Of 148,727 patients diagnosed with FND, 78.5% had another recorded neurological diagnosis. That is an extraordinarily high rate to dismiss as mere coincidence and lends weight to the possibility that FND may possibly represent a common phenotype across different neurological diseases.

This dashboard entry is based on a real, published case report: "Revising a diagnosis of functional neurological disorder—a case report".

In this particular case, I agree that the neurologists did their due diligence. They continued following the patient, recognised that the clinical picture was changing, ordered further investigations and revised the diagnosis to progressive supranuclear palsy. They deserve credit for doing precisely what longitudinal neurological care should involve.

That does not, however, make the case irrelevant to a website focused on sceptical examination of FND. The authors themselves state that the FND diagnosis was revised and that diagnostic overshadowing "likely occurred." The case demonstrates both sides of the issue: an early presentation may genuinely be difficult to interpret, while continued reassessment can prevent an FND diagnosis from becoming permanently fixed despite new evidence.

My father used to talk about first-year psychology students who became convinced they had every condition they were studying. It is an old and familiar phenomenon, but nobody suggests that psychology students should therefore be shielded from the literature. The proper response to possible misunderstanding is education and context, not withholding information.

Similarly, the suggestion that visitors to this website "won't understand" the case and will conclude that they have a terminal neurodegenerative disease is speculative and medically paternalistic. It assumes that patients are incapable of engaging responsibly with published evidence and must therefore have information filtered for them.

This is explicitly a website concerned with sceptical examination of FND: its evidence, diagnostic practices, limitations and potential for diagnostic harm. It would be strange to exclude a published case because it could cause someone to question an FND diagnosis. Scepticism does not mean claiming that everyone diagnosed with FND has PSP. It means presenting the evidence, including cases that reveal diagnostic uncertainty, and allowing it to be examined critically.

We also cannot generalise from the diligence shown in this case and assume that every patient receives the same standard of care. We cannot assume that doctors are always correct, always consider every reasonable differential diagnosis or always apply the FND criteria as intended.

In my country, roughly 150 neurologists serve a population of approximately 62 million people. They are overworked, services are understaffed and consultations can become something of a conveyor belt. That is not necessarily the fault of individual neurologists; it is often the unavoidable consequence of a severely constrained healthcare system. Nevertheless, it means that comprehensive investigation and reliable longitudinal follow-up cannot simply be presumed.

Training in FND is also not consistently up to scratch. In our experience, and in reports from many other patients, clinicians who diagnose FND sometimes appear genuinely unfamiliar with the requirement for positive clinical signs. When asked which positive signs supported the diagnosis, some effectively respond, "What positive signs?" We therefore cannot assume that every FND diagnosis was made according to modern standards merely because a neurologist recorded it.

I also disagree that an incorrect initial diagnosis is necessarily harmless simply because PSP has no disease-modifying treatment. Diagnosis affects prognosis, counselling, symptom management, monitoring of risks, access to appropriate services and the patient's ability to plan. The absence of a cure does not make diagnostic delay inconsequential.

The answer is not to treat patients like children who must be protected from medical information. Patients should be empowered to understand what evidence supports their diagnosis, ask which positive signs were demonstrated, recognise meaningful changes in their presentation and request reassessment where appropriate. Patients should be partners in diagnostic safety, not passive recipients expected to accept every clinical conclusion without question.

I think there may be a misunderstanding of what is being discussed.

1. Nobody is saying that FCD/FND does not exist or is impossible.
2. Seeking clarification or a second opinion is not FND denial; it is good clinical practice, particularly when someone develops sudden, life-changing cognitive symptoms.
3. The question is whether the diagnosis, in this particular case, was accurate and established using the recommended diagnostic process.
4. The author himself says he doesn't know how the clinicians reached their conclusion, received no explanation of the positive clinical features supporting the diagnosis. Given that, it is entirely reasonable to ask whether the recommended diagnostic criteria were actually applied. Without clear communication from the clinicians, neither the patient nor we can know.

It is also not helpful to dismiss alternative explanations outright, especially when there remains uncertainty about how the diagnosis was established. Considering reasonable differential diagnoses is part of good medicine and does not imply rejecting FND.

Ultimately, I think everyone here wants the same thing: that @Con Bradley receives the correct diagnosis and the most appropriate treatment, whatever that diagnosis ultimately proves to be.

https://my.clevelandclinic.org/departments/neurological/depts/multiple-sclerosis/ms-approaches/adult-onset-anti-nmda-receptor-encephalitis

Did the clinicians provide you with a treatment plan? Or with any steps forward?

