ou une maladie peut précéder certains symptômes sans démontrer qu’elle a déclenché le TNF ni par quel mécanisme.

Chez certaines personnes, aucun événement précis n’est retrouvé avant les symptômes. Cette absence ne confirme ni n’infirme le diagnostic.

What factors can influence the persistence of symptoms?

The duration of symptoms varies depending on the presentation, associated conditions, activities, and context. Relevant factors are assessed on a case-by-case basis.

This persistence often represents the most confusing aspect of FND. The initial trigger might have been resolved a long time ago, yet the symptoms remain. Why is this the case?

L’attention portée aux sensations peut être discutée lorsqu’elle gêne les activités. Cette attention ne suffit pas à expliquer la cause des symptômes.

Une réduction d’activité peut être abordée selon ses raisons, ses effets fonctionnels et les autres problèmes de santé. Elle ne permet pas de conclure qu’un évitement maintient le TNF ni qu’une faiblesse précise s’y ajoute.

Les explications données sur les symptômes peuvent influencer les choix et les objectifs de soins. Elles doivent être discutées sans attribuer les symptômes à des croyances erronées ni supposer un manque d’engagement.

Persistent pain may occur alongside TNF. An evaluation helps clarify its characteristics and tailor treatment. See the guide on chronic pain. See the guide on pain associated with changes in signal processing by the nervous system.

Les conséquences familiales, professionnelles et sociales du TNF peuvent être discutées. Elles ne permettent pas de conclure à un avantage, à une simulation ou à un mécanisme qui maintient les symptômes.

What treatments have been studied for functional neurological disorders?

Treatments studied for TNF include, in particular, physical therapy for motor symptoms and cognitive-behavioral therapy for dissociative episodes—a form of psychotherapy that explores the connections between thoughts, emotions, and behaviors. Results vary depending on the intervention, the presentation of symptoms, and the individual.

Symptoms may improve, stabilize, or persist. Responses to treatment vary; no treatment guarantees a specific outcome for each individual.

How does physiotherapy help in treating FND?

Physical therapy can address functional tasks, more automatic movements, or changes in attention, depending on the symptoms and goals. The response is assessed individually for each person without assuming a single mechanism.

Physical therapy is tailored to functional symptoms, observed abilities, and any coexisting conditions. It does not assume that all muscle strength is intact or that a specific motor circuit must be reactivated.

Une modification de l’attention ou une tâche rythmée peut être essayée pendant certains mouvements. Son effet varie; il ne démontre pas qu’un contrôle volontaire défaillant bloque le mouvement.

Rehabilitation approaches are among the treatments available for functional motor symptoms. Responses vary depending on the individual and the available studies. ³⁸

La disponibilité, la composition, la durée et les critères du programme du CHUM doivent être confirmés directement auprès de l’établissement. Le résultat du traitement varie selon la personne.

Tasks that alter attention can be used depending on the presentation. Their effects vary, and it cannot be concluded that a movement occurs naturally or that a specific automatic response takes over.

To learn more about this approach, consult our guide on physiotherapy for FND.

What is the role of psychotherapy in the treatment of FND?

Psychotherapy may be recommended depending on the individual’s needs, goals, and related circumstances. Its content and effects vary; no single psychological factor is believed to cause TNF in every person.

A person may be reluctant to see a psychologist if they fear that the suggestion might downplay the reality of their symptoms. Psychotherapy can be discussed based on individual needs and goals.

Psychotherapy does not mean that the symptoms are imaginary. It may address an associated condition or goals established with the individual, without attributing a psychological cause to TNF.

Cognitive-behavioral therapy (CBT) is a form of psychotherapy that helps individuals examine the connections between thoughts, emotions, and behaviors. It can be offered based on the individual’s needs and goals.

CBT can be tailored to an individual's needs and goals; it does not assume that symptoms are based on erroneous beliefs.

It can be offered without assuming that focusing on the body causes or perpetuates the symptoms.

It may also address a related condition when this aligns with the person’s needs and goals; however, it does not allow for predicting the prognosis of TNF.

The CODES studies on dissociative crises do not allow for the generalization of results or mechanisms to all presentations of TNF.

Le choix d’une psychothérapie dépend des symptômes, des objectifs et des préférences de la personne. Les résultats observés pour les crises dissociatives ne s’appliquent pas automatiquement à toutes les formes de TNF.

