Neurology · neuropsychiatry · UK
Functional neurological disorders - real, common, treatable.
FND affects how the brain sends and receives signals - genuine, involuntary neurological symptoms without a structural lesion. A rule-in diagnosis and a proper multidisciplinary team change the trajectory.
Indicative pricing
What private FND care costs in the UK.
Indicative ranges across UK private providers.
In short
£280–£450, an MDT programme from £2,800.
| Service | Indicative range | Typical duration | Turnaround |
|---|---|---|---|
| Consultant neurology consultation (FND-experienced) | £280–£450 | 45–60 min | Letter in 3–5 days |
| Neuropsychiatry assessment | £350–£600 | 60–90 min | Letter in 5–7 days |
| FND-trained specialist physiotherapy (per session) | £70–£120 | 45–60 min | Same visit |
| CBT for FND (per session) | £120–£200 | 50 min | Same visit |
| Occupational therapy (per session) | £90–£150 | 60 min | Same visit |
| Coordinated MDT programme (6–12 weeks) | £2,800–£6,500 | Weekly | Ongoing |
Prices vary by clinician, by session frequency, and by whether neuropsychiatry input is needed alongside physio and psychology. NHS FND services exist at tertiary centres but ICB commissioning is variable - many patients use private care to start sooner.
The problem
A proper diagnosis, a proper team, without the wait.
FND is one of the most under-served conditions in UK neurology. People wait years, get told it is “nothing” or “in the mind”, and rarely see a full MDT. We fix each of those, in that order.
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Been told everything is normal?
Normal scans don’t mean nothing is happening. FND has positive signs - we find them and explain them.
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Stuck on a long NHS waiting list?
FND services are patchily commissioned. Private access to a full MDT means treatment can start in weeks, not years.
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Given a one-line diagnosis?
A proper diagnostic conversation is itself part of treatment. We insist on the Stone and Carson standard.
Presentations
The many faces of FND - and what unites them.
FND presents in different ways in different people. All of them are real, all involuntary, and all treatable with the right team.
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Functional seizures
Previously called “PNES” or “dissociative seizures”. Real, involuntary events with a distinct semiology - treatable, and not epilepsy.
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Functional motor symptoms
Weakness, tremor, dystonia or gait disturbance that varies with attention and distraction - often dramatic, always genuine.
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Functional sensory symptoms
Hemibody numbness, tingling or visual disturbance (including tubular fields) that doesn’t map to a structural lesion.
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PPPD (persistent dizziness)
Persistent postural-perceptual dizziness - constant unsteadiness, worse with motion, screens or complex visual scenes.
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Functional cognitive symptoms
Brain fog, word-finding difficulty, memory lapses - often mistaken for early dementia, but with a very different pattern and prognosis.
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Functional speech and swallow
Stammer-like speech, whispering aphonia, or globus sensation and swallow difficulty without a structural cause.
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Overlap with epilepsy or MS
FND commonly coexists with epilepsy, migraine, MS or chronic pain. Both diagnoses get treated - one does not exclude the other.
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Red flag: new focal deficit
A sudden new weakness, speech disturbance or severe headache is a stroke concern until proven otherwise - call 999, not a clinic.
Treatment pillars
One team, several disciplines, one shared plan.
FND does best with a coordinated MDT - not a single clinician working in isolation. Each pillar contributes something the others can’t.
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Consultant neurology
A rule-in diagnosis based on positive clinical signs, and a careful explanation of what FND is - real, common and treatable.
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FND-trained physiotherapy
The Nielsen–Edwards model. Motor retraining, movement without excessive attention, and graded functional task practice.
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CBT and psychological therapy
CBT for FND (as in the COST-DSD trial), ACT, and EMDR where trauma is a driver. Specialist psychotherapy, not generic counselling.
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Occupational therapy
Activity pacing, fatigue management, and a realistic return-to-work or return-to-education plan built around your life.
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Neuropsychiatry
Treatment of comorbid anxiety, depression or PTSD, and a careful medication review - cautious with anti-seizure meds for functional seizures.
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Speech and language therapy
For functional speech and swallow presentations - practical techniques that retrain the pathway rather than treat a structural lesion.
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Sleep, exercise and mindfulness
The unglamorous pillars that actually move the needle: consistent sleep, graded aerobic exercise, and a mindfulness practice you will do.
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Coordinated MDT programme
The gold standard: neurology, neuropsychiatry, physio, OT and psychology working from a single plan, with structured reviews.
What to know
The facts about FND - plainly said.
A short list of the things that matter most, said clearly and without euphemism.
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FND is real and treatable
FND is not imagined, not “put on”, and not a diagnosis of exclusion. It is a common, well-characterised condition of brain-network function - and it responds to treatment.
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A positive diagnosis matters
Hoover’s sign, hip-abductor sign, tremor entrainment and distractibility, tubular visual fields, seizure semiology - these rule FND in. We do not accept “everything was normal so it must be functional”.
