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Functional Neurological Disorder (FND) : a patient's guide

including Functional/Dissociative (non-epileptic) Seizures,  Functional Movement Disorder and other functional symptoms


Functional Speech and Swallowing Symptoms

The commonest functional speech and swallowing symptoms are:


Slurred Speech – this is usually described as slurring of speech that is sometimes normal and sometimes not. It may sound a bit like you are 'drunk' even though you have had nothing to drink. It usually gets worse with increasing tiredness. Your neurologist will often consider the diagnosis of myasthenia gravis if you have this symptom but it does occur as a functional symptom.


Stuttering Speech – people who have never had a stutter before may experience a stutter similar to an acquired stutter. Speech may be hesitant, often with gaps in the middle of words rather than at the ends of words. Alternatively there may be a 'telegrammatic' type of speech in which words like 'and' or 'the' are missed out from the sentence


Word Finding Difficulty – this is really a ‘thinking’ (cognitive) symptom more than a speech symptom. You may find that:


oYou are searching for the right word but it just won’t come

oYou mix up words in a sentence

oWords come out wrong or as nonsense words – e.g. ‘where is the train spation’ instead of ‘train station’


Whispering /Hoarse Speech – this sounds like the kind of speech people have when they have a sore throat (laryngitis)  except it is not due to a sore throat or any other abnormality visible on the vocal cords and lasts for much longer. This is often called functional dysphonia. It is usually investigated by an Ear, Nose and Throat doctor (ENT, Otolaryngology) to make sure there is no identifiable cause. It may come and go and sometimes may even be triggered by a bout of laryngitis, but the vocal cords ‘forget to work’ properly after the virus has gone.


Occasionally people can lose their speech completely, this is called functional aphonia


Foreign Accent Syndrome. Another rare functional speech problem is called foreign accent syndrome. This can be caused by a variety of neurological conditions but can also be a functional neurological symptom. There are two closed facebook groups here and here run by patients with this problem. There is also a site about foreign accent syndrome run by Bill Katz at the University of Texas at Dallas


Swallowing problems – typically, if a person with functional symptoms has related swallowing problems they will experience a sensation of something stuck in the upper part of their throat. This can occur even when they are not swallowing anything but can also make swallowing difficult. This symptom is often called globus or globus pharyngis. It is usually investigated by an Ear, Nose and Throat doctor (ENT, Otolaryngology) to make sure there is no identifiable cause.


Why are my tests normal?

In these kinds of speech and swallowing problems all the parts of the nervous system are there, they are just not working properly at certain times.


Your doctor will make this diagnosis after listening to your symptoms and examining you


Normal scans and tests help to make the diagnosis, but the diagnosis is usually made by a neurologist (or in the case of functional dysphonia, an ENT doctor) when they first meet you.


Am I imagining it then?

The answer is ‘no’ but click on ‘Am I imagining it’  to find out more



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