What initial investigations are recommended for a patient presenting with symptoms suggestive of FND?

For a patient presenting with symptoms suggestive of functional neurological disorder (FND), initial investigations primarily focus on clinical assessment and exclusion of other neurological conditions rather than extensive routine testing. It is recommended to arrange referral to a neurology specialist for further assessment and confirmation of the diagnosis, as FND diagnosis is ideally made by a neurologist with expertise in neurological conditions NICE CKS.

Initial investigations may include structural and functional neuroimaging and neurophysiological testing when needed to differentiate FND from epilepsy and other neurological disorders, especially in cases of functional seizures NICE CKS. Videotelemetry electroencephalographic (EEG) recording can be useful to exclude epilepsy in patients with seizure-like events NICE CKS.

Routine blood tests or other investigations are not specifically recommended for FND diagnosis but may be considered to exclude other diagnoses based on clinical judgement NICE CKS.

In summary, the initial approach involves clinical evaluation, targeted investigations to exclude other neurological diseases, and early referral to neurology rather than broad initial testing in primary care NICE CKS.