(Es)ketamine in functional neurological disorder: a systematic review
Abstract
Background and aim: Functional 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.
Methods: A 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.
Results: Thirteen 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.
Conclusion: The current evidence base is limited to predominantly uncontrolled and highly heterogeneous studies…
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Evidence Hub reads this as a systematic review, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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