Life Expectancy in Functional Neurological Disorder
FND does not reduce life expectancy—mortality rates are not elevated compared to the general population, and this is not a degenerative or life-threatening condition. 1
Key Prognostic Points
FND is fundamentally a disorder of function, not structure or degeneration. The condition does not cause death or shorten lifespan. 1 This is a critical point to communicate to patients, as many harbor fears about progressive deterioration or premature mortality.
Clinical Course and Disability
While FND does not affect longevity, the symptom trajectory varies considerably between individuals:
- Acute presentations can resolve quickly with appropriate intervention 2
- Chronic presentations frequently result in high levels of distress, disability, unemployment, and reduced quality of life 2
- The median time from first symptom to diagnosis is approximately 2 years, which represents a significant delay 3
Treatment Outcomes and Timeline
With multidisciplinary intervention, 60-96% of patients report improvement, with measurable gains across mobility, depression, and quality of life domains. 1 However, realistic timelines for improvement typically range from 12-25 months with comprehensive treatment. 1
Positive prognostic factors that predict better treatment success include:
- Patient understanding and agreement with the diagnosis 1
- Motivation to make changes 1
- Ability to identify rehabilitation goals 1
Associated Symptom Burden
The complexity of FND extends beyond motor and sensory symptoms. Most patients (97.3%) experience multiple core FND symptoms simultaneously. 4 Common associated features include:
- Fatigue (78-93% of patients) 4, 3
- Pain (78% of patients) 4
- Sleep disturbances (46.7% of patients) 4
- Memory and cognitive difficulties (80% of patients) 3
- Psychiatric comorbidities including depression (43%) and anxiety (51%) 3
These associated symptoms often exist before FND diagnosis and may worsen afterward, requiring ongoing monitoring. 4
Clinical Pitfall
Do not dismiss FND as benign simply because it doesn't affect mortality. The disorder causes genuine disability comparable to other serious neurological conditions—the incidence of FND (4-12 per 100,000) is comparable to multiple sclerosis and amyotrophic lateral sclerosis. 5 Patients experience high healthcare utilization, and many remain chronically disabled without appropriate intervention. 6
Outcome Assessment
Prognosis should be evaluated across multiple domains rather than symptom change alone, including core FND symptom change, life impact measures, additional physical and psychological symptoms, and healthcare resource utilization. 1 This comprehensive approach optimizes functional outcomes and provides a more accurate picture of disease burden than focusing solely on the primary neurological symptoms.