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FND can coexist with other conditions
Epilepsy, MS, migraine, chronic pain - FND often sits alongside them. Both diagnoses need treating in parallel, not one instead of the other.
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Explanation is treatment
The Stone and Carson diagnostic conversation is not optional - patients told their diagnosis clearly and compassionately do better than those left in the dark.
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Medication is not the answer
Anti-seizure medication for functional seizures rarely helps and often harms. Antidepressants may help comorbid anxiety or depression - but they are not the treatment for FND itself.
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Early treatment does better
Shorter duration of symptoms, active patient engagement and MDT access all predict better outcomes. Delay is the single biggest modifiable factor.
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Prognosis with the right team
30–70% of patients achieve substantial improvement with proper MDT input. Worse outcomes correlate with longer duration, ongoing trauma, and disability payments in contention.
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Language matters
DSM-5-TR calls it “functional neurological symptom disorder”. Older terms like “conversion disorder” or “psychogenic” are unhelpful and, frankly, inaccurate.
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Red flags
A new sudden focal deficit, thunderclap headache, or first seizure of any kind still needs urgent assessment - FND does not exempt you from stroke or acute neurology.
Reading your clinic letter
Your FND letter in four parts. Read the last one first.
Whichever specialist you see, the letter that follows keeps to the same shape.
A quiet reminder
Neurological 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 appointment, just ask.
- 01 Header
Positive signs elicited
Which clinical signs were positive - Hoover’s, tremor entrainment, distractibility, tubular fields, seizure semiology - and what they mean.
- 02 Assessment
Presentation and comorbidities
The full picture: motor, sensory, seizure, cognitive or PPPD features, plus any coexisting epilepsy, migraine, MS, pain or mood disorder.
- 03 Findings
Prior investigations reviewed
A summary of every scan, EEG and blood test done so far - and a clear statement of what has been ruled out and why FND now fits.
- 04 Impression
MDT plan, review timing, self-management
Read this first: which therapies you need, in what order, when the next review is, and the written plan for managing symptoms between visits.
Recognised by major UK insurers
Insurer cover for FND varies. Neurology and neuropsychiatry consultations are usually funded; ongoing physio and psychology programmes may need pre-authorisation.
Frequently asked
Everything we get asked about FND.
Quick answers on what FND is, how it is diagnosed, what treatment looks like, and what recovery actually involves.
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What is a functional neurological disorder?
FND is a common, disabling condition affecting how the brain sends and receives signals. Symptoms - weakness, tremor, seizures, sensory changes, dizziness, cognitive difficulty - are real and involuntary. There is no structural lesion, but there is genuine dysregulation of brain networks. Formerly called “conversion disorder”; the current DSM-5-TR term is “functional neurological symptom disorder”.
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Is FND all in my head?
No. FND is a neurological condition with established neuroscience behind it. The symptoms are not imagined, not put on and not under conscious control. Brain-network dysregulation is a real biological process - it just doesn’t show up as a lesion on a standard scan.
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How is FND diagnosed?
By positive clinical signs - Hoover’s sign for functional weakness, tremor entrainment and distractibility, hip-abductor sign, tubular visual fields, and the distinctive semiology of functional seizures. Modern practice rules FND in, alongside excluding structural disease. It is not, and should not be, a diagnosis of exclusion.
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What are functional seizures?
Functional (dissociative) seizures were previously called “PNES”. They look like epileptic seizures but arise from a different mechanism - brain-network dysregulation rather than abnormal electrical discharge. They are real, involuntary and treatable. Anti-seizure medication rarely helps and often harms; psychological therapy with an FND-trained team does.
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What is the treatment for FND?
A multidisciplinary team: consultant neurology or neuropsychiatry, FND-trained physiotherapy (Nielsen–Edwards model), psychological therapy (CBT for FND, ACT, EMDR where indicated), occupational therapy for pacing and return-to-work, and speech therapy for functional speech or swallow problems. Sleep, exercise and mindfulness underpin all of it.
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Will I get better?
With the right MDT, 30–70% of patients see substantial improvement. Better outcomes correlate with early diagnosis, active engagement in therapy and access to a full team. Worse outcomes correlate with long duration before diagnosis, comorbid personality disorder, ongoing trauma, or disability payments in contention. Early, coordinated treatment matters.
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How much does FND treatment cost privately in the UK?
Roughly £280–£450 for a neurology consultation, £350–£600 for neuropsychiatry, £70–£120 per physio session, and £120–£200 per psychology session. A coordinated 6–12 week MDT programme is typically £2,800–£6,500. Many patients use private care because NHS FND services are unevenly commissioned by ICBs.
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Are there NHS services for FND?
Yes - specialist tertiary services exist at the National Hospital for Neurology and Neurosurgery (Queen Square), King’s, Sheffield NGH, Salford, and elsewhere, with community neuropsychiatry in some regions. But ICB commissioning is variable, waiting lists are often long, and many patients use private care to start treatment sooner. FND-UK, FND Hope and neurosymptoms.org are excellent patient resources.
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