The Importance of Early Referral
The prognosis for FND is significantly improved when specialized treatment begins early. Clinical pathways should aim to minimize the "diagnostic odyssey" and transition the patient to a functional management model as soon as positive signs are identified.
The Standard Referral Flow
1
Primary Care: Identification of neurological symptoms & referral to Neurology.
2
Secondary Care (Neurology): "Rule-In" diagnosis based on physical exam & education.
3
MDT Assessment: Combined evaluation by Physio, OT, and Psychology.
When to Refer to Specialized Care
Patients should be referred to a specialized FND clinic or neuro-rehabilitation unit if they meet any of the following criteria:
- Diagnostic Uncertainty: When the diagnosis is complex due to comorbid structural disease.
- Severity: Immobile patients or those with frequent, injurious seizures.
- Failure of Local Care: When standard community physiotherapy or psychotherapy has not resulted in functional gain.
- Pediatric Cases: All children and adolescents should be seen by a pediatric FND specialist.
The Triage Model
Many successful clinics use a "Triage Day" where the patient is seen by the entire MDT in a single morning. This ensures a unified message and a coordinated treatment plan from day one.
Writing the Referral
To ensure a smooth transition, the referral letter should explicitly include:
- The specific Positive Signs found during the exam (e.g., "Positive Hoover's sign in right leg").
- The patient's Understanding of the diagnosis and their readiness for rehab.
- A clear list of Functional Goals identified by the patient.
Find a Clinic
Our global directory of specialized FND clinics can help you find the nearest accredited center for your patient.