Building a Functional Neurological Disorder Program: Finding Solutions to Common Obstacles

Abstract

We describe efforts to systematically improve care delivery and outcomes in patients with functional neurological disorder (FND) via the creation of a program that allows the delivery of comprehensive clinical care, backed by administrative support. Collaborative efforts are necessary to develop an efficient, effective, long-term, and sustainable program. The creation of multi-site clinic service agreements, electronic medical records templates, multidisciplinary meetings, and trainee and staff education aids in guaranteeing the reliability and impact on patient care, outcomes, and knowledge in the FND field. We review barriers encountered in the process of creating a program and describe solutions to enable a system that builds bridges to integrate whole-person care for patients with FND. The success of a multidisciplinary program relies on a systems approach, administrative coordination, team communication, defined roles, and initiative and oversight by a site champion, for a focus on each patient as an individual and on continuity of care. The FND program also established an educational path to train clinicians and encourage interdisciplinary clinical research in the field and programmatic evaluation.

Keywords

functional neurological disorder - seizures - barriers

Contributors' Statement

M.R.L. and W.C.L. take responsibility for the integrity and accuracy of the information displayed and the concept and design of the study. Drafting of the manuscript and critical revision of the manuscript for important intellectual content were done by both authors. Supervision was done by W.C.L.

