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Ketamine or esketamine may improve functional motor symptoms and dissociative seizures in functional neurological disorderKetamine may improve symptoms for people with functional neurological disorder

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Key Takeaway
Note that while ketamine and esketamine show reported improvements in FND, evidence is currently insufficient for clinical claims.

This systematic review evaluates the clinical outcomes of ketamine and esketamine administration in patients with functional neurological disorder (FND). The review synthesizes evidence regarding functional motor symptoms, functional dissociative seizures, and other functional presentations. In all three categories, the review reports improvements following administration of these agents.

The authors note that the evidence base is characterized by low certainty due to the uncontrolled nature of the studies and high heterogeneity of both diagnoses and outcomes. The review highlights that the evidence is primarily derived from case reports and small case series, which may be influenced by publication bias and expectancy bias. It remains unclear if observed improvements result from direct effects on functional symptoms, indirect psychiatric benefits, or non-specific factors.

Due to these limitations, the evidence is currently insufficient to establish the efficacy of ketamine or esketamine for FND. Clinical application should be approached with caution, and the authors call for further investigation through prospective controlled trials to clarify the therapeutic role of these medications in this population.

How this fits prior evidence

This finding addresses a gap in the management of functional neurological disorder (FND). While prior evidence indicates that alexithymia and interoceptive disturbances are consistently associated with FND, this review specifically examines the role of ketamine and esketamine in treating the associated motor symptoms and dissociative seizures. The current evidence is limited by low certainty and a lack of controlled trials.

Living with functional neurological disorder (FND) can be incredibly frustrating. It affects how the body moves and functions, sometimes causing symptoms like motor issues or dissociative seizures. Because these symptoms are complex, finding the right treatment is a major challenge for patients and doctors alike.

A review of existing reports shows that ketamine or esketamine may lead to improvements in several areas. These include motor symptoms, dissociative seizures, and other functional presentations. While these results are encouraging, the evidence comes mostly from small cases and reports rather than large, controlled studies. This means the data is currently limited and varied.

Safety is a key consideration. While some side effects were reported, they were generally short-lived when given in a supervised clinic. However, because the current evidence is not yet strong enough to prove exactly how well the drug works, more large-scale trials are needed to see if the improvements are caused directly by the medication or other factors.

What this means for you:
Ketamine shows promise for FND symptoms, but more large-scale research is needed to confirm its effectiveness.

Common questions

What symptoms can ketamine help with in FND?

Reports suggest that ketamine or esketamine may improve functional motor symptoms, functional dissociative seizures, and other functional presentations in people with functional neurological disorder. Because the current evidence comes from small cases and reports, these results are not yet definitive.

Is ketamine safe for people with functional neurological disorder?

Side effects from ketamine were reported in some cases, but they were generally described as transient when administered in a supervised clinical setting. However, more research is needed to fully understand the safety and effectiveness of this treatment.

Is ketamine a proven treatment for FND?

The current evidence is not enough to confirm if ketamine is an effective treatment for FND. Because the existing data is limited and varied, doctors need more large-scale, controlled trials to see if the improvements are caused directly by the medication.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedJul 2026
View Original Abstract ↓
Background and aimFunctional neurological disorder (FND) is a common and disabling condition for which effective treatments remain limited. Clinical outcomes are often variable, particularly in chronic and comorbid presentations. Ketamine and esketamine are increasingly used across a range of neuropsychiatric conditions. This review aimed to synthesise the existing evidence regarding their use in FND.MethodsA systematic review of PubMed, PsycINFO and Google Scholar was conducted up to December 2025. Studies reporting clinical outcomes following (Es)ketamine administration in functional neurological symptoms were included. Owing to substantial clinical and methodological heterogeneity, findings were synthesised narratively.ResultsThirteen studies were identified, predominantly comprising case reports and small case series. Across the included studies, some patients were reported to experience improvement in functional motor symptoms, functional dissociative seizures, and other functional presentations following ketamine or esketamine administration. Interpretation of these findings is limited by the uncontrolled nature of the evidence base, heterogeneity of diagnoses and outcomes, and the potential influence of publication and expectancy bias. Adverse effects were variably reported and were generally described as transient in supervised clinical settings.ConclusionThe current evidence base is limited to predominantly uncontrolled and highly heterogeneous studies and is insufficient to establish the efficacy of (Es)ketamine for FND. Although improvements in functional symptoms have been reported across several FND presentations, it remains unclear whether these reflect direct effects on functional symptoms, indirect benefits arising from psychiatric improvement, or other non-specific therapeutic factors. While no firm conclusions regarding efficacy can be drawn, the existing data suggest that further investigation is justified, and prospective controlled trials are needed to clarify the potential role of (Es)ketamine in FND.
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