BACKGROUND: Functional neurological disorder (FND) is a common cause of neurological disability. Despite recent advances in pathophysiological understanding and treatments, application of this knowledge to clinical practice is variable and limited. OBJECTIVE: Our aim was to provide an expert overview of the state of affairs of FND practice across Europe, focusing on education and training, access to specialized care, reimbursement and disability policies, and academic and patient-led representation of people with FND. METHODS: We conducted a survey across Europe, featuring one expert per country. We asked experts to compare training and services for people with FND to those provided to people with multiple sclerosis (MS). RESULTS: Responses from 25 countries revealed that only five included FND as a mandatory part of neurological training, while teaching about MS was uniformly included. FND was part of final neurology examinations in 3/17 countries, unlike MS that was included in all 17. Seventeen countries reported neurologists with an interest in FND but the estimated mean ratio of FND-interested neurologists to MS neurologists was 1:20. FND coding varied, with psychiatric coding for FND impacting treatment access and disability benefits in the majority of countries. Twenty countries reported services refusing to see FND patients. Eight countries reported an FND special interest group or network; 11 reported patient-led organizations. CONCLUSIONS: FND is largely a marginal topic within European neurology training and there is limited access to specialized care and disability benefits for people with FND across Europe. We discuss how this issue can be addressed at an academic, healthcare and patient organization level.

Department of Clinical Brain Sciences The University of Edinburgh Royal Infirmary of Edinburgh Edinburgh UK

Department of Neurology and Center of Clinical Neuroscience Charles University 1st Faculty of Medicine and General University Hospital Prague Prague Czechia

Department of Neurology and Neurosurgery Institute of Clinical Medicine Faculty of Medicine Vilnius University Vilnius Lithuania

Department of Neurology Avicenne Hospital AP HP Bobigny France

Department of Neurology Clinical Hospital Centre Zagreb Zagreb Croatia

Department of Neurology Geneva University Hospital Geneva Switzerland

Department of Neurology Ghent University Hospital Ghent Belgium

Department of Neurology Kolding Hospital Kolding Denmark

Department of Neurology L Pasteur University Hospital Košice Slovakia

Department of Neurology Medical University of Graz Graz Austria

Department of Neurology Pavol Jozef Šafárik University Košice Slovakia

Department of Neurology St James's Hospital Dublin Ireland

Department of Neurology Ulm University Ulm Germany

Department of Neurology University Hospital Knappschaftskrankenhaus Bochum Ruhr University Bochum Bochum Germany

Department of Neurology Vrije Universiteit Amsterdam Amsterdam The Netherlands

Department of Neurosciences Biomedicine and Movement Sciences University of Verona Verona Italy

Division of Neurology Institute of Clinical Neurophysiology University Medical Centre Ljubljana Ljubljana Slovenia

Faculté des Sciences et de Médecine Université de Fribourg Fribourg Switzerland

Faculty of Medicine Brasov Transilvania University of Brașov Brașov Romania

FND Action Chatham UK

FND Hope UK Banbury UK

Institute of Psychiatry Psychology and NeuroscienceKing's College London London UK

Movement Disorders Program Neurology Department Hospital Ruber Internacional Madrid Spain

Movement Disorders Unit Neurology Department Hospital Universitario Ramón y Cajal Madrid Spain

Neurology Department Centro Hospitalar Universitario de Sao Joao Porto Portugal

Neurology Department CHU Grenoble Alpes Grenoble France

Parkinson's Disease and Movement Disorders DepartmentHygeia Hospital Athens Greece

Primary Care West Gästrikland Sandviken Sweden

Psychiatric Clinic of the Faculty of Health Sciences Medical University of Warsaw Warsaw Poland

Psychosomatic and CL Psychiatry Division of Mental Health and Addiction Oslo University Hospital Oslo Norway

Ukrainian Medical Academy Kyiv Ukraine

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