Functional
Neurological
Disorder
Understanding Functional Neurological Disorder (FND) in New Zealand
Functional Neurological Disorder (FND) is a common and often misunderstood neurological condition where the brain has trouble sending and receiving signals correctly.
What is FND?
You can think of your body like a computer: in many neurological diseases, the "hardware" (the physical structures like nerves or the brain) is damaged. In FND, however, the "hardware" is intact, but there is a problem with the "software" – the way information moves through the system and is processed by your brain.
FND arises from disruptions in brain networks – specifically those responsible for movement, cognition, vision, sensation, and emotional processing. This can lead to a state of hyperarousal, worsening symptoms and making the brain oversensitive to emotional and sensory signals (e.g. touch, sound, sight). These symptoms, which are very real and involuntary, may include:
Non-epileptic seizures and blackouts
Movement problems (tremors, tics, etc)
Limb weakness
Problems with cognitive function
Dizziness
Speech difficulties, such as sudden onset of stuttering or trouble speaking
Problems with vision or hearing
Pain (including chronic migraine)
Numbness or inability to sense touch
Fatigue
While FND varies between people, there are similarities in common, and people can experience a range of symptoms affecting multiple systems of the body. People also frequently experience chronic pain, fatigue and cognitive fog along with their FND symptoms.
The “invisibility” of FND is extremely difficult for those with the condition. Unlike conditions such as stroke or multiple sclerosis, the physical structures in the brains and spines of people with FND appear normal in scans and other imaging. This can lead some medical professionals to question the reality of a person’s experiences and symptoms, especially since FND has been a highly stigmatised diagnosis. This can lead some people to question the validity of their symptoms and experiences (many fear that it’s “all in their head”), and the burden of trying to get the medical profession to take them seriously can take a toll.
Research consistently shows that the greater the delay in a diagnosis, the worse the patient’s outcome. Despite the prevalence of FND globally, it continues to be largely under-researched, highly stigmatised and misunderstood, and access to healthcare continues to be problematic. However, in recent years, it’s been exciting to see a groundswell of interest in FND in New Zealand as well as internationally.
FND in Aotearoa New Zealand
FND is far more common than many people realise. In the United Kingdom, FND is the second most common reason people visit neurology clinics (after headaches), and New Zealand is likely to be similar. Research suggests that a minimum of 10-22 people per 100,000 are diagnosed each year, and, based on estimated global prevalence, there is likely to be a minimum of 80 -140 people per 100,000 living with FND. Comparing FND to other conditions, the Global Burden of Disease Study suggests that the global prevalence is 30 per 100,000 for multiple sclerosis and 11 per 100,000 for brain cancers.
In New Zealand, a study at Christchurch Hospital found that FND accounted for 9% of all acute neurology admissions between 2016 and 2018. The study estimated an annual admission rate of 10 per 100,000 people for the region, representing a significant cost to the New Zealand medical system.
Despite these statistics, there is currently little support for FND in New Zealand. There is a general lack of understanding about FND and its treatment, minimal FND-specific funding in our medical system, and there are few FND-focused health practitioners. These facts are striking when you consider the support provided to equally prevalent conditions like MS and Parkinson’s, for example.
However, there are some encouraging signs of change for FND patients in New Zealand. In response to the general lack of knowledge about the condition, both among medical practitioners and the general public, a group of volunteers founded FND Aotearoa (FNDA) in 2024, to help people navigate the condition. Then, in 2025, Victoria University and the Neurological Foundation hosted New Zealand’s first Symposium on FND, bringing together both professionals and people living with FND, to try to make headway in improving treatment options and quality of life.
What is the Outlook (Prognosis)?
Research shows that often the prognosis is not positive for people in whom FND is left untreated — especially if a person’s symptoms have been longstanding. While recovery is possible because the nervous system isn't permanently or structurally damaged, the prognosis for FND varies significantly from person to person. According to one study, approximately 20% of patients recover fully, while 40% may see their symptoms stay the same or get worse over time (with another 40% assumedly improving). The statistics are worse for some types of FND (for example, those with movement disorders).
For adults, early and accurate diagnosis is critical, as long delays in diagnosis can lead to worse long-term outcomes. According to Dr Alex Lehn, a healthcare professional’s explanation of FND and the way they deliver the diagnosis, can significantly impact a patient’s understanding and acceptance of the condition; it also affects their engagement in treatment, with a major impact on treatment outcomes.
However, rehabilitation is possible, with the right support and given enough time. Research shows that even in severe cases of FND, treatment is possible through intensive rehabilitation with a specialist multidisciplinary team, if the person is supported for a sufficient period of time. Failing to accept an FND diagnosis and the psychological aspects of it, along with a lack of belief in the possibility of recovery are predictors of a worse outcome in FND patients. For this reason, at Mastering Mountains we believe that maintaining hope is a powerful factor.
Treatment & Self-Management: The Way Forward
Treatment for FND focuses on rehabilitation, retraining the brain to function correctly again. Because FND is a "software glitch" in the brain, the goal is to use targeted strategies to restore the brain's normal communication patterns. Effective treatment typically involves a coordinated, specialist multidisciplinary team, including neurologists, physiotherapists, occupational therapists, and psychologists.
A neurologist is often a person’s first point of contact. The neurological assessment and diagnosis is itself considered the first step of treatment, where a clear and empathetic explanation of the diagnosis can significantly shape a person’s rehabilitation outcomes. Psychoeducation about FND (providing knowledge and understanding of the condition) is a treatment in itself, and a vital part of recovery. Research has shown that understanding the diagnosis positively impacts prognosis and confidence in treatment strongly predicts treatment outcome. Likewise, accepting a diagnosis of FND (including a psychological explanation of symptoms) predicts symptom improvement and increases the likelihood of a positive recovery.
