SHM's Clinical Quick Talks-Acute Inpatient Management of Functional Neurological Disorder

Pdf Summary

This document provides a comprehensive overview of the acute inpatient management of Functional Neurological Disorder (FND), a condition characterized by neurological symptoms (e.g., weakness, movement disorders, non-epileptic seizures) that result from abnormal brain functioning rather than structural damage.<br /><br />Etiology includes psychological stressors, physical illness, abnormal brain connectivity, and less commonly genetic, autoimmune, or metabolic causes. History taking focuses on symptom onset, triggers, prior conditions, and functional impact.<br /><br />Clinically, FND presents with motor symptoms (weakness, tremors), sensory disturbances (numbness), cognitive symptoms (memory problems), and dissociative events like non-epileptic seizures. Red flags include abrupt symptom onset without stressors, steady progression, and neurological signs inconsistent with anatomical patterns.<br /><br />Differential diagnoses cover common neurological disorders such as epilepsy, stroke, multiple sclerosis, and migraines, as well as rarer conditions like autoimmune encephalitis and paraneoplastic syndromes. Diagnostic workup involves labs (BMP, CBC, thyroid tests), brain/spine MRI, EEG, and neuropsychological testing to exclude structural or epileptic causes.<br /><br />Treatment emphasizes clear communication and patient education, reassurance about reversibility, physical/occupational therapy, and a multidisciplinary approach including neurology and psychiatry. First-line management includes SSRIs and CBT for comorbid anxiety/depression. Structured follow-up and referral to subspecialists are advised if symptoms worsen or diagnostic uncertainty persists.<br /><br />Clinical pearls highlight the importance of positive diagnostic signs (e.g., Hoover’s sign) to confirm FND and avoid over-investigation. Physicians should validate patient symptoms and avoid dismissing them as purely psychological.<br /><br />In summary, FND is a treatable, functional disorder requiring careful diagnosis based on positive signs, multidisciplinary management, patient education, and avoidance of unnecessary testing. The mnemonic "FND" stands for “Functional, Not Disease” to emphasize its nature.

Asset Subtitle

Zain Abidin, Nicole Terrigno

Keywords

Functional Neurological Disorder

FND

acute inpatient management

neurological symptoms

non-epileptic seizures

diagnostic workup

multidisciplinary treatment

SSRIs

cognitive behavioral therapy

positive diagnostic signs