FND Education Project

REFERENCE · RECOVERY TECHNIQUE

Coexisting-Condition and Load Review for Functional Seizures

Most likely fit: When pain, migraine, sleep problems, mental-health needs, epilepsy or practical demands require care alongside functional seizures. [Clinical guideline and multidisciplinary care; benefits for another condition do not prove a seizure effect]

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

Treat the whole situation

You can have more than one condition. Improving sleep, treating pain or obtaining practical help may be worthwhile even if seizures continue. The aim is not to identify something you failed to manage. [1][2]

Make a short list of what is most difficult now. Separate symptoms needing medical assessment from demands that could be reduced. For example, a migraine review and a quieter appointment setting are different kinds of help; neither requires deciding that migraine caused every event.

Available capacity is a practical way to describe what you can manage at the moment. It is not a measurable quantity that identifies the cause of a seizure. If you use “spoons,” explain which tasks or symptoms consume your current capacity rather than trying to calculate a medical threshold.

Choose one manageable change

Ask the appropriate clinician about the most important untreated symptom. Ask a supporter about one practical change, such as reducing competing tasks or helping organize appointments. Avoid starting many treatments at once when that makes their effects hard to understand.

During a familiar flare, pause optional demands and use the episode plan. New chest symptoms, breathing problems, fainting or other major changes need assessment on their own merits, not simply more pacing.

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

Offer a concrete choice: help with a meal, appointment notes, transport or reducing noise. Do not turn the person’s day into a regulation checklist. A calm day does not guarantee that seizures will stop.

Report medication effects or new symptoms accurately. Take your own need for rest and practical help seriously; a plan that depends on one exhausted supporter is difficult to sustain.

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

Explicit procedure

  1. Separate event diagnosis, comorbid diagnoses, symptom burden and social/access barriers in the clinical record.
  2. Ask which issue most limits daily life and which requires prompt medical assessment.
  3. Review relevant neurological, psychiatric, sleep, pain and cardiopulmonary symptoms without presuming a single autonomic or psychological cause.
  4. Coordinate condition-specific assessment and treatment with the relevant clinician; avoid duplicating or contradicting medication plans.
  5. Map practical demands and retained supports with occupational therapy or social care where appropriate.
  6. Agree one feasible adjustment and review both the target condition and any adverse effects.
  7. Continue indicated care even when functional-seizure frequency is unchanged.

Mechanism and outcomes

The autonomic nervous system helps regulate involuntary functions such as heart rate and digestion. It is one part of the nervous system, not a complete explanation of FND. Avoid claims that all functional seizures mean persistent fight-or-flight or insufficient regulation.

Review function, pain, sleep, distress, appointment burden and supporter capacity. Increase activity only as appropriate to the person’s conditions; delayed worsening warrants reassessment and adaptation rather than an automatic increase.

Basis and evidence boundary

AAN supports assessing and treating co-occurring conditions; occupational-therapy consensus supports individualized daily-life care. The prioritization example is not a trial-tested seizure intervention. [1][2]

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

Research and Sources

Citation Full citation and source
[1] Tolchin B, Goldstein LH, Reuber M, Stone J, Perez DL, LaFrance WC Jr, et al. Management of Functional Seizures Practice Guideline Executive Summary: Report of the AAN Guidelines Subcommittee. Neurology. 2026;106(1):e214466. https://doi.org/10.1212/WNL.0000000000214466 FND-CIT-0010.
[2] Nicholson C, Edwards MJ, Carson AJ, et al. Occupational therapy consensus recommendations for functional neurological disorder. Journal of Neurology, Neurosurgery & Psychiatry. 2020;91(10):1037–1045. https://doi.org/10.1136/jnnp-2019-322281 FND-CIT-0011.

Created September 14, 2026 · Neurology, relevant therapy, lived-experience, caregiver and accessibility review pending

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