Functional neurological disorder in the medical setting

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Target exams

Red flags

• Hyperacute lateralising weakness or speech change that could be stroke — complete stroke pathway first; prior FND or positive signs never cancel emergency work-up when indicated
• First or atypical seizure-like events without established functional diagnosis — protect airway, time the event, and do not assume functional seizures until epilepsy is adequately considered
• Pejorative staff language ('faking', 'attention-seeking', dismissive 'pseudo') — iatrogenic harm and care disengagement
• Psychiatric abandonment after 'no organic disease found' without explanation, MDT plan, or follow-up
• Leaving a patient on escalating antiepileptic polypharmacy after clear video-EEG diagnosis of functional seizures alone
• Assuming malingering without clear evidence of intentional symptom production
• Missing dual pathology (FND plus MS, epilepsy, or structural disease) on the medical ward