Why Your Scans Came Back Normal and You Still Have FND

One of the hardest moments in a functional neurological disorder diagnosis is being told the scans are normal. It sounds like being told nothing is wrong. For a lot of people it lands as being told they are imagining it.

That is not what it means. A normal MRI is an expected part of an FND diagnosis, not a contradiction of it.

We are Starling Homecare, an independent family run home care provider registered with the Care Quality Commission, and we support people living with FND at home across Hertfordshire. Families ask us this question more than almost any other, usually some weeks after the appointment, once the shock has worn off and the confusion has not. This page explains how the diagnosis is actually made.

FND is diagnosed on what is there, not on what is absent

The old understanding was that FND was a diagnosis of exclusion: rule out everything else, and what is left must be functional. That is not how it is done now, and it has not been for some years.

FND is diagnosed on positive clinical signs. A neurologist looks for specific things in the examination that are characteristic of FND itself, in the same way they would look for characteristic signs of any other condition.

As neurosymptoms.org, written by the neurologist Professor Jon Stone, puts it, the diagnosis depends on finding positive evidence on assessment. It is not about doing a lot of scans and showing they are normal.

What a positive sign actually looks like

The best known is Hoover's sign, used where there is functional leg weakness. The affected leg is weak when the person tries to push their foot down. When they are asked to lift the other leg instead, the strength in the affected leg comes back.

That is not a trick and it is not a test of honesty. It shows that the pathway works, and that the problem is in how the nervous system is running the movement rather than in whether the equipment is intact.

There is a similar test for functional tremor, the tremor entrainment test, where the tremor changes or stops when the person is asked to tap a rhythm with the other hand. There are many other signs, each tied to a particular symptom.

Why the scan is normal, and why that is not the point

An MRI shows structure. FND is a problem with function, with how the brain and nervous system are running a movement or a sensation, not with the wiring being damaged.

This is not unique to FND. Standard MRI and CT scans are typically normal in Parkinson's disease too. Parkinson's was diagnosed clinically for most of the last hundred years, on the pattern a doctor could see, long before any scan could contribute.

So a normal scan is not the absence of a diagnosis. In FND it is part of the expected picture.

How reliable is it, honestly

We should be straight about this rather than reassuring for the sake of it. No clinical sign in neurology is one hundred per cent reliable, in FND or anywhere else.

Studies show that these signs can discriminate between people who have functional weakness and people who have other neurological disease, even when the examining doctor does not know the diagnosis in advance. Hoover's sign performs well. For some of the others there is less data and more caution is needed.

Each sign is weighed alongside the other findings and the clinical story. A good neurologist will also say when they are not sure, which is a sign of care rather than of doubt about you.

Having FND does not rule out having something else

This matters and it is often missed. It is common for someone to have both a neurological disease and FND at the same time. Multiple sclerosis and FND together is a recognised combination.

So a diagnosis of FND is not a door closing on further investigation. If something changes, or a new symptom appears that does not fit, that is worth raising with your GP or your neurology team.

What good support at home looks like

Starling Homecare provides visiting care and live-in care for people living with FND at home. The practical support that helps most is rarely medical.

It is consistency, so the person is not re-explaining themselves to a new face every visit. It is knowing what to do during a functional seizure and, just as importantly, what not to do. It is help that steps back as function returns rather than taking over permanently, because FND fluctuates and support that assumes decline can entrench it.

Every person is different, which is why we build a person-centred care plan for each individual. What helps one person with FND can be the wrong approach for another, so the plan is written around that person rather than around the diagnosis.

FND care at home across Hertfordshire

You can read more about FND care at home, and about the other FND pieces we have written: what to do when someone has a functional seizure, which FND service covers you in Hertfordshire and whether someone with FND can live alone.

Each town has its own team and its own number: St Albans 01727 324 127, Harpenden 01582 824 830, Welwyn Hatfield 01707 714 000, Hemel Hempstead, Berkhamsted and Tring 01442 954 137, Hitchin 01462 534739, Hertford 01920 746779, and Radlett and Shenley 01923 988 550. You can also read about home care in Hemel Hempstead on our area page.

Common questions

Does a normal MRI mean I do not have FND?
No. A normal MRI is expected in FND. The diagnosis is made on positive signs found during the examination, not on the scan.

Is my neurologist saying it is psychological?
No. FND is a disorder of how the nervous system functions. It is a neurological diagnosis, made by a neurologist, on neurological signs.

Can the diagnosis be wrong?
Any diagnosis can be. The signs are reliable enough to be used, but not infallible, and it is reasonable to raise new or changing symptoms with your team.

Sources checked on 8 September 2026: neurosymptoms.org on the reliability of clinical signs in FND, and FND Action on how FND is diagnosed. This article is general information written to raise awareness of FND. It is not medical advice. FND affects everyone differently, and what helps one person can be wrong for another, which is why every care plan we write is built around the individual. Please talk to your own GP, neurologist or therapy team about your situation.