A Nine-Year Case of “Functional Sneeze” Highlights a Little-Known Neurological Disorder

They looked exactly like sneezes: repeated contractions of the diaphragm, forced exhalation through the nose, and tic-like rhythmic vocalizations layered on top. Strong smells often set them off, though they could also arrive at random.

They were not sneezes.

A 32-year-old teacher arrived at a functional neurological disorder clinic having lived with these episodes for nine years. At presentation, the attacks lasted up to 10 minutes and occurred several times a day, reaching a maximum of 78 episodes. He reported that the episodes sometimes woke him at night, though without a sleep study, clinicians could not confirm whether they occurred during true sleep or in early wakefulness.

Writing in Movement Disorders Clinical Practice earlier this year, the clinical team described the presentation and named it functional sneeze.

The Trigger Was an Operation

One detail anchors the whole timeline. The attacks began shortly after he had surgery under general anesthesia to repair a fractured left arm, a procedure that involved fixing the bone with a metal plate.

A physical trigger of that sort is a recognized feature of functional neurological disorder rather than a coincidence to be explained away. Injuries, operations, and anesthesia turn up repeatedly in the histories of people who develop these symptoms.

His medical history was otherwise unremarkable. He kept working as a teacher and stayed active. Standard neurological investigation did not produce an explanation, which is not incidental to this diagnosis. It is characteristic of it, and it also makes the condition easy to dismiss.

What Functional Neurological Disorder Actually Is

The old name for this was conversion disorder, and the old framing was that symptoms were psychological rather than real. Both have been retired for good reason.

Functional neurological disorder is now understood as a problem in how the brain’s networks for movement, attention, and the sense of voluntary control operate, rather than damage to the nervous system’s hardware. The symptoms are genuine and involuntary. They are not produced deliberately, and they are not imagined.

It is also common. FND is the second most common reason people see a neurologist, behind only headache, and accounts for about 5% to 10% of new neurological consultations. Estimates of how many people have it vary widely by method. A systematic review of incidence and prevalence put incidence at 10 to 22 per 100,000 and minimum prevalence at 80 to 140 per 100,000, while cautioning that heterogeneity between studies is significant and most estimates are probably too low. A separate epidemiological review reported that prognosis is poor without early intervention, with long diagnostic delays contributing to chronic symptoms and disability. Clinical reviews note the incidence is comparable to multiple sclerosis and ALS.

Nine years is a long delay by any measure.

Why Naming a Subtype Matters

Functional neurological disorder covers a wide territory: functional seizures, tremor, weakness, gait disturbance, speech and sensory symptoms. Adding sneezing movements to that list is a small technical contribution with a practical purpose.

A doctor who has never heard of functional sneeze has few places to put a patient whose sneezing fits do not respond to antihistamines, are not explained by nasal disease, and produce nothing on imaging. Naming the pattern gives clinicians a category, which is the first step toward a positive diagnosis rather than a diagnosis of exclusion after years of testing.

It also matters that this diagnosis is based on positive features. Modern practice does not treat FND as whatever remains after ruling out everything else. Clinicians look for characteristic signs: variability over time, distractibility, sudden onset, and inconsistency with the patterns known neurological diseases produce.

Where the Story Goes

His sneezes were well controlled for several years after treatment. Then, five years after that first clinic review, he relapsed. The attacks became more forceful, ran three to five minutes, and came with new symptoms including dribbling and dissociation. They arrived without an obvious trigger, which made them less predictable and harder to control. He stopped going to the gym. A social event triggered the worsening, and he had around 30 episodes in a single day.

Around the same time, he noticed increasing pain in his left arm despite no new injury. Specialist talking therapy informed by cognitive behavioral principles did not relieve the symptoms.

Then surgeons removed the plate from his arm, two years after the relapse began. In the two months that followed, he had a single mild sneeze, down from several distressing episodes a day.

That ending is striking, and it is also exactly where caution belongs. This is one patient. A single case cannot establish that the plate was causing anything, whether the improvement will last beyond two months, or whether functional sneeze will be accepted as a distinct subtype. The proposal invites other clinicians to report similar cases, not a settled classification, and nobody should read it as a reason to seek hardware removal.

For readers, the transferable point is narrower. Persistent involuntary movements that resist explanation are worth pursuing with a neurologist rather than abandoning after a normal scan, and a normal MRI is not the same as nothing being wrong. Diagnosing functional neurological disorder requires a clinical examination that no article can substitute for.

Key Questions Answered

What is a functional sneeze?

A proposed presentation of functional movement disorder in which involuntary diaphragm contractions closely resemble sneezing but are not caused by nasal irritation.

Were the attacks real?

Yes. Functional neurological disorder produces genuine, involuntary symptoms. They are not deliberately produced and not imagined.

How common is functional neurological disorder?

It is the second most common reason for a neurology visit after headache and accounts for 5% to 10% of new consultations. Population estimates vary widely by method.

What triggered his attacks?

They began shortly after surgery under general anesthesia to plate a fractured left arm. A physical trigger of that kind is described in the FND literature, though one case cannot establish cause.

Did treatment work?

Symptoms were controlled for several years, then relapsed. Talking therapy did not help the relapse, but he improved sharply after the arm plate was removed, with only two months of follow-up reported.

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