What role can medications play in healthcare?

No specific TNF-inhibitor medication has been proven effective for all of its symptoms. However, a medication may be prescribed for an associated condition or a specific symptom, depending on the indication, risks, interactions, and the individual’s medical history. ³⁰

Un antidépresseur peut être prescrit pour une dépression ou un trouble anxieux diagnostiqué séparément. Le choix et la surveillance relèvent du prescripteur; aucun effet indirect sur le TNF n’est garanti.

Une douleur doit être évaluée et traitée selon son diagnostic propre. La présence d’un TNF ne suffit pas à conclure que la douleur vient d’une atteinte d’un nerf.

Les benzodiazépines, des médicaments utilisés notamment contre l’anxiété, ne sont pas recommandées pour traiter les crises fonctionnelles sans autre indication médicale. Toute indication, durée, surveillance ou modification relève du prescripteur et du dossier individuel.

Certains médicaments peuvent présenter des risques ou effets indésirables. Leur indication, leurs effets et toute modification doivent être discutés avec le prescripteur; leurs risques dépendent du médicament et de la situation.

What is the prognosis for FND, and can one fully recover?

Symptoms of TNF may disappear completely in some people and persist in others; it is not possible to accurately predict an individual’s course of the disease. Group data do not allow us to promise functional recovery or to attribute a better prognosis solely to age or the timing of treatment. The duration of symptoms does not allow us to predict an individual’s course of the disease.

Group data cannot be used to predict an individual’s course of the disease or guarantee a specific outcome. Symptoms of TNF may decrease, stabilize, or disappear in some people. The frequency varies depending on the presentation and the studies, while symptoms persist long-term in many people.

The current results, duration, and composition of the CHUM program should be verified directly with the department. No recovery rate can predict an individual’s outcome.

A small randomized controlled trial reported greater perceived improvements at six months in the specialized group. ³⁹ In the subsequent multicenter Physio4FMD study, physical therapy designed for TNF was compared to locally available neurological physical therapy. The two groups showed no statistically significant difference in their ability to perform physical activities at 12 months, the primary outcome measure. Some other measures, including improvements in motor symptoms reported by participants, favored the TNF-specific approach. ⁴⁰

In a new analysis of data collected after the diagnosis was announced, 15 of the 54 people—or 27.8%—stopped having seizures within the following week. Without a comparison group, this association does not prove that the announcement caused the remissions. ⁴¹

What factors influence the chances of recovery?

The course of the condition varies greatly from person to person. The available prognostic literature does not allow for a precise prediction of individual recovery based on the time of diagnosis, age, acceptance, commitment, pain, other health issues, or a dispute related to compensation. ⁴²

In some studies, a shorter duration of symptoms and an earlier diagnosis were associated with a better outcome. These associations do not allow us to predict a person’s recovery or to conclude that earlier treatment is the cause. Improvement is still possible even after a prolonged course of the disease. ⁴²

A clear explanation of the diagnosis helps the person understand TNF and discuss treatment options. ⁴³ If you still have questions or if other symptoms appear, talk to your doctor.

Engagement in treatment allows patients to practice tasks and adjust strategies with the team. Results vary, and the available sources do not allow for the isolation of the causal effect of participation.

The link between disputes over compensation and recovery is unclear. Studies do not agree, and the cited follow-up study found no baseline factors that independently predict the course of the condition. ⁴⁴

Age is one of the characteristics studied, but the progression varies greatly from person to person and cannot be predicted by age alone. ⁴⁵ Age does not determine the mechanism behind symptoms or a person’s progression.

Chronic pain can coexist with TNF and make daily activities more difficult. It warrants evaluation and appropriate care. The course of the condition varies depending on the presentation and the individual; no specific individual course can be predicted.

Des problèmes de santé mentale peuvent coexister avec le TNF. Ils méritent une prise en charge propre lorsqu’ils sont présents, sans servir à prédire l’évolution individuelle du TNF.

How long does it take to see improvement?

The time it takes to see improvement and the extent of that improvement vary depending on the individual, the presentation, associated conditions, and the care provided. There is no single timeframe that applies to everyone.