Or was this a hit and run diagnosis?

Thank you for this, will definitely check Dr Binita Kane out.

Another angle around Long Covid is that there seems to be a gut microbiome connection?

(As it is with Multiple Sclerosis and Parkinson's)

Research shows that many people with Long COVID have persistent dysbiosis lower, diversity in gut bacteria and a loss of beneficial SCFA-producing species like Faecalibacterium, Bifidobacterium, and Roseburia. This imbalance can weaken the gut barrier, fuel ongoing inflammation, and contribute to fatigue, brain fog, GI issues, and other symptoms via the gut-brain and gut-lung axes.

But not something I've investigated in too much details yet.

Definitely worth an investigation @jakovmrc

Hi @Con Bradley , I merged your anonymous accounts, so all good 🙂

Generally, Functional Neurological Disorder (FND), when clinicians follow the rules and guidelines, is supposed to be diagnosed on the basis of positive signs rather than by exclusion. It is not meant to be a "nothing else fits" diagnosis. Unfortunately, in practice many clinicians still use it as a wastebasket category.

That said, even when the diagnosis is made according to correct guidelines, the so-called positive signs are not specific to FND, they are also found in many other conditions. We would go so far as to suggest that what is currently labeled "functional" may in the future prove to be a common phenotype, much like pain is a shared feature across many different disorders. In other words, the "functional" presentation is likely a reflex reaction to an underlying cause that is triggering the symptoms. Clinicians will therefore need to focus on identifying that underlying cause.

Did you ask for a second opinion yet?

I will be sure to check out the book you mentioned.

Thank you for sharing your story. I'm really sorry you've been through this. We understand how frightening and life changing cognitive symptoms can be because we've experienced similar challenges ourselves. The way you describe losing abilities that once came naturally is something many people can relate to, and it sounds incredibly difficult.

Can I ask how your doctors arrived at the FND diagnosis? Your symptoms seem to be almost entirely cognitive rather than motor. Did they specifically diagnose Functional Cognitive Disorder (FCD), which is generally considered a cognitive subtype within the FND umbrella, or was it diagnosed simply as FND? We'd be interested to know what positive clinical features or assessments led them to that conclusion.

Also have a look at https://fndnope.org/posts?postId=55

Researchers say medicine doesnt work for FND but thats pure conjecture when no one fully knows what causes these symptoms or how the brain is glitching. We cant keep denying people treatments that might help just because of an unproven hypothesis. If it works for someone its usually just treating their claimed comorbidities like pain mood or sleep not the core FND itself. Stop gatekeeping based on theories. Personal results matter more than the current official line.

Whenever I read an FND advocacy page, I like to go back in time using the Internet Archive to see how the narrative has evolved. Comparing older versions with current ones often reveals not just changes in wording, but shifts in priorities and values.

1. Original page: http://web.archive.org/web/20160904034822/https://www.fndaction.org.uk/diagnosis/
2. Current page: https://www.fndaction.org.uk/diagnosis/

The 2016 page had soul. It was written by patients, for patients. It openly acknowledged the harm people experienced: being made to feel their symptoms were "their fault," being dismissed, left without support, and let down by inconsistent care. It felt urgent, validating, and unapologetically activist.

The current page feels sanitized and clinician focused. It reads as though it was edited by neurologists concerned about sounding too speculative or unscientific. The raw expression of patient suffering is gone. The frustration with poor care is gone. In its place are lengthy discussions of diagnostic pitfalls, positive signs, research priorities, and carefully worded disclaimers. It is all very proper, but it also feels cold and defensive.

Rather than centering the needs of people living with FND, the page seems more concerned with protecting the reputation of the diagnosis. The charity appears to have exchanged genuine patient advocacy for mainstream medical respectability, and in doing so, lost much of its original purpose and emotional impact.

The end result is a page that may be more technically accurate, but is significantly less human. It serves clinicians and the diagnosis better than it serves the patients who are suffering.

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This is the place to share the craziest "my FND did this" claims you’ve seen, hair loss, sudden allergies, psychic powers, eyes changing color, poltergeist activity, speaking unknown languages, etc.

Drop the most ridiculous ones below!

When we initially investigated FND, we were surprised to find almost no official skepticism.

Dr. David Tuller, through his “Trial By Error” series on virology.ws (https://virology.ws/tag/fnd/)He has challenged inflated prevalence claims, the reliability of diagnostic signs, and aspects of FND’s psychological framing.

Are there any other skeptical sources out there?