FND Education Project

REFERENCE · DIAGNOSIS

Functional Sensory Symptoms

Refers to:

  • numbness or reduced, absent or altered touch sensation;
  • tingling, burning, hypersensitivity or unusual bodily sensation; and
  • an assessed body part feeling different, distant or absent when this is a sensory presentation.

Scope boundary: Visual and other special-sense symptoms need their own assessment, and dissociative disconnection is not automatically a sensory sign. This page’s examinations concern sensory modalities and should not be substituted for motor, seizure or cognitive assessment.

Quick Reference

Presentation: Altered bodily sensation assessed through its quality, distribution and carefully interpreted comparisons.

More techniques: See the full list below.

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For the Person With FND

Your hand may feel numb, a patch of skin may tingle or burn, or touch may feel unusually strong. A limb may feel distant or absent even though you can see it. These are among the experiences people describe with functional sensory symptoms. Recognizing an experience here helps identify the relevant page; it does not establish its cause. The clinician first works out which kind of sensation has changed and whether the pattern fits a nerve, nerve root, spinal cord, brain or another recognized condition.

A sensory assessment brings together the type and distribution of altered feeling, the history and the rest of the neurological examination. A sharp dividing line or a difference in vibration between the two sides cannot establish the cause alone: similar reports occur after stroke. These observations need careful interpretation rather than being treated as proof of FND. [1][2]

Your examination may still help by documenting the symptom accurately and placing it beside the history, motor examination and necessary tests. The aim is not to catch you giving two different answers.

Sensory symptoms may come and go or remain

Functional numbness, tingling, altered sensation or hypersensitivity may be intermittent, fluctuate in location or intensity, occur during broader symptom flares, or persist for long periods. The pattern can change with activity, attention, pain, migraine, fatigue or sensory load in some people. Those changes are useful history but are not a diagnosis by themselves.

At the onset of familiar reduced or distorted sensation, protect the affected area from falls, burns, sharp objects and pressure injury. Use a previously taught sensory or attention strategy only if it is safe. Sudden new one-sided numbness, rapidly spreading symptoms or sensory change with weakness, speech difficulty or another acute neurological symptom needs medical assessment rather than being assumed to be FND.

What this page covers

This page concerns bodily sensation. Visual symptoms need their own assessment. Feeling disconnected from yourself is not automatically sensory loss. If “numb” means “I cannot move it,” the clinician should assess weakness as well as sensation.

What might be happening?

Sensation involves how the nervous system processes information as well as signals arriving from the body. Attention and expectations are among proposed influences in FND; an examination cannot identify one mechanism that explains every person’s symptoms. A psychological stressor is not required for diagnosis. [2]

Being understood in everyday life

Tell the team what the change means for you: whether contact with clothing is painful, handling objects feels uncertain, or an affected area needs protection. These are questions to explore, not a list of difficulties everyone has. Occupational therapy can help assess everyday tasks; neurology and primary care can explain findings and coordinate further assessment. A brief response to touch does not measure how reliably you can manage a whole day. See assessment and everyday function.

The 2026 motor-FND study linked sensory symptom burden with disability and depression. That association does not establish a psychological cause. Of 90 participants followed for a year, 27 reported improvement; the result is not an individual prognosis. [1]

For practical management, see the separate sensory recovery collection.

Urgent change: New sudden one-sided numbness needs emergency assessment even without weakness. New saddle-area numbness with bladder or bowel change needs urgent assessment; see cauda equina presentations. An existing FND diagnosis does not settle the cause of a new symptom. [6][8]

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For Family, Friends, and Other Supporters

Do not use pins, heat, ice or repeated touching to map another person’s sensation at home. Reduced sensation can make injury easier, and interpretation requires anatomical knowledge and the rest of the examination. Help the person describe the location, timing and practical effect of the symptom instead.

When sensation changes suddenly

An episode may last briefly or become part of a much longer flare. Help protect numb or poorly controlled areas from heat, pressure, cuts and falls. Ask before touching a hypersensitive area, and use only the sensory or grounding method already agreed with the person. Do not repeatedly test whether they can feel an object.

Once safe, note location, quality, onset, duration, associated symptoms and recovery. A familiar intermittent pattern and a new acute neurological pattern should not automatically be treated as the same thing.

Sudden one-sided numbness, a rapidly changing pattern or sensory loss with other urgent symptoms needs appropriate medical assessment even when the person already has FND.

Help during the appointment

With permission, help explain what happens between appointments and which activities need assistance. Ask about comfortable touch, breaks and communication before an examination. It is useful to leave knowing what the findings support, what remains uncertain, and who will review a changed pattern. Support should follow the person’s priorities; a family member does not need to reproduce the examination.

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For Clinicians and the Care Team

Start with the actual sensory complaint

Separate reduced detection, unpleasant sensation, pain, loss of position sense and altered body perception. Record the person’s own wording before translating it into a neurological label. Establish onset and progression, affected modalities, distribution, associated symptoms, previous diagnoses and practical consequences. Do not assume all sensory symptoms in someone with motor-FND have the same cause.

