1. The diagnostic journey

Receiving an FND diagnosis can take time. Because standard tests—like MRI scans or blood work—often appear “normal” in people with FND, many patients undergo a long series of investigations to rule out other medical conditions first. Importantly, FND is not just a diagnosis made when nothing else is found. It should be identified positively by recognising specific clinical signs and characteristic symptom patterns that point directly to FND, rather than relying on exclusion alone.

Lincolnshire NHS ICB and system partners are currently working on a Clinical Pathway for the diagnosis of FND

2. Referral and assessment

If your GP suspects FND, they will usually refer you to a neurologist or another specialist for a more detailed assessment. During this appointment, the neurologist will take a thorough history and carry out a physical examination to look for positive signs that point toward FND. For example, in functional limb weakness, strength may change depending on focus or distraction—something that typically does not happen with muscle or nerve diseases. These positive findings help confirm the diagnosis rather than relying only on normal test results.

3. Recognising functional signs

In cases of functional tremor, certain tests—such as asking you to mimic a rhythmic movement with another part of your body—may cause the tremor to match that rhythm (entrain) or momentarily stop. This type of response is a strong indicator that the tremor is functional rather than caused by a structural neurological disease. Findings like these give clinicians confidence in making an FND diagnosis.

Importantly, receiving a clear and well-explained diagnosis can be reassuring. It confirms that your symptoms are real and have a recognised cause, and it allows you to move forward with appropriate treatment and support.

4. The importance of early recognition

Early diagnosis makes a significant difference. Unfortunately, many people with FND say it took a long time before their symptoms were recognised and given a name. We are working with local health services to improve awareness and understanding of FND across Lincolnshire. FNDLincs promotes a quicker, more compassionate diagnostic process—one in which patients are clearly told that FND is a genuine and treatable condition.

If you or someone you know is experiencing unexplained neurological symptoms, it may be helpful to mention FND as a possible explanation to your doctor. This can support timely referral to a specialist who is familiar with FND and able to provide appropriate assessment and guidance.