Diagnosis

A diagnosis of Functional Neurological Disorder (FND) should be made by a Neurologist from positive signs/tests. It is not a diagnosis of exclusion, nor should symptoms be categorised as medically unexplained (MUS).

However, with currently no national NICE guidelines on how to diagnose and treat people with FND, in addition to the complexities surrounding the FND diagnosis in general and the lack of local funded services, inconsistencies in diagnosis and treatment continue to occur. This is unfair to both clinicians and people who receive the diagnosis. This has resulted in some people having good care and some not so good, with the most reporting that they have been given the FND diagnosis, been made to feel it is their fault, and directed to look it up online.

How a diagnosis of FND is delivered can have a positive or detrimental effect on the person receiving the diagnosis. Among other specialists in the field, Professor Mark Edwards runs an out-patient clinic in London specifically for those diagnosed with FND. In a publication[1] he discusses the importance of explaining to the patient what a diagnosis of FND means and what to do about it, and how failure to deliver the diagnosis correctly can impact on the therapeutic benefit of the consultation which is then lost. This in turn makes subsequent treatment more difficult.

Professor Edwards and colleagues also make it clear that focusing on the “how” rather than the “why” works well for many patients and their recovery. 

Depending on symptoms presented the following tests/investigations may be used as part of diagnosing FND:

General medical examination, review of past history, and assessment of symptoms
It’s expected that this is performed at every initial appointment with the Neurologist. A medical examination is important to assess a person’s general health and wellbeing, and consider any other health problems/conditions that may be present given FND is not an overall diagnosis. Blood tests and other samples may be taken depending on symptoms. Other conditions that relate to the neurological symptoms the person is presenting with should be considered to avoid misdiagnosis. In addition; B12 and other deficiencies, side effects of medication, and emotional/mental health diagnosis’ should be considered.

Hoover’s Sign
A test which is commonly used to diagnose functional weakness. This is a clinical test performed by painless touch and maneuvers.

CT (Computed Tomography) scan
An x-ray imaging test that provides detailed information on head injuries, stroke, brain tumours and other brain diseases. The examination involves you laying on a bed which slides into a ring shaped x-ray scanner.

MRI (Magnetic Resonance Imaging) scan
An imaging test that uses powerful magnets and radio waves to create pictures of the brain and surrounding nerve tissues, and used for the same purposes as a CT scan. As with a CT scan, you lay on a bed which slides in to the scanner, and creates more detailed pictures of tissues, organs and other structures within the body.

EMG (electromyography)/Nerve Conduction test
Test to measure and record electrical activity of the nerves and muscles. 

EEG (Electroencephalogram)
A test used to assess electrical activity in the brain. It is performed by attaching sensors to the scalp to pick up electrical signals.

To learn more about diagnostic signs and tests please visit the neurosymptoms website

References
[1] Edwards, MJ. Functional neurological symptoms: welcome to the new normal Practical Neurology, 2016;16:2-3 doi:10.1136/practneurol-2015-00131

Stone JBurton CCarson ARecognising and explaining functional neurological disorder doi:10.1136/bmj.m3745

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Diagnosis should be made by a Neurologist from positive signs and tests. Symptoms can be extremely disabling and it can take several years to receive the correct diagnosis.