By Ansley Franco

For many patients living with Functional Neurological Disorder (FND), the path to diagnosis and treatment can take years. Symptoms may resemble serious neurological conditions such as seizure-like episodes, weakness, paralysis, speech problems and gait disorders, but the root cause lies elsewhere.

“Functional neurological disorder consists of neurological symptoms that are not due to a neurological pain condition or another medical condition,” Aaron Fobian, founder of ReACT FND Health, said. “Instead of it having a structural issue that’s causing the problem, it’s the result of the communication between the brain and the body.”

Despite being one of the most common diagnoses seen in outpatient neurology clinics, FND has long been misunderstood. To address the gap, Fobian helped create a telehealth-based program designed to expand access to specialized treatment.

Historically, the condition carried heavy stigma. “It used to be called hysteria, and it was believed to be a woman’s uterus moving around in the body. During the Salem witch trials, a lot of people who had FND were believed to be witches,” Fobian said.

For decades, theories surrounding FND focused primarily on psychological explanations. Sigmund Freud coined the term “conversion disorder.” It was theorized to be a psychological conflict resulting in a communication problem between the brain and body caused by unresolved trauma.

Research conducted in the past several decades has reshaped that late-1800s understanding of FND. Fobian said that while psychological factors can interact with and trigger FND symptoms, that’s not the main underlying cause for the disorder, as studies have found that a lot of patients don’t have a history of trauma.

Even with improved understanding, people often spend years searching for answers. Some studies show it can take an average of seven years for adults with functional seizures to receive an accurate diagnosis. In her pediatric research, Fobian said most patients have experienced symptoms for more than a year before they reach her for treatment.

Diagnosis itself can be complex. For functional seizures, the gold standard involves capturing an episode during an EEG, which can take time to arrange. Patients may also be given medication that they don’t need, causing other side effects. But even after diagnosis, treatment access can remain limited.

By using ReACT FND Health, Fobian hopes to address that gap. A key factor enabling this approach is PSYPACT, a reciprocal licensing system that allows psychologists authorized in participating states to practice telehealth across state lines.

“Telehealth is particularly beneficial for patients outside major academic medical centers,” Fobian said. “Psychologists have a unique opportunity to be able to treat in most of the U.S. Most of the access is in larger cities around academic medical centers, and it’s often hard for people in Birmingham to get downtown. Pediatric patients get taken out of school for treatment and adults have to miss work.

“Telehealth removes many of those barriers, and being able to use it increases the patient’s ability to maintain the treatment. Since launching, the program has already expanded nationwide and continues to grow.”

ReACT has treated patients across dozens of states and recently expanded care to New York and California by hiring psychologists licensed in those states. Delivering care nationwide has also expanded other opportunities for specialized medicine in medical deserts.

Someone is described as living in a healthcare desert if they “have insufficient access to healthcare due to a low number of providers of services, long waiting times to have access to a health professional, and long travel distances to facilities,” according to a 2023 study published by the National Library of Medicine. Data collected by GoodRX in 2025 revealed that 80 percent of U.S. counties are considered healthcare deserts, impacting one in three Americans.

“I think this can be the future of healthcare, where you don’t have to rely on a specialist somewhere close to you, but where you can get someone very specialized,” Fobian said.

Technology is also helping improve treatment delivery. The ReACT Precision Treatment Tool, a digital adaptive manual for clinicians, helps tailor therapy sessions to a patient’s evolving symptoms.

“One of the biggest challenges in mental health treatment in general is disseminating the treatment with fidelity,” Fobian said. “Most mental health treatments are linear, and it’s incredibly hard to treat someone with FND in a linear fashion.”

Interest in the program continues to surge. More than 500 providers are currently waiting to train in the ReACT method, with clinicians from around the world seeking education on FND treatment.

“I think even just on an international level, there’s more awareness and excitement in trying to gain more knowledge and resources,” Fobian said.