Publication History

Received: 06 November 2025

Accepted: 24 January 2026

Article published online:
13 February 2026

• References

• 1 Williams S, Southall C, Haley S. et al. To the emergency room and back again: Circular healthcare pathways for acute functional neurological disorders. J Neurol Sci 2022; 437: 120251
• 2 Altalib HH, Galluzzo D, Argraves S. et al. Managing functional neurological disorders: protocol of a cohort study on psychogenic non-epileptic seizures study. Neuropsychiatr Dis Treat 2019; 15: 3557-3568
• 3 Stone J, Carson A, Duncan R. et al. Who is referred to neurology clinics?–the diagnoses made in 3781 new patients. Clin Neurol Neurosurg 2010; 112 (09) 747-751
• 4 Bennett K, Diamond C, Hoeritzauer I. et al. A practical review of functional neurological disorder (FND) for the general physician. Clin Med (Lond) 2021; 21 (01) 28-36
• 5 Carson A, Lehn A. Epidemiology. Handb Clin Neurol 2016; 139: 47-60
• 6 Cuoco S, Scannapieco S, Carotenuto I. et al. Higher health service costs associated with delayed diagnosis of functional neurological disorder. 2023; 35 (01) 86-91
• 7 Lagrand TJ, Jones M, Bernard A, Lehn AC. Health care utilization in functional neurologic disorders: impact of explaining the diagnosis of functional seizures on health care costs. Neurol Clin Pract 2023; 13 (01) e200111
• 8 Woodward J, Asadi-Pooya AA, Mildon B, Tolchin B. Work difficulties, work restrictions, and disability benefits in people with functional seizures: a survey study. Epilepsy Behav Rep 2023; 23: 100610
• 9 LaFrance Jr WC, Tedesco R, Baird GL, Wincze J, Tocco K, Anderson J. Clinician-rated outcomes of patients with functional neurological disorders treated in an outpatient clinic. Seizure 2023; 107: 21-27
• 10 Gelauff J, Stone J, Edwards M, Carson A. The prognosis of functional (psychogenic) motor symptoms: a systematic review. J Neurol Neurosurg Psychiatry 2014; 85 (02) 220-226
• 11 Finkelstein SA, Diamond C, Carson A, Stone J. Incidence and prevalence of functional neurological disorder: a systematic review. J Neurol Neurosurg Psychiatry 2024
• 12 Bean MR, Watson MM, Moore ML, Strom LA. Referral to a functional seizures clinic reduces inpatient and emergency department health care utilization and costs. Neurol Clin Pract 2025; 15 (01) e200393
• 13 Seneviratne U, Low ZM, Low ZX. et al. Medical health care utilization cost of patients presenting with psychogenic nonepileptic seizures. Epilepsia 2019; 60 (02) 349-357
• 14 Stephen CD, Fung V, Lungu CI, Espay AJ. Assessment of emergency department and inpatient use and costs in adult and pediatric functional neurological disorders. JAMA Neurol 2021; 78 (01) 88-101
• 15 Finkelstein SA, Carson A, Edwards MJ. et al. Setting up functional neurological disorder treatment services: questions and answers. Neurol Clin 2023; 41 (04) 729-743
• 16 Kanner AM. When did neurologists and psychiatrists stop talking to each other?. Epilepsy Behav 2003; 4 (06) 597-601
• 17 Bradaric BD, Kirby AE, Napier TC. Integrating neurology and psychiatry throughout educational curricula for healthcare professionals. J Exp Neurol 2020; 1 (04) 168-172
• 18 Dubrovsky DI. “The hard problem of consciousness.” Theoretical solution of its main questions. AIMS Neurosci 2019; 6 (02) 85-103
• 19 White PD, Rickards H, Zeman AZJ. Time to end the distinction between mental and neurological illnesses. BMJ 2012; 344: e3454
• 20 Fitzgerald M. Do psychiatry and neurology need a close partnership or a merger?. BJPsych Bull 2015; 39 (03) 105-107
• 21 Ibáñez A, García AM, Esteves S. et al. Social neuroscience: undoing the schism between neurology and psychiatry. Soc Neurosci 2018; 13 (01) 1-39
• 22 Frank R, Quezada J. An integrative approach to functional neurologic disorder. Semin Neurol 2025;
• 23 Serranová T, Di Vico I, Tinazzi M. et al. Functional neurological disorder in Europe: regional differences in education and health policy. Eur J Neurol 2024; 31 (10) e16350
• 24 int/classifications/apps/icd/icd WHOJhww. International statistical classification of diseases and related health problems: 10th revision (ICD-10). 1992.
• 25 Association AP. Diagnostic and statistical manual of mental disorders. American Psychiatric Association; 2013
• 26 Herbert LD, Kim R, Hassan AA, Wilkinson-Smith A, Waugh JL. When neurologists diagnose functional neurological disorder, why don't they code for it?. CNS Spectr 2021; 1-30
• 27 Chandawarkar A, Chaparro JD. Burnout in clinicians. Curr Probl Pediatr Adolesc Health Care 2021; 51 (11) 101104
• 28 Portoghese I, Galletta M, Coppola RC, Finco G, Campagna M. Burnout and workload among health care workers: the moderating role of job control. Saf Health Work 2014; 5 (03) 152-157
• 29 Patel RS, Bachu R, Adikey A, Malik M, Shah M. Factors related to physician burnout and its consequences: a review. Behav Sci (Basel) 2018; 8 (11) 98
• 30 Cook SC, Schwartz AC, Kaslow NJ. Evidence-based psychotherapy: advantages and challenges. Neurotherapeutics 2017; 14 (03) 537-545
• 31 Myers L, Sarudiansky M, Korman G, Baslet G. Using evidence-based psychotherapy to tailor treatment for patients with functional neurological disorders. Epilepsy Behav Rep 2021; 16: 100478
• 32 DeGrush E, LaFrance Jr WC. Psychotherapeutic tools to enhance the neurologist-patient interaction. Semin Neurol 2022; 42 (02) 107-113
• 33 Lopez MR, Mordecai K, Blanken AE, LaFrance Jr WC. Caring for patients with functional neurological disorder-a new paradigm. Cogn Behav Neurol 2024; 37 (01) 1-2
• 34 VanderWeele TJ, McNeely E, Koh HK. Reimagining health-flourishing. JAMA 2019; 321 (17) 1667-1668
• 35 VanderWeele TJ. On the promotion of human flourishing. Proc Natl Acad Sci U S A 2017; 114 (31) 8148-8156
• 36 T. Radhakrishnan S, Perry R, Misra S. et al. Targeted education for clinicians and clinical coding staff improves the accuracy of clinical coding: a quality improvement project. Future Healthc J 2024; 11 (01) 100127