Feb. 04, 2026
Functional neurologic disorder (FND) reflects functional network dysregulation rather than structural pathology. Effective treatment focuses on education, expectation setting, family engagement and graded rehabilitation to restore movement and participation.
What is FND?
FND is a condition in which neurological symptoms arise from how the brain functions, not from structural pathology. FND can cause real, involuntary symptoms such as changes in movement patterns, weakness, tremors, spells, and sensory symptoms including changes to vision and hearing. The symptoms typically do not match patterns in neurological diseases and do not correlate to findings on imaging such as brain MRI.
Treatment: Retraining the brain and the body
An important part of treating FND is communicating that FND is real — it's not "in a patient's head" and patients are not "faking it." This acknowledges that symptoms are involuntary and distressing and provides hope that FND is a treatable condition. Education about risk factors such as stress or trauma, which can be physical or mental, coexisting mental health disorders, and recent illnesses are important for patients and their families. Reducing medicalization and guiding patients and their families to supportive integrative care can help them understand that recovery is possible and may look different from the treatment they have received. The focus shifts to retraining the brain and the body through integration of psychological principles and therapies to redirect symptom-focused attention to the promotion of functional recovery.
"Functional neurologic disorder is a real and treatable condition. Our goal is to help patients and families understand that symptoms are involuntary and distressing — and recovery is possible. Through a multidisciplinary approach that integrates physical, occupational and recreational therapy, psychology, and education, we focus on retraining the brain and body to restore function and improve quality of life," says Amy E. Rabatin, M.D., a pediatric physiatrist at Mayo Clinic Children's.
The level and components of treatment depend on severity, functional impact and coexisting conditions. Multidisciplinary care is paramount, and treatment plans should be individualized, considering the specific symptom subtype — motor, sensory and seizure-like — and the severity of functional impairment. Treatment should also be adapted to address coexisting conditions such as pain, anxiety, and depression or other mental health disorders.
Outpatient treatment encompasses a variety of services, including occupational, speech or physical therapy, as well as psychological support or participation in intensive outpatient programs. Cognitive behavioral therapy (CBT) is foundational to FND recovery and can include concepts of relaxation, distraction, reframing, and identifying and managing stress as well as the use of strategies to recognize and mitigate symptom exacerbation. Referral to occupational therapy, physical therapy or speech therapy depends on the FND symptoms.
Inpatient treatment may be needed depending on the severity of functional impairment. This treatment focuses on multidisciplinary care with CBT and therapies with additional support for patient safety.
Family involvement
Family involvement at all levels of care is vitally important. Family interventions include shifting attention away from symptoms and toward functional activities such as school, friends and hobbies. It also includes using motivators, such as rewards, to encourage coping and regulation strategies and completion of functional activities such as schoolwork and chores. If necessary, family involvement may also include assessing and treating family stressors such as marital or sibling conflict.
"Once FND is diagnosed, the most important next step is helping the patient and family understand the condition and what recovery can look like. We focus on shifting the narrative from searching for a cause to building strategies for functional improvement. That clarity and hope are often the turning point in a patient's journey," says Cynthia Harbeck-Weber, Ph.D., L.P., a psychologist and co-medical director of the Pediatric Pain Rehabilitation Center (PPRC) at Mayo Clinic Children's.
Katie's success
Katie was a healthy 13-year-old until she abruptly began experiencing episodes of heat all over her body, dizziness, chest pain, shaking and unresponsiveness. Several weeks later, she also began experiencing leg pain and the feeling of her legs "giving out," which caused some falls. Katie started using a wheelchair for safety and stopped attending school. An EEG and full medical work-up revealed no epileptic activity in her brain, and thus a diagnosis of functional neurological disorder was made. Katie was referred to the PPRC for a three-week outpatient program for youth ages 13 to 22 who are experiencing pain, autonomic disorders or functional symptoms.
Once at the PPRC, Katie met her treatment team, which consisted of a physician, nurses, psychologists, physical therapists, occupational therapists and recreational therapists. The team worked together to help Katie understand her symptoms and develop new strategies to prevent them. Physical therapy emphasized full-body strength and conditioning as well as learning to walk safely again. In biofeedback training, Katie learned to use slow, relaxed breathing in high-risk situations and if she started to notice dizziness or heat in her body. She also learned elements of CBT to reduce her anxiety about her symptoms and prevent future episodes.
Katie's parents focused their conversations with Katie on her goals and functioning rather than her symptoms. They also supported her coping strategies.
After three weeks, Katie was both walking independently and back to light running. She stopped using a wheelchair or gait aid, as she was no longer falling or having episodes of lost consciousness. Since returning home, she has been thriving and has returned to school and her favorite activities.
For more information
Refer a patient to Mayo Clinic.