Positive Clinical Signs in Functional Neurological Disorders: A Narrative Review and Development of a Clinical Decision Tool. [Review]

Mavroudis, I.; Franekova, K.; Petridis, F.; Ciobica, A.; Papagiannopoulos, S.; Kazis, D.

Positive Clinical Signs in Functional Neurological Disorders: A Narrative Review and Development of a Clinical Decision Tool. [Review]

All Authors

Mavroudis, I.

Franekova, K.

Petridis, F.

Ciobica, A.

Papagiannopoulos, S.

Kazis, D.

LTHT Author

Mavroudis, Ioannis

LTHT Department

Neurosciences

Publication Date

2025

Item Type

Journal Article
Review

Abstract

Background: Functional Neurological Disorders (FNDs) encompass a spectrum of disabling conditions, including functional limb weakness, tremor, gait disorders, seizures, and cognitive impairments. While previously diagnosed by exclusion, a growing consensus now supports the use of positive clinical signs as a basis for diagnosis. Despite this paradigm shift, frontline clinicians lack an integrated, accessible clinical tool for guiding diagnostic reasoning across FND subtypes. Objectives: This study aims to (1) synthesize the contemporary evidence on positive clinical signs across major FND subtypes and (2) develop a structured Clinical Decision Tool to support early and confident diagnosis in routine clinical settings. Methods: A focused narrative review was conducted using peer-reviewed publications and neurology reference texts, identifying reproducible positive clinical signs relevant to FND diagnosis. Signs were extracted, tabulated by subtype, and integrated into a modular decision-making framework designed for usability across outpatient, emergency, and specialist contexts. Results: The review identified 60+ positive signs across seven FND subtypes. These include Hoover's sign for limb weakness, entrainment for tremor, variable responsiveness in NESs, and paradoxical memory performance in Functional Cognitive Disorder. A Clinical Decision Tool was developed, featuring subtype-specific checklists, diagnostic confidence indicators, and red flag alerts, and it is currently available in printable format. Conclusions: This study offers a novel, evidence-based decision tool to facilitate the positive diagnosis of FND. By consolidating observable signs into a practical format, it aims to reduce diagnostic delays, avoid unnecessary investigations, and enhance patient-clinician communication. Future efforts will focus on clinical validation and digital implementation.