Clinical Focus
Functional Neurological Disorder (FND)
Specialized care for Functional Neurological Disorder outside of an academic medical center.
What is it?
Functional neurological disorder (FND) is a condition in which patients experience clinically recognizable neurological symptoms—such as weakness, tremor, seizure-like episodes, gait abnormalities, sensory changes, or speech difficulties—that are not explained by structural neurological disease. FND is a disorder of brain network functioning, not a disorder of brain structure. It is real, it is common, and it is treatable.
FND is the second most common reason for outpatient neurology referral and accounts for an estimated 16% of new neurology consultations. Despite this prevalence, most neurologists and psychiatrists have limited training in FND, and patients frequently experience delays of years between symptom onset and accurate diagnosis.
Clinical Presentation
FND presentations include functional movement disorders (tremor, dystonia, gait abnormalities, myoclonus), functional seizures (previously called non-epileptic seizures), functional weakness or paralysis, functional sensory symptoms (numbness, vision changes), and functional cognitive symptoms.
A defining feature of FND is that symptoms are inconsistent with recognized neurological disease but consistent with recognizable FND patterns. Functional tremor, for example, changes frequency when the patient is distracted. Functional weakness shows patterns that do not follow anatomical nerve distributions. These positive diagnostic signs allow neuropsychiatrists to make the diagnosis based on what the examination shows, not simply by excluding other conditions.
Many patients with FND have been told "there's nothing wrong with you" or "it's all in your head," which is both clinically inaccurate and profoundly damaging. FND symptoms are involuntary, genuinely experienced, and often severely disabling. The symptoms are not volitional, and attributing them to malingering is almost always wrong.
Our Approach
FND sits precisely at the intersection of neurology and psychiatry, making it a paradigmatic neuropsychiatric condition. Neurologists can make the diagnosis but typically lack expertise in the psychiatric comorbidities that maintain symptoms. General psychiatrists rarely have training in the neurological examination findings that distinguish FND from structural disease.
Psychiatric comorbidity in FND is high. Depression is present in 40% to 50% of FND patients. Anxiety disorders co-occur in approximately 40%. PTSD and childhood trauma are risk factors but are not universally present. Chronic pain syndromes, fibromyalgia, and other functional disorders frequently co-occur.
The neuropsychiatric evaluation for FND includes review of the neurological workup, assessment for psychiatric comorbidities, evaluation of predisposing and perpetuating factors, and development of an integrated treatment plan.
Treatment Approach
Dr. Lodhi and Dr. Patel both completed behavioral neurology and neuropsychiatry fellowships at Stanford, where FND is a core area of clinical and research focus. This training provides the integrated neurological and psychiatric expertise that FND management requires.
Treatment for FND is multimodal. Specialized physiotherapy using a motor retraining approach has the strongest evidence base for functional motor symptoms. Cognitive-behavioral therapy adapted for FND addresses the beliefs and behavioral responses that maintain symptoms. Pharmacotherapy targets comorbid psychiatric conditions that can perpetuate FND symptoms.
We emphasize patient education as a therapeutic intervention in itself. Explaining the diagnosis clearly, validating the patient's experience, and providing a neuroscience-informed framework for understanding their symptoms can be transformative for patients who have spent years being told nothing is wrong.
Why This Is Different at Our Practice
FND is a condition that most psychiatric practices refer out and most neurology practices cannot manage alone. Dr. Lodhi and Dr. Patel both completed BNNP fellowships at Stanford, where FND is a core clinical focus. This training is what distinguishes a neuropsychiatric approach from the standard approaches that leave most FND patients without adequate care.
We do not treat FND as a diagnosis of exclusion. FND has positive diagnostic criteria based on specific examination findings. We believe that how the diagnosis is communicated is itself a therapeutic intervention, because patient understanding and acceptance of the diagnosis is one of the strongest predictors of treatment response.
Psychiatrist: Dr. Lodhi or Dr. Patel
Frequently Asked Questions
Is FND a real condition?+
Yes. FND is a recognized neuropsychiatric condition with positive diagnostic criteria, identifiable examination patterns, and evidence-based treatments. It is not imagined, fabricated, or "all in your head." FND is a disorder of brain network functioning that produces genuinely experienced, involuntary neurological symptoms.
Why is specialized care important for FND?+
FND sits at the intersection of neurology and psychiatry. Neurologists can diagnose FND but typically lack expertise in the psychiatric comorbidities that affect treatment. General psychiatrists rarely have training in the neurological findings specific to FND. Neuropsychiatrists are trained in both disciplines.
Is FND caused by trauma?+
Trauma is a risk factor for FND but is not required for the diagnosis. Many FND patients have no identifiable trauma history. Current neuroscience understands FND as a disorder of brain network functioning that can be triggered by physical injury, illness, psychological stress, or a combination of factors.
Do you accept insurance for FND treatment?+
Yes. FND is a recognized medical condition billed under standard diagnostic codes. We accept Aetna, Anthem Blue Cross, Blue Shield of California, Cigna, and Lyra Health. Network status varies by provider.