Neurological physiotherapists help people with FND manage symptoms, address movement challenges, and improve the quality of their daily life. Strategies may include graded exercise, attentional shift strategies, balance and gait retraining, activity modification and relaxation. Occupational therapy can help overcome obstacles to daily living, identify the need for adaptive equipment, and help to manage sleep, diet, and exercise.
There is accumulating research demonstrating that psychological therapies are an effective part of treatment for people with FND. Cognitive Behaviour Therapy (CBT) helps people modify unhelpful thinking and behaviour patterns that contribute to distress and disability. Psychodynamic therapy focuses on emotional and interpersonal challenges (both current and past) impacting their condition. Relaxation and mindfulness strategies are also useful. Through effective self-management involving goal-setting, identifying triggers, establishing coping strategies, developing plans to manage setbacks and skills to manage relational conflicts, along with tools such as pacing, grounding, and mindfulness, people with FND can better manage their daily lives and improve the likelihood of reaching remission.
Our Approach
Mastering Mountains provides nature-based rehabilitation, helping people access neurological physiotherapy in the context of working toward an outdoor goal. We use the goal and the goal-setting process as a vehicle for learning effective self-management. We help people define what wellbeing looks like for them, describe their triggers, identify the resources (internal and external) they can draw upon, establish coping strategies and develop plans to manage setbacks. We focus on equipping people with tools such as pacing, grounding, and mindfulness, so that people with FND can better manage their daily lives and improve their long-term outcomes.
Sources:
Erratum. (2018). Epilepsia, 59(2), 507–507. https://doi.org/10.1111/epi.14027
Finkelstein, S. A., Diamond, C., Carson, A., & Stone, J. (2024). Incidence and prevalence of functional neurological disorder: a systematic review. Journal of Neurology, Neurosurgery & Psychiatry, 96(4), 383–395. https://doi.org/10.1136/jnnp-2024-334767
Feigin V, Nichols E, Alam T et al. Global, regional, and national burden of neurological disorders, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet Neurology, 2019; 18, 459-480 [Link]
Gelauff, J., Stone, J., Edwards, M., & Carson, A. (2013). The prognosis of functional (psychogenic) motor symptoms: a systematic review. Journal of Neurology, Neurosurgery & Psychiatry, 85(2), 220–226. https://doi.org/10.1136/jnnp-2013-305321
Goldstein, L. H., Robinson, E. J., Pilecka, I., Perdue, I., Mosweu, I., Read, J., Jordan, H., Wilkinson, M., Rawlings, G., Feehan, S. J., Callaghan, H., Day, E., Purnell, J., Baldellou Lopez, M., Brockington, A., Burness, C., Poole, N. A., Eastwood, C., Moore, M., … Chalder, T. (2021). Cognitive–behavioural therapy compared with standardised medical care for adults with dissociative non-epileptic seizures: the CODES RCT. Health Technology Assessment, 25(43), 1–144. https://doi.org/10.3310/hta25430
Goldstein, L. H., Robinson, E. J., Mellers, J. D. C., Stone, J., Carson, A., Reuber, M., Medford, N., McCrone, P., Murray, J., Richardson, M. P., Pilecka, I., Eastwood, C., Moore, M., Mosweu, I., Perdue, I., Landau, S., Chalder, T., Abe, A.-M., Adab, N., … Yogarajah, M. (2020). Cognitive behavioural therapy for adults with dissociative seizures (CODES): a pragmatic, multicentre, randomised controlled trial. The Lancet Psychiatry, 7(6), 491–505. https://doi.org/10.1016/s2215-0366(20)30128-0
Prognosis of functional neurologic disorders. (2016). In Handbook of Clinical Neurology (pp. 523–541). Elsevier. https://doi.org/10.1016/b978-0-12-801772-2.00043 M.Hallett,J.Stone,andA.Carson,Editors
Lehn, A., Petrie, D., Palmer, D., Bradbury, C., Guest, R., Schuurs, A., Lewis, J., Madden, R., McLeod, J., Marsh, R., Slade, C., Davis, J., Cheah, V., Broughton, M., & Lagrand, T. J. (2025). Managing functional neurological disorder: treatment recommendations for health professionals in Australia. BMJ Neurology Open, 7(1), e000970. https://doi.org/10.1136/bmjno-2024-000970
MacDuffie, K. E., Grubbs, L., Best, T., LaRoche, S., Mildon, B., Myers, L., Stafford, E., & Rommelfanger, K. S. (2020). Stigma and functional neurological disorder: a research agenda targeting the clinical encounter. CNS Spectrums, 26(6), 587–592. https://doi.org/10.1017/s1092852920002084
Saunders, C., Bawa, H., Aslanyan, D., Coleman, F., Jinadu, H., Sigala, N., & Medford, N. (2024). Treatment outcomes in the inpatient management of severe functional neurological disorder: a retrospective cohort study. BMJ Neurology Open, 6(2), e000675. https://doi.org/10.1136/bmjno-2024-000675
Shipston-Sharman, O., Popkirov, S., Hansen, C. H., Stone, J., & Carson, A. (2022). Prognosis in functional and recognised pathophysiological neurological disorders - a shared basis. Journal of Psychosomatic Research, 152, 110681. https://doi.org/10.1016/j.jpsychores.2021.110681
Woo, E., & Gilmour, G. S. (2025). Epidemiology of Functional Neurological Disorder: The Clinical Spectrum. Seminars in Neurology, 46(02), 134–141. https://doi.org/10.1055/a-2753-9092