Functional Neurological Disorder: Diagnosis and Management

Clinical Features and Diagnosis

Functional tremor is characterized by its variability in frequency and amplitude, and most importantly, its distractibility (stopping when attention is redirected), according to the American Academy of Neurology 1, 2
Parkinsonian tremor is primarily a resting tremor (4-6 Hz) that may have postural components but lacks the distractibility seen in patients with functional tremor, as noted by the American College of Radiology 3
Cerebellar tremor (intentional tremor) becomes more pronounced during goal-directed movements and is associated with dysarthria and ataxic gait, but doesn't typically stop with distraction, as reported in medical literature 4

The American Academy of Neurology recommends explaining to patients that functional neurological disorder (FND) is a real neurological condition caused by a potentially reversible miscommunication between the brain and the body 2
Avoid reinforcing abnormal movement patterns by minimizing attention to the tremor, as suggested by the American Academy of Neurology 1, 2
Implement rehabilitation strategies that focus on redirecting attention away from symptoms, teaching patients how self-directed attention can make symptoms worse, and using distraction techniques that have already demonstrated effectiveness in stopping the tremor, according to the American Academy of Neurology 1, 2
The American Geriatrics Society notes that considering underlying psychological factors that may contribute to symptom development and exacerbation is important, but recognizes that not all patients have obvious psychological symptoms 5, 2
Avoid providing adaptive equipment in the acute phase, as this may prevent improvement by reinforcing maladaptive movement patterns, as recommended by the American Academy of Neurology 1
Occupational therapy focusing on normal movement patterns and redirecting attention can be helpful, according to the American Occupational Therapy Association 2
A 24-hour approach to therapy is recommended, implementing rehabilitation strategies throughout daily routines as part of self-management, as suggested by the American Academy of Neurology 2