The time it takes and the extent of improvement vary from person to person. Studies on symptom progression use different methods and study groups and do not allow for predicting an individual’s course of the disease. ⁴²

Une amélioration peut apparaître tôt ou plus tard. Une réponse initiale ne permet pas, à elle seule, de prédire l’évolution à long terme.

D’autres personnes progressent graduellement. La durée dépend de la présentation, des objectifs, des soins et de la personne; le programme du CHUM ne fixe pas une durée individuelle.

Les symptômes et la fonction peuvent fluctuer. Une variation doit être interprétée selon sa durée, son contexte et son effet sur les activités, sans la qualifier automatiquement de rechute normale.

Des changements de symptômes ou de fonction peuvent être suivis avec la personne. Leur signification et la trajectoire future ne se déduisent pas d’un pourcentage isolé.

Where to seek treatment for FND in Quebec and how to access treatments?

In Quebec, your doctor can evaluate your symptoms and refer you to the appropriate care; the CHUM’s TNF Clinic accepts medical referrals for individuals with a confirmed and explained diagnosis. A physical therapy evaluation does not replace a confirmed medical diagnosis.

The course of action depends on the diagnosis, any concerning symptoms, the patient’s needs, and the available resources. Eligibility criteria must be confirmed directly with the relevant departments.

When should I seek consultation for possible FND symptoms?

New, persistent, or changing neurological symptoms warrant a clinical evaluation. The timing and the healthcare professional involved depend on the symptoms, their progression, and the context.

Early consultation may be recommended depending on the symptoms, although it does not guarantee a diagnosis or a faster recovery.

Quand demander une évaluation urgente?

• You suddenly develop weakness or paralysis in a limb
  
• You experience seizures resembling epilepsy
  
• You lose the ability to walk or move normally
  
• Your symptoms rapidly worsen

Sudden weakness, a seizure, a significant loss of function, or rapid deterioration warrants an urgent evaluation to identify causes that require immediate treatment.

Avec un diagnostic déjà établi, tout symptôme nouveau ou nettement changé doit être réévalué selon les signes et le contexte.

• You do not have access to specialized treatment
  
• Your symptoms are not improving with the current treatment
  
• You are developing new symptoms that are different from your initial symptoms
  
• Your function continues to worsen

What is the CHUM FND Clinic and how can you access it?

The CHUM TNF Clinic evaluates and provides care for adults with complex TNF or a related syndrome.

The team includes doctors, physical therapists, and occupational therapists. The care provided depends on the assessment and the patient's needs.

Le programme peut comprendre de la réadaptation pour les mouvements et les activités du quotidien. L’équipe précise la durée et les objectifs adaptés à votre situation.

Les progrès sont suivis selon vos symptômes et vos activités; aucun résultat individuel n’est garanti.

Pour demander une consultation, votre médecin transmet une référence et un résumé médical lorsque le diagnostic est confirmé, qu’il vous a été expliqué et que vous acceptez cette démarche. Vérifiez les délais actuels auprès du service.

What other resources are available in Quebec for FND?

The availability, qualifications, and eligibility requirements for resources must be verified directly with each organization or professional.

A private practice consultation may be considered depending on the diagnosis, symptoms, needs, the professional’s expertise, and the available services.

Physioactif may offer a physical therapy evaluation to individuals with TNF, depending on the expertise of the available professional and the individual’s needs. A physical therapist may explain their training and the proposed approach during the evaluation; no specific techniques or results are guaranteed. Eligibility for physical therapy and the need for a medical evaluation depend on the individual’s situation, symptoms, and applicable professional guidelines. You may request a physical therapy appointment; availability, wait times, and the need for a medical evaluation vary depending on the situation.

Pour une consultation en psychologie, vérifiez directement la formation, l’approche, la disponibilité et l’adéquation aux besoins de la personne.

Les Resources en ligne peuvent fournir de l’information ou du soutien; leur contenu, leur disponibilité et leur mandat doivent être vérifiés directement.

• neurosymptoms.org : vérifiez directement la langue, le contenu et la disponibilité du site
  
• Site du CHUM : vérifiez directement les renseignements actuels sur ses Services et Resources
  
• FND Hope : vérifiez directement le mandat, le contenu et la disponibilité de cette ressource
  
• FND Friends: Check this resource's mandate, moderation status, and availability directly

These resources provide information or support in accordance with their mandate; their quality, availability, and individual impact must be evaluated. ⁴⁶

How can I check my insurance coverage or eligibility for a program?

