Functional neurological disorder — diagnosis and MDT care (MEQ)

(i) Diagnosis. Working diagnosis: functional neurological symptom disorder (FND) with mixed motor features (functional weakness and functional tremor), acute episode, with recent physical and panic-related precipitants. Justification is rule-in: internal inconsistency, Hoover's sign, and tremor entrainment/distractibility, not merely a normal MRI. A stressor/panic event supports formulation but is not required for diagnosis. This is not malingering and not “all in the mind” as pejorative dualism.^[1][2][7]

(ii) Explanation. Structure: name the condition (FND); state symptoms are real and not invented; explain mechanism in plain language (nervous system “software/function” problem rather than MS-style permanent damage); show how positive signs prove the pathways can still work; emphasise potential for improvement; invite questions; offer written information and a follow-up plan. Explicitly reject “crazy/faking” framing.^[3][7]

(iii) MDT plan. (1) Shared diagnostic formulation across neurology/psychiatry. (2) Specialist physiotherapy per Nielsen consensus — education, reduce symptom-focused attention, retraining automatic movement, self-management; cite Physio4FMD as the major phase 3 specialist physio trial context for functional motor disorder. (3) Psychological care for panic, illness threat, and motor reattribution (CBT-informed approaches; for seizure phenotypes, reference LaFrance/CODES evidence base). (4) Treat comorbidity; avoid unnecessary further imaging unless new red flags; occupational support for graded return to work; no disease-modifying psychotropic for core FND motor signs.^[4][5][6][7]

(iv) Differentials and red flags. MS and other CNS inflammatory disease, stroke/TIA (if hyperacute vascular features), peripheral nerve injury from sprain, functional overlay on early organic disease, factitious/malingering only with positive evidence of intentional production. Red flags: progressive UMN signs, optic neuritis clues, encephalopathy, fever, sphincter failure, or evolving inconsistency with FND alone — reinvestigate.^[1][7]