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Neurology · London

A private FND clinic, by neurologists who specialise in it.

Functional neurological disorder is a rule-in diagnosis based on positive clinical signs, not a diagnosis of exclusion.

A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Indicative pricing

What a private FND clinic costs in London.

Indicative ranges across UK private providers.

In short

Initial FND-specialist consultation in London: £450 to £750, then a costed multidisciplinary plan.

Service Indicative range
Initial FND-specialist neurology consultation (60 min) £450–£750
Video-EEG telemetry (inpatient, for functional seizures) £3,500–£7,500
FND-specialist physiotherapy programme (Nielsen protocol) £2,500–£6,000
CBT-based psychotherapy for functional seizures (course) £2,000–£4,500
Specialist SLT for functional voice or swallow £1,200–£3,000
Residential intensive multidisciplinary programme £8,500–£16,000
Second-opinion review of records and prior investigations £300–£500

Prices vary by clinic, by which neurologist and therapy team you see, and by the number of sessions your plan requires. Residential programmes are quoted per week, all-inclusive of therapy, accommodation and meals.

The problem

A rule-in diagnosis, delivered well, with a real team behind it.

The single biggest predictor of outcome in FND is how the diagnosis is explained. A hurried consultation with a normal scan and a shrug is not a diagnosis. It is a wound.

  • Told your MRI is normal and sent away?

    A normal MRI is expected in FND. It is not reassurance and it is not a diagnosis. You need positive signs found and shown to you.

  • Given a name but no plan?

    FND without a rehabilitation plan is a label. We convert the diagnosis into a costed, sequenced programme with named clinicians.

  • Practising the wrong physio?

    Standard neuro-rehab with intense focus on the affected limb often makes FND worse. Nielsen-protocol physiotherapy uses distraction, not concentration.

Presentations

The shapes FND takes, and how they are recognised.

Each of these is diagnosed on positive clinical signs. Your brain is capable of doing the movement. The software is glitching, and the software is what we retrain.

  • Functional (dissociative) seizures

    Episodes resembling epilepsy but with retained awareness, prolonged duration, side-to-side head movement or eye closure. Video-EEG telemetry confirms.

  • Functional tremor

    A tremor that entrains, distracts or pauses when the patient copies rhythmic tapping in the other hand. A rule-in sign, not exclusion of essential tremor.

  • Functional weakness

    Hoover positive weakness of hip extension that returns to normal when the opposite hip is flexed against resistance. Classic and reproducible.

  • Functional gait disorder

    Astasia-abasia, buckling, dragging or excessive slowness that is inconsistent with the neurological examination or with unobserved walking.

  • Functional dystonia

    Fixed posturing, most often of the foot or hand, of sudden onset and often after a minor injury. Diagnosed on positive signs, not on MRI or EMG.

  • Functional cognitive symptoms

    Brain fog, word-finding difficulty and memory lapses in a young adult with preserved encoding on formal testing. Not early dementia.

  • PPPD (persistent postural perceptual dizziness)

    Chronic non-spinning dizziness worse on standing, walking in busy visual environments or on patterned floors. Common after vestibular neuritis.

  • Red flag: acute stroke-like weakness

    Any sudden focal weakness, speech disturbance or visual loss needs an emergency department and a stroke pathway, not a private FND booking.

Treatment options

FND treatment is a team, not a single therapy.

What each option involves, which presentations it suits, and how a plan is sequenced. The CODES trial evidence, the Nielsen protocol and the PhysioForFND retreat model all sit behind our recommendations.

  • The explanation itself

    The single most important intervention. The diagnosis is shown, not told: positive signs demonstrated on your own body, with an honest account of what FND is and is not.

  • FND-specialist physiotherapy (Nielsen protocol)

    Movement retraining that bypasses attention: distraction, mirror work, weight-shifting drills. Not general physio, and different from rehabilitation for structural injury.

  • CBT-based psychotherapy

    Structured CBT for functional seizures (CODES model), for symptom-focused catastrophising and for the anxiety cycles that keep episodes going. Time-limited, goal-based.

  • Specialist SLT

    For functional voice loss, functional stutter and functional dysphagia. Techniques include humming, laryngeal massage and shaping around retained automatic speech.

  • Occupational therapy

    Pacing, fatigue management, return-to-work planning and activity re-grading. Vital for functional cognitive symptoms and for post-episode recovery.

  • Neuropsychiatry input

    For comorbid trauma, PTSD, depression or medically unexplained symptoms. Medication is not a primary treatment for FND but treats what sits alongside it.

  • Vestibular rehabilitation for PPPD

    Graded visual-vestibular exposure with a specialist physiotherapist. Often combined with SSRI or SNRI cover under the neurology or neuropsychiatry team.

  • Residential intensive programmes

    One to three weeks of daily multidisciplinary input for patients who have stalled with outpatient work. Modelled on the Sheffield and PhysioForFND retreat protocols.

Evidence and outcomes

What the evidence says, honestly.

The CODES trial showed CBT was no better than standardised medical care on its primary endpoint, but improved several secondary outcomes. Physiotherapy trials and the PhysioForFND retreat data support specialist multidisciplinary work.

