The Urgency of Addressing FND 

As physical therapists, we play a vital role in treating neurological conditions. However, one disorder that demands our immediate attention is Functional Neurological Disorder (FND). Recent research highlights the prevalence and impact of FND, with population studies suggesting 50-100 cases per 100,000 people. FND is a real and treatable condition, yet it remains neglected due to outdated perceptions and inadequate health care provider knowledge. This neglect leads to significant iatrogenic harm, which has persisted for centuries despite efforts to address it. 

Misdiagnosis and Its Consequences 

Misdiagnosis is a major concern in FND. Alarmingly, FND is often mistaken for other neurological conditions like epilepsy or multiple sclerosis. The consequences of such misdiagnosis can be severe: 

  1. Unnecessary Treatments: Patients misdiagnosed with epilepsy may receive unnecessary and potentially harmful anti-epileptic medications. 

  2. Invasive Procedures: Some patients have undergone unnecessary intubation, ICU admissions, and even vagal nerve stimulator implantations due to misdiagnosis. 

  3. Long-term Health Risks: Misdiagnosis can lead to prolonged use of inappropriate medications, increasing the risk of side effects and complications. 

Delayed Diagnosis and Treatment 

Patients with FND often face significant delays in receiving a correct diagnosis and appropriate treatment. This delay can hinder recovery and prolong suffering1. Physical therapists can identify positive signs to rule in the diagnosis and refer patients for care.   

Stigma and Psychological Harm 

People with FND frequently encounter stigma in medical settings. They may be dismissed, doubted, or even accused of faking symptoms. This can lead to severe psychological harm and reluctance to seek further medical care. Research from fMRI studies confirms that patients with functional symptoms are not faking or feigning. 

The Role of Physical Therapists 

As physical therapists, we are uniquely positioned to make a difference in the lives of people with FND. By improving our understanding and approach to FND, we can: 

  1. Contribute to accurate diagnosis by identifying and documenting rule in signs 

  2. Provide appropriate, evidence-based treatments that address the underlying neuroscience of FND 

  3. Reduce stigma and iatrogenic harm 

Call to Action: Enhance Your FND Expertise 

To address the critical need for improved FND care, the Institute for Knowledge Translation collaborated with two experts in FND care, Julie Maggio and Heather Salon, to develop a course for physical therapists. This course will provide: 

  • In-depth understanding of FND diagnosis and treatment 

  • Strategies to avoid iatrogenic harm 

  • Skills to effectively communicate, support, and provide care for people with FND. 

Register now to enhance your expertise and positively impact people with FND. Registration is open at:  https://learn.knowledgetranslation.org/courses/FND_Spring2025  

By improving our collective knowledge and skills in managing FND, we can significantly reduce iatrogenic harm, improve patient outcomes, and elevate the standard of care for this underserved patient population. 

Reference 

Caoimhe Mcloughlin, Wei Hao Lee, Alan Carson, Jon Stone. Iatrogenic harm in functional neurological disorder, Brain, Volume 148, Issue 1, January 2025, Pages 27–38, https://doi.org/10.1093/brain/awae283