Clinical diagnosis and communication in functional neurological disorders: a survey among Italian neurologists

Functional neurological symptom disorder (FND), including functional motor disorders (FMD) and psychogenic non-epileptic seizures (PNES), is a common yet under-recognized condition, often associated with diagnostic uncertainty. This national survey investigated how Italian neurologists apply validated clinical signs and communication strategies in FND diagnosis.

A cross-sectional survey was distributed to approximately 2,700 members of three Italian neurological societies. The questionnaire assessed demographic and professional characteristics, the frequency of use of specific clinical signs for FMD and PNES, and strategies for communicating the diagnosis. Responses were rated on a five-point frequency scale and analyzed using ordinal generalized linear models and Spearman's correlations, adjusting for demographic covariates.

A total of 245 neurologists (43.3% general neurologists, 35.9% movement disorder specialists, 20.8% epileptologists) completed the survey. Movement disorder specialists more frequently assessed tremor entrainment and fixed dystonia in FMD, while epileptologists were more likely to assess signs such as eye closure and irregular jerks in PNES. Clinicians with greater experience more frequently evaluated established signs for both FMD and PNES and employed broader communication strategies. Communication practices were largely consistent across subspecialties. Written information was rarely provided across all groups.

The application of validated clinical signs and communication strategies for FND varies by subspecialty and clinical experience. While epileptologists and movement disorder specialists demonstrate greater familiarity with signs relevant to their subspecialty, key diagnostic tools for FMD remain underutilized. These findings highlight the need for targeted educational interventions to improve diagnostic accuracy, enhance communication, and optimize care for people with FND.