Functional Neurological Symptoms After Mild Traumatic Brain Injury: A Scoping Review and Framework for
Ioannis Mavroudis1,2, Foivos Petridis2, Alin Ciobîcă3,4,5,6
1Faculty of Medicine, University of Leeds, Leeds LS2 9JT, UK.
Abstract:
Persistent post-concussion symptoms (PPCS) following mild traumatic brain injury (mTBI) are common and frequently disabling. However, symptom persistence is often poorly correlated with injury severity or structural brain abnormalities. Increasing clinical and research evidence suggests substantial overlap between PPCS and functional neurological disorder (FND), yet this interface remains poorly synthesised and conceptually unresolved. To systematically review and synthesise the evidence linking mTBI with functional neurological symptoms, and to refine existing conceptual models by proposing a clinically useful framework for differentiating functional and organic contributions to persistent post-concussion presentations. A scoping review with narrative synthesis were conducted. Database searches yielded 120 records; after duplicate removal and abstract screening, 57 studies underwent full-text review. Included studies comprised systematic reviews, narrative and conceptual reviews, mechanistic hypothesis papers, primary observational studies, case series, case reports, and early interventional and neuroimaging investigations examining functional neurological symptoms in the context of mTBI. The literature demonstrates substantial phenomenological overlap between PPCS and FND across cognitive, motor, sensory, visual, and seizure-related domains. Functional neurological symptoms can emerge after concussion and may closely resemble PPCS, often in association with psychiatric comorbidity, dissociation, trauma exposure, and maladaptive attentional or illness-belief processes. Objective neurological impairment and injury severity show weak and inconsistent associations with symptom persistence. The evidence base is dominated by clinic-derived observational studies, with no population-level incidence estimates identified. Functional neurological symptoms represent a significant and under-recognised contributor to persistent symptoms after mTBI. Existing evidence supports moving beyond binary organic-psychogenic models toward a functional-organic differentiation framework that acknowledges dynamic interactions between injury-related and functional mechanisms. Improved screening, diagnostic communication, and stratified management are likely to enhance outcomes for patients with persistent post-concussion symptoms.