To verify your coverage or eligibility, ask your insurer or the program for the written criteria that apply to your situation. Also, have your functional limitations documented without making any assumptions about the outcome of your application.

This issue raises legitimate concerns. The financial implications and forms of support vary depending on the job, the position, and the rules of the relevant plan.

La reconnaissance administrative du TNF et l’admissibilité à une prestation dépendent du régime, du contrat, de la preuve et du dossier individuel.

Recognition and eligibility depend on the contract or program; they must be confirmed in writing by the relevant payer. The required documents and criteria are determined by the insurer or program; there is no single piece of evidence that applies to all cases. The required documents and their weight are determined by the contract or program; no specific type of professional or level of detail guarantees the acceptance of a case.

The CNESST (Commission des normes, de l'équité, de la santé et de la sécurité du travail) evaluates each claim based on the law, medical evidence, and the facts of the case. A healthcare professional can document the diagnosis and limitations, but cannot guarantee that a work-related connection will be recognized. ⁴⁷

The SAAQ, the Quebec Automobile Insurance Corporation, evaluates each claim based on the law, medical evidence, and the facts of the case; the onset of symptoms following an accident does not guarantee that a causal link will be recognized.

Your commitment to the processing alone is not sufficient to establish its legitimacy or good faith. The rights, obligations, and consequences of a decision to process data depend on the specific regulations and the case at hand; appropriate legal or administrative advice may be sought.

References

The references for this article include the following studies and guides.

