Functional neurological disorder (FND) is a disabling neuropsychiatric condition characterized by involuntary motor, sensory, or cognitive symptoms that are not explained by identifiable structural pathology. Once considered purely psychogenic, FND is now increasingly understood as a condition involving abnormal brain network connectivity and shaped by biopsychosocial factors.

Highlights:

• FND is the second most common diagnosis in outpatient neurology, disproportionately affecting women and often emerging in early adulthood.
• Neuroimaging studies reveal altered connectivity in circuits governing emotion, motor control, and self-agency, supporting FND as a genuine brain-based disorder.
• Symptoms may include functional tremors, gait impairment, non-dermatomal sensory changes, and cognitive difficulties that do not align with classical neurological patterns.
• Diagnosis increasingly focuses on “positive signs” of internal inconsistency and incongruence during neurologic examination, rather than exclusion of other diseases.
• Optimal management requires a multidisciplinary approach—including neurology, psychiatry, psychology, and rehabilitation medicine.
• Emerging predictive imaging techniques may enable future personalization of treatment strategies.

What sets this study apart:

This review underscores the evolution in how FND is diagnosed and treated—shifting from misdiagnosis and stigma toward evidence-based, multidisciplinary care. It highlights the need for early recognition, tailored interventions, and the continued development of objective diagnostic tools.

Limitations:

Challenges remain, including diagnostic uncertainty, persistent stigma, and the absence of standardized imaging protocols or individualized treatment pathways based on neurobiological profiles.

What role could predictive imaging play in guiding individualized treatment plans for FND?