Functional Neurological Disorder (FND) and Essential Tremor are distinct conditions.

FND involves an internal problem in how the brain and body communicate, while Essential Tremor is a common, progressive nervous system disease that causes rhythmic shaking. They differ significantly in their onset, movement patterns, and underlying physical characteristics
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Onset and Progression
  • FND (Functional Tremor): Starts suddenly; symptoms can appear overnight or after a specific trigger like a minor injury, stress, or illness. 
  • Essential Tremor: Starts slowly and builds up gradually over years; usually affects both sides of the body symmetrically, most commonly the hands. 

Movement Patterns and Behavior
  • FND (Functional Tremor): The shaking changes in speed or rhythm, can move to different parts of the body, and often stops or changes when the person is distracted or asked to tap a different rhythm with another limb (entrainment). 
  • Essential Tremor: The rhythmic shaking happens mostly when using the hands or holding a posture; it follows a steady, predictable pattern and does not change or disappear with simple distraction tests. 

Cause and Brain Changes
  • FND (Functional Tremor): There is no physical damage or degeneration in the brain; instead, the brain’s software or network communication has a functional glitch.
  • Essential Tremor: It is linked to structural and genetic changes in the brain areas that control movement, often running in families. 

Treatment Approach
  • FND (Functional Tremor): Treated with specialized physical therapy, retraining how the body moves, and managing stress or underlying anxiety. 
  • Essential Tremor: Treated with prescription medications (like beta-blockers) or specialized medical devices and deep brain stimulation in severe cases. 

Functional Neurologic Disorder (FND) symptoms include movement problems, seizure-like episodes, and cognitive changes.


  These real, disabling signs reflect a problem with how the brain sends and receives signals, rather than physical damage.​
1. Movement and Motor Dysfunction
  • Functional Tremor: Uncontrollable, rapid shaking of the hands, limbs, or body that can change in speed or temporarily vanish when distracted. 
  • Limb Weakness or Paralysis: Sudden loss of strength in an arm or leg, often displaying a clinical feature known as "Hoover’s sign" (where strength returns when moving the opposite leg). 
  • Gait Disorders: Abnormal walking patterns, which may include leg dragging, knee buckling, or a distinct unsteadiness resembling "walking on ice". 
  • Dystonia and Spasms: Painful, involuntary muscle contractions causing body parts like a clenched fist or turned-in ankle—to freeze in position. 
  • Jerks and Tics: Sudden, shock-like muscle twitches or vocalizations. 
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​2. Cognitive and Systemic Symptoms​
  • Brain fog: Trouble with memory, losing track of conversations, or poor concentration.
  • Fatigue and pain: Long-lasting tiredness, chronic headaches, and widespread body pain. 
3. Sensory and Communication Deficits
  • Altered Sensation: Numbness, tingling, or chronic pain, which frequently presents on only one side of the body.
  • Speech and Swallowing Difficulties: Slurred speech, sudden stuttering, whispering, or a feeling of a lump in the throat.
  • Visual Disturbances: Double vision, blurred vision, or hypersensitivity to light. ​
  • Vision and hearing changes: Sudden blurred vision, double vision, or temporary loss of sight and sound.
  • Dysfunctional Breathing: Breathing symptoms include dysfunctional breathing patterns, breath-holding, and hyperventilation. 

​​4. Dissociative (Functional) Seizures & Attacks
  • Non-Epileptic Seizures: Episodes of limb thrashing, fainting, blank staring or blackouts that mimic epilepsy but lack abnormal electrical brain waves.
  • Drop Attacks: Sudden falls to the ground without a complete loss of consciousness. 
  • Numbness: Loss of touch sensation or a feeling that a limb does not belong to the body.

Evidence-Based Treatments for FND

There is no "one-size-fits-all" cure for FND, but the nervous system can be retrained. A multidisciplinary treatment plan combining physical and psychological therapies yields the highest success rates. ​
Specialized Physical & Occupational Therapy
Physical therapy is widely accepted as the most vital treatment for motor-related FND. 
  • Movement Retraining: Physical therapists utilize specific exercises to bypass conscious brain control and tap into automatic movement pathways. 
  • Distraction Techniques: Learning to focus on an external target—such as listening to music or counting backward—while walking helps minimize active tremors. 
  • Pacing and Energy Management: Occupational therapists help patients structure daily activities to prevent physical fatigue and symptom flares. 

Psychological & Mind-Body Therapies
Because physical symptoms are linked to nervous system regulation, targeted psychological interventions help rewire faulty signaling pathways: 
  • Cognitive Behavioral Therapy (CBT): The foundational psychological option. As outlined in management studies published on Psychiatrist.com, CBT helps patients process stressors, develop distraction strategies, and regain physical control.
  • Stress Reduction and Mindfulness: Deep breathing, grounding mechanisms, and meditation techniques help down-regulate an overactive "fight-or-flight" response.
  • Clinical Hypnotherapy: Can establish a state of deep relaxation to help block or alleviate acute episodes. 

Medical and Pharmacological Options
  • No Direct FND Medication: There are currently no specific drugs designed to cure FND itself.
  • Managing Comorbidities: Doctors regularly prescribe medications to treat co-occurring symptoms like chronic pain, migraines, sleep insomnia, or severe anxiety.
Step One: A Clear Diagnosis
The single most imperative step to recovery is receiving an accurate, clear explanation from a qualified neurologist. Understanding that the symptoms are real—and that the brain retains the structural capability to function normally again—provides the necessary foundation for active rehabilitation.
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Functional Neurologic Disorder & the NIH Read More >
Diann Shaddox Foundation for Essential Tremor