Table 3

Some suggested ingredients for a therapeutic explanation for patients with functional neurological disorders

Explain what they do have…“You have functional weakness”
“You have dissociative seizures”
Emphasise the mechanism of the symptoms rather than the causeWeakness: “There is a problem with the way your brain is sending messages to your body—its a problem with the function of your nervous system”
Seizures: “You are going into a trance-like state a bit like someone being hypnotised”
Explain how you made the diagnosisShow the patient their Hoover's sign or dissociative seizure video
Indicate that you believe them“I do not think you are imagining/making up your symptoms/mad”
Emphasise that it is common“I see lots of patients with similar symptoms”
Emphasise reversibility“Because there is no damage, you have the potential to get better”
Explain what they do not have“You don't have multiple sclerosis, epilepsy”, etc
Emphasise that self-help is a key part of getting better“This is not your fault but there are things you can do to help it get better”
Metaphors may be useful“There's a problem with the software of the nervous system rather than the hardware”
Introducing the role of depression/anxiety“If you have been feeling stressed/low/worried, that will tend to make the symptoms even worse” (often easier to achieve on a second visit)
Use written informationSend the patient their clinic letter. Give them some written information, eg,,
Stop the antiepileptic drug in dissociative seizuresIf you have diagnosed dissociative (non-epileptic) attacks and not epilepsy, stop the antiepileptic drug
See the patient again“I'll see you again. Please have a read of my letter and the information I have given you and come back with questions”
Making the physiotherapy or psychiatric referral (preferably at a second visit)“My colleague X (or my colleague Dr X) has a lot of experience and interest in helping patients with functional movement disorder—he won't think you are crazy either”