Life Expectancy in Functional Neurological Disorder
Functional Neurological Disorder (FND) does not reduce life expectancy—mortality is not elevated compared to the general population, and this is not a degenerative or life-threatening condition. The focus of prognosis in FND centers on disability, quality of life, and functional recovery rather than survival.
Key Prognostic Considerations
FND Is Not a Fatal Condition
- FND does not cause death or shorten lifespan 1
- The disorder causes real disability through altered neurological symptoms (motor, sensory, cognitive) but these symptoms are incompatible with recognized degenerative neurological diseases 2
- Unlike progressive neurological conditions such as multiple sclerosis or amyotrophic lateral sclerosis (which have similar incidence rates), FND does not follow a degenerative course 3
What Actually Matters: Functional Outcomes
- 60-96% of patients report improvement after intervention, with Clinical Global Impression-Improvement scores typically falling in the minimally to much improved range post-treatment 4
- Measurable improvements occur across mobility, depression, and quality of life domains, with patients experiencing symptoms as more understandable and less distressing after treatment 4
- Multidisciplinary studies report improvements in physical function and quality of life at 12-25 month follow-up periods 1, 2
Chronic Disability Is the Real Concern
- Many patients have a chronic course and remain disabled despite FND not being life-threatening 5
- High healthcare utilization and costs characterize the disorder, reflecting significant functional impairment rather than mortality risk 5
- Symptoms can present acutely and resolve quickly or can be long-lasting, with those affected frequently experiencing high levels of distress, disability, unemployment, and reduced quality of life 1
Factors That Predict Better Functional Recovery (Not Survival)
Positive Prognostic Indicators
- Patient understanding and agreement with the diagnosis predicts treatment success 4
- Motivation to make changes and ability to identify rehabilitation goals are associated with better outcomes 4
- Early diagnosis and shorter symptom duration improve prognosis, though unfortunately most patients are diagnosed after considerable delays 3
Burden of Comorbidities
- Fatigue is the most common symptom (47-93% of patients), followed by cognitive symptoms (80-85%) 6
- Psychiatric disorders occur in 40-100% of FND patients depending on subtype, with anxiety disorders most frequent 6
- Chronic pain syndromes are associated with FND in approximately 50% of cases 6
- These comorbidities affect quality of life and functional status but do not impact mortality 6, 7
Clinical Pitfall to Avoid
Do not frame FND prognosis discussions around life expectancy or survival. This fundamentally misunderstands the nature of the disorder. Instead, focus conversations on:
- Expected functional recovery with appropriate treatment 4, 2
- Realistic timelines for improvement (12-25 months with multidisciplinary intervention) 1, 2
- The importance of early diagnosis and treatment initiation to optimize functional outcomes 3
- Assessment across multiple outcome domains including symptom change, life impact, physical and psychological symptoms, and healthcare utilization 1, 4