When should I consider referring a patient with Functional Neurological Disorder to a specialist for further evaluation or treatment?

Consider referring a patient with Functional Neurological Disorder (FND) to a specialist for further evaluation or treatment if they present with new neurological symptoms or signs that have not been previously assessed by a specialist. Adults who have been diagnosed with FND by a specialist and have recurrent limb weakness as part of the disorder do not usually need re-referral unless new neurological signs develop. New symptoms or signs should be assessed according to the relevant sections of the NICE guideline on suspected neurological conditions.

In summary, referral is indicated when:

• There are new neurological signs or symptoms in a patient with known FND.
• The diagnosis is uncertain or the presentation is atypical.
• There is a need for specialist input for treatment or management beyond initial diagnosis.

Memory problems and concentration difficulties alone, if consistent with FND and without new neurological signs, do not routinely require re-referral.

This approach ensures appropriate use of specialist resources while providing timely assessment for changes in clinical status.

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