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. 2025 Mar 24;96(4):383-395.
doi: 10.1136/jnnp-2024-334767.

Incidence and prevalence of functional neurological disorder: a systematic review

Sara A Finkelstein  1   2 , Clare Diamond  3 , Alan Carson  4 , Jon Stone  5
Affiliations

Incidence and prevalence of functional neurological disorder: a systematic review

Sara A Finkelstein et al. J Neurol Neurosurg Psychiatry. .

Abstract

Background: Robust epidemiological data regarding population incidence and prevalence of functional neurological disorder (FND) would be helpful with regards to resource allocation and planning for this disorder, particularly given high symptom burden and high healthcare utilisation. We therefore aimed to systematically review and synthesise available data on FND incidence and prevalence.

Methods: PubMed was searched to identify original research articles that reported on the incidence or prevalence of FND. Risk of bias assessment for each study was conducted. Incidence and prevalence rates of FND were additionally estimated by extrapolating data from low risk of bias studies on functional seizures alone.

Results: Thirty-nine articles were included. Nineteen reported on FND incidence, 21 reported on prevalence. Comparison between studies was difficult due to methodological differences and significant heterogeneity of incidence and prevalence estimates was found. The incidence of FND was estimated at 10-22/100 000, while minimum prevalence of FND was estimated at 80-140/100 000, with a possible range of 50-1600/100 000. Incidence of paediatric FND was estimated to be between 1 and 18/100 000.

Conclusions: The range of incidence and prevalence varies widely across studies, with significant heterogeneity among studies and most studies likely provide underestimates due to methodological challenges. However, using our best method as a conservative estimate, there are likely a minimum of 50-100 000 people with FND in the UK, as an example country. Given that FND appears to be more prevalent than many other well-known and well-funded neurological disorders, incidence and prevalence data suggested here indicate the need for greater research and clinical funding allocation to FND programmes.

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Conflict of interest statement

Competing interests: JS provided expert witness testimony in personal injury and negligence cases, received royalties from UpToDate and received support from Sun Pharma to attend an educational course. JS is the Secretary of the FND Society, serves on the medical advisory boards of FND Hope, FND Hope UK and FND Action, and is a member of the European Academy of Neurology Coordinating Panel on FND and the UK FND Network Board. JS is also the creator of the freely available website www.neurosymptoms.org. AC is a paid editor of the Journal of Neurology, Neurosurgery, and Psychiatry, provides expert witness testimony and is the past President of the FND Society and the British Neuropsychiatric Association. SF has received speaker’s honoraria for lectures on FND.

Figures

Figure 1
Figure 1. Study selection flow chart. FND, functional neurological disorder.
Figure 2
Figure 2. Factors leading to underestimation or overestimation of prevalence of functional neurological disorder (FND). ALS, amyotrophic lateral sclerosis; EEG, electroencephalogram; MS, multiple sclerosis.
See this image and copyright information in PMC

References

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