1. Edwards MJ, Adams RA, Brown H, Pareés I, Friston KJ. A Bayesian account of 'hysteria'. Brain. 2012;135(Pt 11):3495-512.↩ Back to text
2. Vuilleumier P. Brain circuits implicated in psychogenic paralysis in conversion disorders and hypnosis. Neurophysiol Clin. 2014;44(4):323-37.↩ Back to text
3. Stone J, Carson A, Hallett M. Explanation as treatment for functional neurologic disorders. Handb Clin Neurol. 2016;139:543-553.↩ Back to text
4. Stone J, Carson A, Duncan R, Roberts R, Warlow C, Hibberd C, et al. Who is referred to neurology clinics?--the diagnoses made in 3781 new patients. Clin Neurol Neurosurg. 2010;112(9):747-51.↩ Back to text: 1st, 2nd mentions
5. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Association; 2013.↩ Back to text
6. Pareés I, Brown H, Nuruki A, Adams RA, Davare M, Bhatia KP, et al. Loss of sensory attenuation in patients with functional (psychogenic) movement disorders. Brain. 2014;137(Pt 11):2916-21.↩ Back to text
7. Van den Bergh O, Witthöft M, Petersen S, Brown RJ. Symptoms and the body: Taking the inferential leap. Neuroscience & Biobehavioral Reviews. 2017;74:185-203.↩ Back to text
8. Voon V, Brezing C, Gallea C, Ameli R, Roelofs K, LaFrance WC, et al. Emotional stimuli and motor conversion disorder. Brain. 2010;133(Pt 5):1526-36.↩ Back to text: 1st, 2nd mentions
9. MedlinePlus. Functional neurological disorder. Medical Encyclopedia. Consulté le 17 septembre 2026.↩ Back to text: 1st, 2nd, 3rd, 4th, 5th, 6th mentions
10. Nicholson C, Edwards MJ, Carson AJ, Gardiner P, Golder D, Hayward K, et al. Occupational therapy consensus recommendations for functional neurological disorder. J Neurol Neurosurg Psychiatry. 2020;91(10):1037-1045.↩ Back to text
11. Stone J, Warlow C, Sharpe M. The symptom of functional weakness: a controlled study of 107 patients. Brain. 2010;133(5):1537-1551.↩ Back to text: 1st, 2nd, 3rd, 4th mentions
12. Kranick S, Ekanayake V, Martinez V, Ameli R, Hallett M, Voon V. Psychopathology and psychogenic movement disorders. Mov Disord. 2011;26(10):1844-50.↩ Back to text: 1st, 2nd mentions
13. Stone J, Warlow C, Deary I, Sharpe M. Predisposing Risk Factors for Functional Limb Weakness: A Case-Control Study. J Neuropsychiatry Clin Neurosci. 2020;32(1):50-57.↩ Back to text: 1st, 2nd, 3rd, 4th mentions
14. Hallett M. Functional (psychogenic) movement disorders - Clinical presentations. Parkinsonism Relat Disord. 2016;22 Suppl 1(0 1):S149-52.↩ Back to text
15. Ludwig L, Pasman JA, Nicholson T, Aybek S, David AS, Tuck S, et al. Stressful life events and maltreatment in conversion (functional neurological) disorder: systematic review and meta-analysis of case-control studies. Lancet Psychiatry. 2018;5(4):307-320.↩ Back to text: 1st, 2nd mentions
16. Carson A, Lehn A, Ludwig L, Stone J. Explaining functional disorders in the neurology clinic: a photo story. Pract Neurol. 2016;16(1):56-61.↩ Back to text
17. Daum C, Hubschmid M, Aybek S. The value of 'positive' clinical signs for weakness, sensory and gait disorders in conversion disorder: a systematic and narrative review. J Neurol Neurosurg Psychiatry. 2014;85(2):180-90.↩ Back to text: 1st, 2nd, 3rd, 4th mentions
18. Schwingenschuh P, Katschnig P, Seiler S, Saifee TA, Aguirregomozcorta M, Cordivari C, et al. Moving toward "laboratory-supported" criteria for psychogenic tremor. Mov Disord. 2011;26(14):2509-15.↩ Back to text: 1st, 2nd mentions
19. Baik JS, Lang AE. Gait abnormalities in psychogenic movement disorders. Mov Disord. 2007;22(3):395-9.↩ Back to text
20. Ziv I, Djaldetti R, Zoldan Y, Avraham M, Melamed E. Diagnosis of "non-organic" limb paresis by a novel objective motor assessment: the quantitative Hoover's test. J Neurol. 1998;245(12):797-802.↩ Back to text: 1st, 2nd mentions
21. Schrag A, Trimble M, Quinn N, Bhatia K. The syndrome of fixed dystonia: an evaluation of 103 patients. Brain. 2004;127(Pt 10):2360-72.↩ Back to text
22. Anzellotti F, Dono F, Evangelista G, Di Pietro M, Carrarini C, Russo M, et al. Psychogenic Non-epileptic Seizures and Pseudo-Refractory Epilepsy, a Management Challenge. Front Neurol. 2020;11:461.↩ Back to text
23. Reuber M, Fernández G, Bauer J, Helmstaedter C, Elger CE. Diagnostic delay in psychogenic nonepileptic seizures. Neurology. 2002;58(3):493-5.↩ Back to text: 1st, 2nd mentions
24. Avbersek A, Sisodiya S. Does the primary literature provide support for clinical signs used to distinguish psychogenic nonepileptic seizures from epileptic seizures? J Neurol Neurosurg Psychiatry. 2010;81(7):719-25.↩ Back to text
