Functional Neurological Disorder in Injury Claims: Key Medico-Legal Insights

Functional Neurological Disorder (FND) is one of the most frequently misdiagnosed and misunderstood conditions in medico-legal practice. This article unpacks the clinical and legal relevance of FND - highlighting diagnosis, causation, prognosis, and recovery within personal injury and clinical negligence claims.

Watch the full webinar with Dr Christopher Price here >

Clinical Features and Diagnostic Challenges

FND often presents like stroke, epilepsy, or brain injury - but with no identifiable structural pathology. It is a common referral in neurology, with up to 30% of outpatient appointments involving a functional component.

• Patients may exhibit seizures, limb weakness, speech loss, or movement disorders.

• Symptoms are real and disabling, but are due to dysfunction in brain networks - not damage.

• FND is not diagnosed by exclusion. It requires identifying positive signs, such as Hoover’s sign or entrainment of tremor.

“We confirm FND using positive signs - not just ruling everything else out.”
- Dr Christopher Price

Medico-Legal Considerations

FND introduces unique complexities in litigation, especially where trauma, psychological history, and functional overlay intersect. Solicitors should consider:

The "3 Ps" Model of Causation:

1. Predisposing factors - early trauma, mental health history, personality traits
2. Precipitating events - often minor physical trauma (e.g. RTA, fall, concussion)
3. Perpetuating factors - ongoing litigation, lack of diagnosis, social stressors

• Malingering is rare - most patients do not consciously fabricate symptoms.
• Litigation itself may act as a stressor, worsening symptom persistence.
• Recovery is linked to acceptance of diagnosis and early intervention.

“Apologies for this - but litigation can be a perpetuating factor.”
- Dr Christopher Price

Case Examples & Outcomes

Case 1: Mild TBI or FND?

A middle-aged man involved in a minor cycling accident exhibited ongoing cognitive and functional symptoms 18 months post-injury. Imaging was normal. A careful records review uncovered inconsistencies, psychiatric history, and life stressors - supporting a dual diagnosis of FND and mild TBI. The case settled pre-trial.

Case 2: Functional Seizures Post-Concussion

Another client presented with non-epileptic attacks (NEAD) following concussion. With no structural findings, but a diagnosis of FND, treatment involved online psychoeducation followed by psychological therapy. Early MDT referral improved prognosis.

Key Takeaways for Solicitors

• FND is real, common, and disabling - even without scan findings.
• Positive diagnosis is key - not exclusion.
• Mixed presentations (e.g. FND + mild TBI) are common and require nuanced expert input.
• Litigation stress can influence recovery and should be factored into causation.
• Early diagnosis and therapy improve functional outcomes and reduce care costs.

“The longer the symptoms go on, the harder they are to treat—but never rule out recovery.”

Quote Highlights from the Webinar

• “It’s a network disorder - like a bad connection across brain systems.”
• “FND is not a diagnosis of exclusion - it’s a diagnosis with identifiable features.”
• “My job is to stop people with FND from ending up in long-term care.”
• “We all have bad days - consistency in ADLs is complex and human.”

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