Episodic and prolonged presentations

Document temporal pattern as carefully as anatomical distribution: continuous versus episodic symptoms, duration, frequency, migration, warning, activity or environmental context, associated motor/migraine/seizure-like symptoms and recovery. A sensory symptom that is absent during examination can still be clinically important, but fluctuation alone is weak evidence for a functional diagnosis.

For an established episodic functional pattern, provide an onset plan that emphasizes injury prevention and a limited, previously trained sensory-discrimination, functional-task or attention strategy. New or substantially changed sensory episodes still require appropriate anatomical and medical reassessment.

Differential diagnosis and investigation

One-sided sensory loss can arise from a brain lesion, including a thalamic stroke. A peripheral nerve, root or spinal-cord pattern calls for its corresponding assessment. Compare sensation with strength, reflexes and the rest of the neurological examination. [6][8]

Migraine, pain disorders and coexisting neurological disease remain relevant even when functional symptoms are present. Select imaging, laboratory or neurophysiological investigations to answer a clinical question, rather than requiring every person to complete every test in the inventory. A normal investigation is not itself a positive functional sign. See what tests can and cannot show.

In a 2026 retrospective emergency-department series, a neurological diagnosis was identified in 55 of 194 people with hemisensory complaints, including stroke/TIA, migraine and multiple sclerosis. The study does not establish that the remaining patients had FND. [7]

Explain the degree of certainty

Specify the positive findings and how they fit together. A functional motor sign supports the motor diagnosis; explain separately why the sensory complaint is thought to be functional. If the evidence is insufficient, document the sensory syndrome, uncertainty and follow-up plan. Neither an unusual description nor distress resolves that uncertainty. [1][2]

Diagnostic techniques at a glance

All seven original entries are retained in the full inventory. These are observations and investigations with different purposes, not seven validated rule-in tests.

The detailed mapping page now holds the original clinical sequence.

The media brief has moved with that method.

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Research and Sources

Evidence notes

Nielsen et al., 2026: 102 adults with established motor-FND were compared with 75 people with recent stroke. Traditional splitting signs overlapped; quantitative sensory testing added no clear diagnostic value. This is not validation in people with isolated sensory symptoms. Groups differed in demographics and illness duration; symptom reports were sensitive to prompting. [1]

Koh et al., 2021: MRI showed acute ischaemic stroke in 18 of 79 hospitalized people with isolated hemisensory symptoms. This selected inpatient sample is not a community risk estimate. It supports taking an acute sensory presentation seriously, including when weakness is absent. [6]

Earlier comparative evidence: Chabrol compared traditional signs in 40 people with neurological disease and 15 with conversion disorder and found substantial overlap. Daum’s pilot combined motor, sensory and gait findings; its combined results are not sensory-only diagnostic accuracy. [3][4]

Evidence reviewed October 10, 2026. Research in isolated sensory presentations remains limited.

Citation table

Citation Full citation
[1] Nielsen G, Higgins R, Stone J, Coebergh J, Edwards MJ. Functional sensory symptoms and signs: a case-control study of 102 patients. Brain Communications. 2026;8(1):fcag031. FND-CIT-0023. https://doi.org/10.1093/braincomms/fcag031
[2] Espay AJ, Aybek S, Carson A, et al. Current concepts in diagnosis and treatment of functional neurological disorders. JAMA Neurology. 2018;75(9):1132–1141. FND-CIT-0002. https://doi.org/10.1001/jamaneurol.2018.1264
[3] Daum C, Gheorghita F, Spatola M, et al. Interobserver agreement and validity of bedside ‘positive signs’ for functional weakness, sensory and gait disorders in conversion disorder: a pilot study. Journal of neurology, neurosurgery, and psychiatry. 2015;86(4):425-430. DOI. PMID: 24994927. FND-CIT-0130.
[4] Chabrol H, Peresson G, Clanet M. Lack of specificity of the traditional criteria for conversion disorders. European psychiatry : the journal of the Association of European Psychiatrists. 1995;10(6):317-319. DOI. PMID: 19698360. FND-CIT-0126.
[5] Edwards MJ, Koens LH, Liepert J, et al. Clinical neurophysiology of functional motor disorders: IFCN Handbook Chapter. Clinical neurophysiology practice. 2024;9:69-77. DOI. PMID: 38352251. FND-CIT-0022.
[6] Koh PX, Ti J, Saffari SE, Lim ZYIC, Tu T. Hemisensory syndrome: Hyperacute symptom onset and age differentiates ischemic stroke from other aetiologies. BMC Neurology. 2021;21:179. DOI. FND-CIT-0243.
[7] Urman I, Sabah K, Naftali J, Djaldetti R. Rate of neurological diagnosis in patients with hemisensory syndrome – A retrospective cross-sectional study. Acta Neurologica Belgica. 2026;126:1201–1207. DOI. FND-CIT-0244.
[8] Newman G. How to assess sensation. MSD Manual Professional Edition. Reviewed August 2025. Clinical examination reference. Accessed October 1, 2026. FND-CIT-0245.

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