Abstract
Functional neurological disorders (FND) are complex and prevalent neuropsychiatric
conditions. Importantly, some patients with FND develop acute onset symptoms requiring
emergency department (ED) evaluations. Historically, FND was a “rule-out” diagnosis,
making assessment and management in the ED difficult. While the rapid triage of potential
neurological emergencies remains the initial task, advancements have altered the approach
to FND. FND is now a “rule-in” diagnosis based on validated neurological examination
signs and semiological features. In this perspective article, we review signs and
semiological features that can help guide the initial assessment of FND in the acute
setting. Thereafter, we outline potential approaches to introduce a suspected diagnosis
of FND to patients in the ED, while emphasizing the need for a comprehensive neurological
evaluation. Physical and occupational therapy may be useful adjunct assessments in
some individuals. Notably, clinicians in the ED setting are important members of the
interdisciplinary approach to FND.
Keywords
conversion disorder - psychogenic nonepileptic seizures - functional movement disorders
- functional paralysis
