Neuropsychology Led Case Management for Functional Neurological Disorder
Neuropsychology Led Case Management for Functional Neurological Disorder
Functional Neurological Disorder (FND) presents unique challenges that sit at the intersection of neurology, psychiatry, and psychology. As our understanding evolves from historical misconceptions toward recognising FND as a genuine disorder of nervous system functioning, neuropsychology-led case management has emerged as a crucial framework for coordinating effective, integrated care that addresses both the neurological symptoms and their complex underlying mechanisms.
Understanding FND through a neuropsychological lens
FND involves genuine neurological symptoms — including seizures, movement difficulties, sensory changes, and cognitive symptoms — without traditional structural neurological disease. Neuropsychology brings essential insight into how altered brain network connectivity and processing create these real, disabling symptoms. This understanding moves beyond outdated “all in your head” conceptualisations toward recognising FND as a disorder of functional connectivity and predictive processing.
Neuropsychologists understand that FND symptoms arise from disrupted communication between brain networks responsible for movement planning, sensory processing, and awareness. They recognise how attention, belief, and expectation influence symptom expression — not as conscious control but through automatic neurological processes. This sophisticated understanding helps validate patients’ experiences whilst providing a framework for intervention.
The neuropsychological perspective also illuminates why FND often develops following physical injury, illness, or psychological stress. These triggers can disrupt normal sensorimotor prediction processes, creating persistent patterns of abnormal movement or sensation that become reinforced through neural plasticity.
Core components of neuropsychological case management in FND
- Comprehensive Functional Assessment Neuropsychologists conduct detailed assessments that map cognitive function, identifying patterns of attention, processing, and executive function that influence symptom presentation. They distinguish between FND-related cognitive symptoms and comorbid conditions, ensuring accurate formulation. This assessment extends beyond testing to understand how symptoms fluctuate with attention, distraction, and emotional state.
- Psychoeducation and Reframing Effective FND management begins with explanation. Neuropsychologists translate complex neuroscience into accessible models, helping patients understand their diagnosis without invalidation. They might explain how the brain’s “software” can malfunction despite intact “hardware,” using metaphors that preserve dignity whilst promoting understanding. This reframing reduces stigma and enhances engagement with treatment.
- Coordinated Multidisciplinary Integration FND requires seamless collaboration between neurology, psychiatry, physiotherapy, and occupational therapy. Neuropsychologists coordinate these services, ensuring consistent messaging and integrated treatment planning. They bridge communication gaps between specialities, translating neurological findings into psychological interventions and vice versa, preventing the fragmentation that often derails FND treatment.
- Cognitive-Behavioural Interventions Neuropsychologists implement targeted interventions addressing the cognitive and behavioural factors maintaining symptoms. This might include attention retraining to reduce symptom-focused vigilance, graded exposure to avoided activities, or cognitive restructuring around symptom beliefs. They understand how to modify standard CBT approaches for the unique features of FND, respecting neurological symptoms whilst addressing perpetuating factors.
- Building Self-Management Capacity Long-term FND management requires patients to become experts in their condition. Neuropsychologists develop personalised strategies leveraging preserved cognitive strengths, teaching symptom management techniques grounded in neuroscience. They help identify early warning signs, develop response plans, and build confidence in managing fluctuating symptoms.
Creating sustainable recovery pathways
Neuropsychology-led case management recognises that FND recovery isn’t linear. Symptoms may fluctuate with stress, fatigue, or life changes, requiring flexible, responsive support. By maintaining long-term case management relationships, neuropsychologists provide continuity through these fluctuations, adjusting strategies as needed whilst maintaining hope and momentum.
At The London Neurocognitive Clinic, our neuropsychology-led case management approach to FND combines cutting-edge neuroscientific understanding with compassionate, integrated care coordination. Our specialists work collaboratively with patients and their healthcare teams, providing comprehensive assessment, evidence-based interventions, and ongoing case management that addresses FND’s full complexity. We help patients move from confusion and disability toward understanding, agency, and meaningful recovery.