  • FND is a real, common condition

    One of the commonest reasons for a new neurology referral. The symptoms are genuine and disabling. The problem is in the software of the nervous system, not in tissue damage.

  • A rule-in diagnosis

    FND is not made by excluding everything else. It is made on positive signs at the bedside: Hoover, tremor entrainment, tubular visual fields, functional gait patterns.

  • MRI and routine EEG are usually normal

    A normal scan is expected in FND and is not reassurance that nothing is wrong. Video-EEG telemetry is used when functional seizures need distinguishing from epilepsy.

  • Comorbidity is common

    Migraine, POTS, chronic pain, anxiety, PTSD and neurodivergence sit alongside FND in a large minority. Each is treated on its own merits, not blamed for the FND.

  • Realistic outcomes

    30–50 per cent of patients substantially improve with a well-delivered multidisciplinary programme. Engagement, acceptance of the diagnosis and consistency of practice all matter.

  • Setbacks are part of the trajectory

    Symptoms often fluctuate, worsen briefly with life stress, and settle again. A structured plan and rehearsed coping strategies stop a setback becoming a relapse.

  • Medication is adjunctive, not curative

    No drug fixes FND. SSRIs, SNRIs and low-dose amitriptyline can help comorbid anxiety, pain or sleep and support engagement in rehabilitation.

  • Driving and functional seizures

    You must inform the DVLA if you have episodes involving loss of awareness, whether functional or epileptic. Your neurologist will advise on the exact category.

  • When to reassess

    If new signs appear (persistent focal weakness, cranial nerve signs, cognitive decline), reassessment and repeat imaging are appropriate. Openness to reassessment is part of good FND care.

Reading your clinic letter

Your FND letter in four parts. Read the last one first.

Every neurologist writes a little differently, but a good FND letter keeps to the same shape.

A London neurologist reviewing an FND clinic letter

A quiet reminder

Neurology language is precise and can read coldly. We translate it for you.

If you would like us to talk you through the letter before your next review, just ask.

  1. 01 Header

    Presenting symptoms and duration

    What the episodes or symptoms look like, when they started, triggers, frequency and their functional impact on work, driving and daily activities.

  2. 02 Examination

    Positive signs demonstrated

    The specific rule-in signs elicited: Hoover, hip abductor sign, tremor entrainment, tubular visual field, functional gait. This is the diagnostic core, not a list of normal findings.

  3. 03 Findings

    Investigations and comorbidity

    MRI, EEG, blood work and any video-EEG telemetry summarised. Comorbid migraine, POTS, chronic pain, anxiety or trauma flagged for parallel treatment.

  4. 04 Impression

    Plan, prognosis and next steps

    Read this first: the multidisciplinary plan, which team members you are booked with, what to expect at 6 and 12 weeks, and when the neurologist reviews you next.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Cover for FND consultation and therapy varies by insurer and by policy.

Frequently asked

Everything we get asked about FND.

Quick answers on whether FND is real, insurance, physio, functional seizures, prognosis, and children.

  • Is FND real, or is it made up?

    FND is a genuine, common neurological condition. It is one of the top three reasons for a new neurology referral in the UK. The symptoms are not deliberate, imagined or a sign of weak character. Modern neuroscience shows measurable changes in how the brain generates and monitors movement and sensation. The problem is with the software of the nervous system, not with tissue damage on a scan.

  • Will my insurance cover FND assessment and treatment?

    Most major insurers (Bupa, AXA, Aviva, Vitality, WPA, Cigna) cover the initial neurology consultation. Coverage for physiotherapy, CBT and SLT varies by policy and by whether the referral comes from a recognised consultant.

  • Is FND-specialist physiotherapy really different from ordinary physio?

    Yes. Standard neuro-rehab focuses on strengthening a weak limb and repeating a movement until it is retrained. FND physio uses distraction, automatic movement and attention-shifting techniques to bypass the abnormal control loop. Practising the wrong way, with intense focus on the affected limb, often makes FND worse. Working with an FND-trained physiotherapist matters.

  • Are functional seizures the same as epilepsy?

    No, but they can look almost identical. Video-EEG telemetry (a monitored inpatient stay of three to five days) records both brain activity and the episodes on camera, and is the gold standard for distinguishing the two. Some patients have both. Treatment for functional seizures is CBT-based (the CODES model), not anti-epileptic medication.

  • What are realistic outcomes for adults with FND?

    With a well-delivered multidisciplinary programme, roughly 30 to 50 per cent of patients experience substantial improvement, and a further group make meaningful gains without full remission. Early diagnosis, an accepted explanation, engagement with rehabilitation and treatment of comorbidities all improve the odds. Outcomes are less good when the diagnosis is contested or delivered as an afterthought.

  • Can children and teenagers get FND?

    Yes. Paediatric FND is well recognised and often responds even better to early, joined-up rehabilitation than adult FND. It usually needs a paediatric neurologist, a specialist paediatric physiotherapist and a child psychologist working together.

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