REFERENCE · DIAGNOSTIC TECHNIQUES
Functional Facial Symptoms Diagnostic Inventory
Seven original descriptions and their original source associations are preserved below. They include clinical patterns, comparisons and differential investigations; they are not seven independently validated tests. No new inventory entry is added.
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Detailed guides
- Pattern-Based Facial Examination
- Jaw, Tongue and Mouth Assessment
- Eye Closure, Facial Weakness and Differential Testing
Original seven entries
Lower-lip pulling with jaw deviation
The clinician observes sustained unilateral lip pulling, often with jaw movement and neck-muscle activation. A multicentre series describes this functional phenotype, but a characteristic appearance is not a standalone validated test. Facial weakness and other dystonias require assessment. [1]
Platysma overactivity
Visible activation of the superficial neck muscle can accompany functional facial pulling. This is a descriptive pattern distinct from reduced platysma activation in weakness testing. Neither finding should be interpreted without the corresponding facial and limb examination. [1][6]
Task inconsistency and distractibility
Facial movement is compared during conversation, expression and other comfortable tasks. A clear inconsistency can support the diagnosis; fluctuation alone cannot. The published evidence is mainly observational rather than a validated universal facial test battery. [1][2]
Jaw, tongue and stomatognathic assessment
Specialist examination characterizes mouth, jaw and tongue movements and their task dependence. A clinical cohort proposed a structured approach, but its selected sample limits generalisation. Dental, medication-related and neurological causes remain relevant. [2]
Hemifacial-spasm comparison
The clinician compares the distribution and timing of eyelid and lower-face movements, including eyebrow behaviour where useful. Functional mimics are described, but unusual facial movement alone is insufficient; neurological assessment and selected testing address genuine hemifacial spasm. [1]
Blink-reflex recovery cycle
A small comparative study examined an electrophysiological difference between essential and presumed functional blepharospasm. It is a specialist adjunct with limited validation, not a routine diagnostic test for all facial FND. [7]
Facial strength, reflexes and targeted investigations
Testing facial power and associated neurological findings helps distinguish weakness from overactivity and identify other causes. Imaging or neurophysiology may be appropriate. Normal tests alone do not establish functional facial symptoms. [1][6]
Interpretation update — October 6, 2026
The Horn source attached to the platysma and strength entries studied people with unilateral limb weakness. It does not validate isolated facial findings. The eye and differential guide distinguishes this adjacent evidence from the facial cohorts and the small blink-reflex study. This note qualifies use without changing the historical inventory.
Research and Sources
Original local citation numbers are retained for traceability.
| Citation | Figure | Full citation |
|---|---|---|
| [1] | — | Fasano A, Valadas A, Bhatia KP, et al. Psychogenic facial movement disorders: clinical features and associated conditions. Movement Disorders. 2012;27(12):1544–1551. FND-CIT-0052. https://doi.org/10.1002/mds.25190 |
| [2] | — | Yoshida K. Clinical characteristics of functional movement disorders in the stomatognathic system. Frontiers in Neurology. 2020;11:123. FND-CIT-0053. https://doi.org/10.3389/fneur.2020.00123 |
| [3] | — | Popkirov S, Stone J, Buchan AM. Functional neurological disorder: a common and treatable stroke mimic. Stroke. 2020;51(5):1629–1635. FND-CIT-0054. https://doi.org/10.1161/STROKEAHA.120.029076 |
| [4] | — | Frucht L, Perez DL, Callahan J, et al. Functional dystonia: differentiation from primary dystonia and multidisciplinary treatments. Frontiers in Neurology. 2021;11:605262. FND-CIT-0021. https://doi.org/10.3389/fneur.2020.605262 |
| [5] | — | Stone J. Functional facial symptoms. Neurosymptoms.org. Accessed September 1, 2026. FND-CIT-0056. https://neurosymptoms.org/en/symptoms/fnd-symptoms/functional-facial-symptoms/ |
| [6] | — | Horn D, Galli S, Berney A, et al. Testing Head Rotation and Flexion Is Useful in Functional Limb Weakness. Movement disorders clinical practice. 2017;4(4):597-602. DOI. PMID: 30363481. FND-CIT-0155. |
| [7] | — | Schwingenschuh P, Katschnig P, Edwards MJ, et al. The blink reflex recovery cycle differs between essential and presumed psychogenic blepharospasm. Neurology. 2011;76(7):610-614. DOI. PMID: 21321334. FND-CIT-0124. |
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