FND in the medical setting — C-L structured viva

C-L role. Joint ownership with neurology/medicine: rule-in collaborator, explainer, systems fixer — not a dumping ground or automatic psychiatric admission. Clarify the referral question and refuse diagnostic abandonment at discharge.[3][4][7]

Diagnosis language. Prefer functional/dissociative seizures / FND with attacks. Video-EEG without epileptiform correlate during typical events supports functional seizures; remain open to dual epilepsy if other event types exist.[4][6]

Staff language repair. Challenge “putting it on” as pejorative and inaccurate; educate that symptoms are real and involuntary; model chart language that will not poison the alliance.[3]

Acute events. Protect, time, calm environment; avoid automatic benzodiazepine/clobazam escalation and ICU pathways once the pattern is known, while escalating for true airway risk or uncertainty.[4]

AED plan. With secure pure functional seizures, plan supervised taper/rationalisation with neurology rather than stacking agents “just in case.” Document driving advice per local law.[4][6]

Explanation and therapy. Structured explanation is treatment. Cite LaFrance pilot CBT-informed therapy and CODES pragmatic RCT honestly (primary and secondary outcomes).[1][2][3]

Disposition and prognosis. Do not discharge with only “anxiety” coding and no pathway. Book FND/psychology follow-up; prognosis without treatment is often guarded — early engagement improves outlook relative to nihilism.[5][4][7]