• A functional neurological disorder (FND) is a condition in which patients experience neurological symptoms such as weakness, sensory symptoms (e.g. pain sensitivity/numbness, sound distortion, visual changes etc), abnormal movements (sometimes seizure-like, ‘non-epileptic seizures’) or loss of awareness / dissociation). The brain of a patient with functional neurological symptom disorder is structurally normal, but functions incorrectly at times, with capacity to return to normal function. A diagnosis of a co-morbid psychological/psychiatric disorder is not required in this condition. This disorder is considered due to ‘software glitches’ in automatic brain networks, not under direct control of the patient. Symptoms of functional neurological disorders are clinically recognisable but are not categorically associated with a definable organic disease. FND is a clinical diagnosis based on history and examination. Physical examination can demonstrate positive confirmatory findings of FND. If the clinical presentation is consistent, investigations for other conditions are not necessary.
• In the majority of cases it is thought inappropriate for children to wait more than 6 months for an outpatient initial appointment
• Referral from a health practitioner other than a General Paediatrician may be accepted if there is limited access to public Paediatric services in the patients’ local area
• A change in patient circumstance (such as condition deteriorating) may affect the urgency categorisation and should be communicated as soon as possible.
• Clinical urgency is the dominant consideration in the prioritisation of a referral for a child currently in out of home care (OOHC), or at risk of entering or leaving OOHC.

Clinician resources

• Statement of Intent
• If you have a reason to suspect a child in Queensland is experiencing harm, or is at risk of experiencing harm, you need to contact Child Safety Services
• Functional Neurological Disorder (FND): a patient’s guide
• Sheffield NHS trust patient leaflets:
  • Functional Symptoms: A short guide for patients and families
  • Taking control of your functional symptoms
• Health management plan for functional attacks
• Sensory grounding information sheet
  

Patient resources

• Sheffield NHS trust patient leaflets:
  • Functional Symptoms: A short guide for patients and families
  • Taking control of your functional symptoms
  • Taking control of your non-epileptic attacks
  • Nonepileptic attacks – a short guide for patients and families
• Epilepsy Action Australia: Psychogenic Non-epileptic Seizures Fact Sheet
• Mayo Clinic: Functional Neurological disorders/conversion disorder
• Functional Neurological Disorder (FND): a patient’s guide
  

Highly desirable Information – may change triage category

• Note if there are triggers or associations with the events or not. For example, pain, frustration, exercise, feeding, sleep.
• If the child is in foster care, please provide the name and regional office for the Child Safety Officer who is the responsible case manager.

Desirable information- will assist at consultation

• Any allied health assessments
• Other past medical history
• Immunisation history
• Developmental history
• Medication history
• Significant psychosocial risk factors (especially parents mental health, family violence, housing and financial stress, department of child safety involvement)
• Examination findings inclusive of CNS, birth marks or dysmorphology

Investigation results:

• ECG, EEG and neuroimaging if available. (Do not order these tests for the referral if they are not clinically required)
• If neuroimaging has been done, arrange image transfer to PACS at the hospital the patient is being referred to, with the imaging reports. If electronic imaging transfer is not available, then a CD of the neuroimaging and report should be sent to the neurologist named in the referral.