25. Teodoro T, Edwards MJ, Isaacs JD. A unifying theory for cognitive abnormalities in functional neurological disorders, fibromyalgia and chronic fatigue syndrome: systematic review. J Neurol Neurosurg Psychiatry. 2018;89(12):1308-1319.↩ Back to text
26. Stone J, Edwards M. Trick or treat? Showing patients with functional (psychogenic) motor symptoms their physical signs. Neurology. 2012;79(3):282-284.↩ Back to text
27. Pareés I, Kassavetis P, Saifee TA, Sadnicka A, Davare M, Bhatia KP, et al. Failure of explicit movement control in patients with functional motor symptoms. Mov Disord. 2013;28(4):517-23.↩ Back to text
28. Gelauff JM, Rosmalen JGM, Gardien J, Stone J, Tijssen MAJ. Shared demographics and comorbidities in different functional motor disorders. Parkinsonism Relat Disord. 2020;70:1-6.↩ Back to text
29. Stone J, Carson A. Functional neurologic disorders. Continuum (Minneap Minn). 2015;21(3 Behavioral Neurology and Neuropsychiatry):818-837.↩ Back to text
30. Hospices Civils de Lyon. Trouble neurologique fonctionnel (TNF). Fiche santé HCL. Consulté le 17 septembre 2026.↩ Back to text: 1st, 2nd mentions
31. LaFrance WC, Baker GA, Duncan R, Goldstein LH, Reuber M. Minimum requirements for the diagnosis of psychogenic nonepileptic seizures: a staged approach: a report from the International League Against Epilepsy Nonepileptic Seizures Task Force. Epilepsia. 2013;54(11):2005-18.↩ Back to text: 1st, 2nd mentions
32. Pareés I, Kojovic M, Pires C, Rubio-Agusti I, Saifee TA, Sadnicka A, et al. Physical precipitating factors in functional movement disorders. J Neurol Sci. 2014;338(1-2):174-177.↩ Back to text
33. Stone J, Carson A, Sharpe M. Functional symptoms and signs in neurology: assessment and diagnosis. J Neurol Neurosurg Psychiatry. 2005;76 Suppl 1(Suppl 1):i2-12.↩ Back to text
34. O'Neal MA, Baslet G. Treatment for Patients With a Functional Neurological Disorder (Conversion Disorder): An Integrated Approach. Am J Psychiatry. 2018;175(4):307-314.↩ Back to text
35. Stone J, Wojcik W, Durrance D, Carson A, Lewis S, MacKenzie L, et al. What should we say to patients with symptoms unexplained by disease? The "number needed to offend". BMJ. 2002;325(7378):1449-1450.↩ Back to text
36. Vanini G, Bühler J, Weber S, Steinauer M, Aybek S. Healthcare employment as a risk factor for functional neurological disorder: A case-control study. Eur J Neurol. 2024;31(1):e16056.↩ Back to text: 1st, 2nd mentions
37. Nicholson TR, Stone J, Kanaan RA. Conversion disorder: a problematic diagnosis. J Neurol Neurosurg Psychiatry. 2011;82(11):1267-73.↩ Back to text
38. Aybek S, Perez DL. Diagnosis and management of functional neurological disorder. BMJ. 2022;376:o64.↩ Back to text: 1st, 2nd mentions
39. Nielsen G, Buszewicz M, Stevenson F, Hunter R, Holt K, Dudziec M, et al. Randomised feasibility study of physiotherapy for patients with functional motor symptoms. J Neurol Neurosurg Psychiatry. 2017;88(6):484-490.↩ Back to text
40. Nielsen G, Stone J, Lee TC, Goldstein LH, Marston L, Hunter RM, et al. Specialist physiotherapy for functional motor disorder in England and Scotland (Physio4FMD): a pragmatic, multicentre, phase 3 randomised controlled trial. Lancet Neurol. 2024;23(7):675-686.↩ Back to text
41. Duncan R, Horwood J, Razvi S, Mulhern S. Psychogenic nonepileptic seizures that remit when the diagnosis is given: Just good luck? Epilepsy Behav. 2020;102:106667.↩ Back to text
42. Gelauff J, Stone J, Edwards M, Carson A. The prognosis of functional (psychogenic) motor symptoms: a systematic review. J Neurol Neurosurg Psychiatry. 2014;85(2):220-6.↩ Back to text: 1st, 2nd, 3rd mentions
43. Espay AJ, Aybek S, Carson A, Edwards MJ, Goldstein LH, Hallett M, et al. Current Concepts in Diagnosis and Treatment of Functional Neurological Disorders. JAMA Neurol. 2018;75(9):1132-1141.↩ Back to text
44. Gelauff JM, Carson A, Ludwig L, Tijssen MAJ, Stone J. The prognosis of functional limb weakness: a 14-year case-control study. Brain. 2019;142(7):2137-2148.↩ Back to text
45. Pehlivantürk B, Unal F. Conversion disorder in children and adolescents: a 4-year follow-up study. J Psychosom Res. 2002;52(4):187-91.↩ Back to text
46. FND Hope International. Consulté le 17 septembre 2026.↩ Back to text
47. Commission des normes, de l’équité, de la santé et de la sécurité du travail (CNESST). Admissibilité d’une réclamation. Consulté le 17 septembre 2026.↩ Back to text

Nos physiothérapeutes ont défini la stratégie de recherche, le plan et le contenu clinique de cet article. Un outil d’IA a soutenu la recherche documentaire et la révision du texte pour assurer une cohérence du contenu et du style d’écriture.