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Functional neurological disorder (FND)

What is functional neurological disorder (FND)?

Functional neurological disorder (FND) impacts how the nervous system functions and how the signals to and from the body are processed in the brain.

FND is multifactorial, which means many different risk factors and circumstances can contribute to its development.

FND can lead to a variety of symptoms. This can include losing voluntary control over your body, unexpected sensations like tingling, or even episodes with partial or complete loss of consciousness (functional seizures). The pattern of symptoms can change over time.

FND symptoms can cause severe impairments to quality of life. Symptoms may be similar to, or sometimes worse than, other neurological conditions like stroke or multiple sclerosis.

Functional symptoms are one of the most common reasons people seek neurological advice. Other illness or physical injury may also trigger functional symptoms. Patients may experience functional symptoms alongside symptoms from a different neurological illness. This should not prevent the care and treatment of the other illness.

The underlying structures of the brain are not damaged, so with the right guidance, rehabilitation and engagement in treatment, recovery from FND is possible.

How is FND diagnosed?

A diagnosis of FND is made through a thorough review of the patient’s medical history and a clinical examination. Depending on the symptoms present, it may also be useful to identify positive signs – these indicate that the symptoms are functional rather than resulting from damaged brain cells or nerves. For example, if voluntary movements are impaired but automatic movements remain intact, this points toward a functional cause.

FND Neurology Assessment Clinic

The FND Neurology Assessment Clinic is a specialist clinic for patients in South East London with functional neurological symptoms. Our consultants offer assessments to patients with a diagnosis of functional neurological disorder to provide advice on diagnosis and treatment. This might include referral to the most appropriate treatment service for your condition.

The appointments usually last about an hour. Appointments take place in the outpatient clinics at King’s College Hospital and the Maudsley Hospital. We are a teaching hospital, so other clinicians may sometimes observe.

You are very welcome to bring a family member or friend with you. Please bring a list of your current medication and any videos you may have of your symptoms.

We will also invite you to attend our online FND education group by email. This two-hour session (on Microsoft Teams) includes talks from different members of our multi-disciplinary team.

The FND Neurology Assessment Clinic does not offer long-term follow-up, but some patients will have one further appointment with the consultant about 6 months after the assessment to check on their progress.

How is FND treated?

First, your consultant will assess if they can confirm a diagnosis of FND. If they do, they will explain the disorder to you, and the thought process behind your diagnosis. They will help you to understand which factors may have contributed to your symptoms, why they have come to this diagnosis and why they recommend a certain treatment strategy.

Depending on your symptom profile and your preferences, multiple treatment options or combinations of treatment options can be explored. This can include specialist physiotherapy, specialist psychotherapy, and day case or inpatient multi-disciplinary treatments or community-based treatment pathways.

In some cases, it may be necessary to explore differential diagnoses, and/or treat any other symptoms, like mood changes, which can be both a risk factor or a result of living with FND.

Further information

There are many resources on FND on the web, for example, the website neurosymptoms.org.

Location

First floor, Willowfield Building, King’s College Hospital, Bessemer Road, SE5 9BG

Contact details

The diagnosis of FND is usually made in general neurology. GPs should refer to that service.

Our specialised service can receive direct referrals of patients with a diagnosis of FND from neurologists and psychiatrists.

Please note, we can only accept referrals from patients registered with a GP in South East London.

For patients registered in Bromley, Bexley or Greenwich:

  • please send the referral via EPIC if available:
    • order “Outpatient referral to Neurology”
    • under department select “DH NEUROLOGY – FND”
  • or email: [email protected]

For patients registered in Lambeth, Southwark or Lewisham:

Please make sure that we receive the letter from the primary neurological assessment before the appointment.

FND education group

Patients accepted to our outpatient clinic are normally invited to join our monthly online FND education group (third Wednesday of the month at 1pm). You can also refer them separately via email: [email protected] (please include patient email address and NHS number).

General enquiries

For general requests or to contact the team, email: [email protected]

Key Clinical Staff

Name Role
Laura Coughlan Occupational Therapist and Care Coordinator
Dr Ania Crawshaw Consultant Neurologist, Maudsley Hospital
Dr Natasha Darcy Senior Clinical Fellow in Neurology
Dr Angelo Dawson Consultant Neurologist
Dr Michael Dilley Consultant Neuropsychiatrist
Prof Mark Edwards Consultant Neurologist, Maudsley Hospital and Professor of Interface Disorders, King’s College London
Dr Danielle Phoenix Counselling Psychologist
Dr Biba Stanton Consultant Neurologist