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REFERENCE · RECOVERY TECHNIQUE

Making a Plan for Familiar Facial Episodes

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When this may fit: When an assessed facial symptom comes in episodes and it would help to decide in advance what you and others will do. [One facial case within a case series; individualized care planning]

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
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For the Person With FND

When pulling starts, it can be hard to decide what to do while someone beside you asks several questions at once. An episode plan is a short agreement made at a calmer time. It describes a familiar episode, immediate safety needs, helpful support and when to seek care.

What are warning signs and grounding?

A warning sign is something you sometimes notice before a familiar episode, such as a recognizable change in sensation or effort. Some people have no warning. A trigger is a situation associated with episodes; it is not necessarily their cause, and you do not need to find one.

Grounding means using an accessible cue to connect with your present surroundings—for example listening to one familiar voice while sitting securely. It should not require you to force your eyes open, move your face or complete a long mental task. The choice should suit your symptoms and preferences.

A published facial-dystonia case used warning/trigger recognition, grounding, relaxation and modified cognitive behavioural therapy together. CBT explores how thoughts, feelings and actions interact with difficulties; using it does not mean the symptom is imagined. One case cannot tell us whether a particular cue works. [1]

A short plan to discuss with your team

  1. Make the situation safe. Pause an activity needing clear vision or reliable mouth control; arrange help to sit if necessary.
  2. Identify whether this fits your established pattern. Use the emergency plan for new or different symptoms.
  3. Try one agreed cue, if wanted. Perhaps a supporter speaks slowly while you notice the chair supporting you. These are educational examples, not a tested sequence.
  4. Allow time and space. Avoid repeated requests to smile, speak clearly or demonstrate that the episode has ended.
  5. Decide the next step. This may be rest, an accessible way to communicate or returning to a smaller version of the activity.

Keep the plan somewhere easy to find. It can be a few sentences on a phone rather than a detailed diary.

If it does not stop the episode

The plan can still make the experience safer or less overwhelming. Do not keep adding cues or searching for something you did wrong. Episodes that change, become more frequent or cause new difficulty need review. During a longer flare, the plan may need more support and fewer demands.

New or different symptoms: Sudden new facial droop or weakness, speech difficulty or other possible stroke symptoms need emergency assessment, even if they stop. Call your local emergency number; do not wait for an exercise to work. [2]

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources —

For Family, Friends, and Other Supporters

Agree beforehand whether the person prefers conversation, quiet company or practical help. Use one calm voice if several people are present. Do not hold the face or jaw in position, force eyelids open or put anything in the mouth.

Respect the agreed reassessment threshold. A familiar diagnosis should not become a reason to dismiss new weakness, breathing difficulty or altered awareness.

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources —

For Clinicians and the Care Team

Document a recognizable baseline, escalation criteria and any overlap with functional seizures, syncope or another disorder. Adapt grounding to visual, sensory and cognitive access. Warning monitoring should not become continuous symptom surveillance. The reported facial case involved several interventions and later flares; do not promise episode interruption or generalize its psychosocial formulation to others.

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources —

Research and Sources

This page expands original entry 3, A rehearsed episode plan. Practical examples and questions are educational adaptations, not patient quotations or a reproduced treatment protocol.

The direct facial evidence is a single case within Gros and colleagues’ four-case report and review. Frequency and duration improved after three months, with subsequent flares. Component effects, generalizability and comparative efficacy are unknown. The sample episode card here is an educational adaptation.

Citation Source What it supports and its limits Figure
1 FND-CIT-0055 — Gros P, Bhatt H, Gilmour GS, Lidstone SC. Rehabilitation for functional dystonia: cases and review of the literature. Movement Disorders Clinical Practice. 2024;11:1018–1024. DOI. Four cases, including one episodic facial presentation, and a literature review; no controlled facial protocol or component effect. —
2 FND-CIT-0108 — NHS. Symptoms of a stroke. Source. Accessed September 22, 2026. Emergency safety guidance; not an FND treatment study. —

Sources checked: September 22, 2026 · Movement-disorders, speech-language, eye-care, lived-experience and accessibility review pending

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources —