Quick answer: if symptoms are new, sudden, severe, getting worse, linked to injury, or unlike your usual FND pattern, treat them as medical until a clinician says otherwise. Familiar FND flares can often be managed with an agreed plan, but uncertainty should lead to NHS 111, your care team, urgent care or 999 depending on risk.
Start with safety, not certainty
When symptoms surge, many people with FND feel trapped between two bad options. If they seek help, they worry they will be told "it is just FND". If they stay home, they worry they might miss something serious. The safest starting point is not to guess perfectly. It is to sort symptoms into risk.
FND symptoms are real and can be intense. A familiar flare can include weakness, tremor, pain, fatigue, sensory symptoms, speech changes, dissociation, functional seizures or difficulty walking. But having FND does not protect someone from stroke, infection, injury, epilepsy, migraine, heart problems, medication reactions or other urgent conditions.
A useful rule is: familiar pattern plus agreed plan equals flare management; new, sudden, severe or different equals medical advice.
What a familiar FND flare can look like
A flare is more likely to be manageable through your FND plan when the symptoms are recognisable for you, have happened before, follow your usual pattern, and your care team has already helped you decide what to do.
- You recognise the warning signs and they match your usual FND pattern.
- There is no serious injury, breathing problem, chest pain or stroke-like sudden onset.
- The episode settles in the usual way or within the timeframe in your plan.
- You have support, a safe place to recover and a clear route if things change.
- The symptom is unpleasant or disabling, but not new, rapidly worsening or medically unexplained for you.
Even then, flares deserve care. Pacing, hydration, quiet space, medication as prescribed, sensory reduction, grounding, mobility safety, rest and support can all matter. Managing a flare is not ignoring it. It is using the plan you made for a known pattern.
Red flags: symptoms to treat as urgent
Do not try to prove whether a symptom is FND during a possible emergency. Get help first. Use 999 for life-threatening emergencies and NHS 111 for urgent advice when it is not clearly life-threatening.
Call 999 now for emergency symptoms
- Signs of stroke: face drooping, arm weakness, speech problems, or sudden symptoms where time matters.
- Chest pain, severe breathing difficulty, blue lips, collapse or loss of consciousness that is not your usual plan.
- Serious injury, head injury, severe bleeding, suspected broken bone or unsafe fall.
- A first seizure, a seizure lasting more than 5 minutes, repeated seizures without recovery, or breathing problems after a seizure.
- Symptoms that are new, sudden, severe, rapidly worsening or very different from your usual FND pattern.
Use NHS 111 or urgent advice when
- You are unsure whether a symptom needs same-day assessment.
- A flare is lasting much longer than usual but is not immediately life-threatening.
- You need help deciding between GP, urgent treatment centre, pharmacist, mental health support or emergency care.
- Your care plan says to seek advice if the pattern changes.
Stroke is a key example because FND can involve weakness, speech symptoms or sensory changes, and stroke can also cause sudden weakness or speech changes. The NHS FAST advice is deliberately simple: Face, Arms, Speech, Time to call 999. If stroke is possible, do not wait to see if it is FND.
Functional seizures: when to follow a plan and when to call 999
Functional seizures are seizure-like episodes that are not caused by abnormal electrical activity in the brain, but they can look frightening and can still carry injury risk. Some people with functional seizures also have epilepsy, so personal medical advice matters.
If a person has a known functional seizure pattern and a written care plan, supporters should usually follow that plan: keep them safe, remove hazards, time the episode, avoid restraint, avoid putting anything in their mouth, stay calm, speak gently, and allow recovery time.
Call 999 if the episode matches NHS emergency seizure advice or the person's own care plan says to do so. This includes a first seizure, a seizure lasting more than 5 minutes, repeated seizures without regaining consciousness, injury, breathing problems, or not regaining full consciousness. Also seek urgent help if the episode is very different from the person's usual pattern.
Build a personal flare and emergency plan
A good plan reduces panic because it gives people a route to follow. It should be short enough to use during stress and specific enough that supporters do not have to guess.
Include these headings
- My usual FND symptoms: what they look like, how long they usually last and what warning signs appear.
- What helps: quiet room, low light, grounding, hydration, medication as prescribed, mobility aid, recovery position, pacing or a named person.
- What makes it worse: crowding, repeated questioning, filming without consent, forcing movement, arguing, bright lights or rushing recovery.
- When to seek help: the exact symptoms, timings or changes that mean NHS 111, GP, urgent care or 999.
- Care contacts: GP, neurology, FND team, epilepsy team if relevant, emergency contact and medication list.
Keep a copy on your phone, with a supporter, and in any seizure tracking or symptom tracking app you use. If you use SeizeControl, reports can help show your usual pattern and whether the current episode is outside it.
What supporters should do
Supporters do not need to diagnose the episode. Their job is to make the person safer and notice whether the plan still fits.
- Ask one simple question at a time, or do not question during an episode if that worsens symptoms.
- Move hazards away and protect privacy.
- Time seizure-like episodes and recovery.
- Check breathing, colour, injury and consciousness.
- Use the care plan, but call for urgent help if the pattern is new, unsafe or outside the plan.
- Afterwards, write down what happened without blame or drama.
One of the most helpful things a supporter can say is: "I know this may be FND, but I am watching for anything different and we will get help if we need to." That validates the diagnosis without using it as a reason to ignore risk.
After urgent care or a changed pattern
If you needed urgent care, try to turn the episode into useful information once you are safe. Ask what was ruled out, what needs follow-up, and whether your flare plan should change. If the episode was dismissed without enough explanation, contact your GP or relevant specialist and explain what was different from your usual pattern.
After any new or changed episode, record:
- time and duration
- symptoms and what made them different
- injury, breathing, consciousness and recovery
- recent illness, medication changes, sleep, stress, heat or pain
- what advice was given and what follow-up is needed
The aim is not to live in fear of every flare. It is to create a plan that respects both truths: FND symptoms are real, and new medical problems still deserve proper assessment.
Frequently asked questions
Can FND symptoms be severe without being a medical emergency?
Yes. FND symptoms can be frightening, disabling and severe even when they are part of a familiar pattern. The key question is whether the symptom is usual for you, covered by a care plan, and not linked to new risk or injury.
What should I do if I am not sure whether it is FND?
If you are not sure, seek medical advice. Use NHS 111 for urgent but not life-threatening concerns, or call 999 for life-threatening symptoms, suspected stroke, serious injury, breathing difficulty, chest pain or a dangerous seizure pattern.
When should someone call 999 for a seizure?
NHS seizure advice says to call 999 in situations such as a first seizure, a seizure lasting more than 5 minutes, several seizures without recovery, injury, breathing difficulty, or when the person does not regain full consciousness.
Could someone have FND and another condition?
Yes. FND can coexist with other neurological or medical conditions, so a previous FND diagnosis should not be used to dismiss new, sudden, severe or different symptoms.
Should I avoid A&E because I have FND?
No. If symptoms meet urgent or emergency criteria, seek help. A good care plan can reduce unnecessary emergency visits, but it should never stop someone from getting urgent assessment when the pattern is different or unsafe.
What belongs in an FND flare plan?
A flare plan should include your usual symptoms, what helps, what does not help, who to contact, medication instructions if prescribed, when to use NHS 111 or 999, and what supporters should do during episodes.