Functional Neurological Disorder

FND = positive diagnosis based on examination, NOT diagnosis of exclusion. Signs: • Hoover's sign for functional weakness (give-way; preserved hip extension when contralateral hip flexed against resistance). • Functional tremor entrainment / variability with distraction. • Tubular vision, spiral visual field. • Functional gait (effortful, dragging, knee-buckling). • Functional non-epileptic attacks: closed eyes during event, side-to-side head shaking, prolonged duration, gradual onset/offset, lack of post-ictal confusion. • Inconsistency, distractibility, suggestibility. Does NOT exclude organic disease — many have comorbid neurological disease.