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. Functioning and progression vary depending on symptoms, other health issues, and the care setting; no functional outcome is guaranteed. Imagine that your leg won’t 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 suffering from 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.

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

Pre-existing anxiety and depression are reported more frequently in certain groups, though this does not allow for the attribution of a specific cause to 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.

In some people, stress may precede, accompany, or follow the symptoms. Its presence does not mean it is the cause of TNF.

A procedure, infection, or illness may precede certain symptoms without proving that it triggered TNF or through what mechanism.

In some people, no specific event can be identified prior to the onset of symptoms. This absence neither confirms nor rules out the diagnosis.

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?

Attention to physical sensations may be called into question when it interferes with daily activities. This attention alone is not enough to explain the cause of the symptoms.

A reduction in activity can be analyzed in terms of its causes, functional effects, and other health issues. It does not allow us to conclude that avoidance maintains TNF or that a specific weakness contributes to it.

Explanations of symptoms can influence care choices and goals. They should be discussed without attributing symptoms to mistaken beliefs or assuming a lack of commitment.

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.

The family, occupational, and social consequences of TNF can be discussed. They do not support a conclusion regarding an advantage, malingering, or a mechanism that perpetuates the symptoms.

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.

A shift in attention or a rhythmic task can be tried during certain movements. Its effect varies; it does not demonstrate that impaired voluntary control blocks the movement.

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

The availability, composition, duration, and criteria of the CHUM program must be confirmed directly with the facility. Treatment outcomes vary from person to person.

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.

The choice of psychotherapy depends on the person’s symptoms, goals, and preferences. The results observed for dissociative episodes do not automatically apply to all forms of 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

An antidepressant may be prescribed for depression or an anxiety disorder diagnosed separately. The choice of medication and monitoring are the responsibility of the prescribing physician; no indirect effect on TNF is guaranteed.

Pain must be evaluated and treated based on its specific diagnosis. The presence of TNF alone is not sufficient to conclude that the pain is caused by nerve damage.

Benzodiazepines, medications used primarily to treat anxiety, are not recommended for treating functional attacks in the absence of other medical indications. Any indication, duration, monitoring, or adjustment is at the discretion of the prescriber and depends on the individual patient’s medical history.

Some medications may pose risks or cause side effects. Their intended use, effects, and any changes should be discussed with the prescribing healthcare provider; the risks associated with them depend on the medication and the specific 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.

Mental health issues may coexist with TNF. When present, they warrant separate management but do not serve as predictors of the individual course of 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

Improvement may occur sooner or later. An initial response alone is not enough to predict the long-term outcome.

Others make gradual progress. The duration depends on the presentation, the goals, the care provided, and the individual; the CHUM program does not set a specific duration for each person.

Symptoms and function may fluctuate. Any variation should be interpreted in light of its duration, context, and impact on daily activities, without automatically classifying it as a normal relapse.

Changes in symptoms or function can be monitored together with the individual. Their significance and future course cannot be determined based on a single percentage.

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.

When should you request an urgent evaluation?

• 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.

Once a diagnosis has been established, any new or significantly changed symptom must be reevaluated based on the signs and context.

• 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.

The program may include rehabilitation focused on movement and activities of daily living. The team will determine the duration and goals that are appropriate for your situation.

Progress is tracked based on your symptoms and activities; individual results are not guaranteed.

To request a consultation, your doctor will send a referral and a medical summary once the diagnosis has been confirmed, explained to you, and you have agreed to proceed. Check with the department for current wait times.

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.

When seeking a psychology consultation, be sure to check the therapist’s training, approach, availability, and suitability for the person’s needs.

Online resources can provide information or support; their content, availability, and scope must be verified directly.

• neurosymptoms.org: Check the language, content, and availability of the site directly
  
• CHUM website: Check the latest information on its services and resources directly
  
• FND Hope: Check the scope, content, and availability of this resource directly
  
• 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.

Administrative recognition of the TNF and eligibility for benefits depend on the plan, the contract, the evidence, and the individual’s file.

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.

Links open in a new tab.

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3. Stone J, Carson A, Hallett M. Explanation as a treatment for functional neurological disorders. Handb Clin Neurol. 2016;139:543-553. (Back to section: 1)
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 3,781 new patients. Clin Neurol Neurosurg. 2010;112(9):747-51. (Back to sections: 1, 2)
5. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Association; 2013. (Back to section: 1)
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