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Functional neurological disorder (FND) can lead to significant disability and impact on patients’ quality of life.1, 2 FND can encompass a wide range of presentations.3 We report a case showing a new phenotype of “sneezing movements,” which we propose as a subtype of functional movement disorder (FMD). A 32-year-old male teacher presented to FND clinic with distressing involuntary diaphragmatic contractions resembling sneezes. These first occurred 9 years prior, shortly after undergoing surgery under general anesthesia (GA) for a left arm fracture, which involved fixation with a plate. Each attack is characterized by repeated diaphragmatic contractions associated with forced nasal exhalation and tic-like rhythmic vocalizations, Video 1. Strong smells often trigger attacks, though they can also occur at random. At presentation, he was having attacks lasting up to 10 min in length occurring several times a day, up to a maximum of 78 episodes. He reported episodes during sleep which would wake him, though due to lack of polysomnography confirmation, it cannot be said whether these occurred in true sleep or during early wakeful states. The longest he had gone without having an attack was 10 days. He had previously seen three neurologists and had normal MRI head, c-spine and t-spine, normal somatosensory evoked potentials (SSEP), electromyography (EMG) and nerve conduction studies. Past medical history was significant only for irritable bowel syndrome (IBS) and he had no relevant family history. He continued to work as a teacher, lives with a partner and maintained an active lifestyle. An electroencephalography (EEG) and EMG study was performed to record the sneezing episodes, see Figure 1. Four episodes were captured during the study, three of which were triggered by smells. EMG recorded the jerks as irregular abdominal contractions lasting for a minute with variable duration (200–800 ms) and sudden nasal exhalations. EEG was unremarkable. Abdominal pressure was trialed as a means of aborting attacks. This was successful, giving him the ability to terminate attacks for the first time. The response to this suppression and the variability in frequency and vocalizations met clinically definite criteria for FMD. He was referred to neuropsychiatry and neuro-physiotherapy for treatment. The sessions helped him to gain insight into his condition and identify further triggers. The sneezes were well controlled for several years following treatment; however, he experienced a relapse, 5 years after initial clinic review, with more forceful attacks lasting 3–5 min with new associated symptoms of dribbling and dissociation during episodes. Sneezing attacks were experienced with no obvious trigger, making them less predictable and thus harder to control. This led to impact on quality of life, with cessation of gym attendance due to attacks. The worsening had been precipitated by a social event where he experienced around 30 episodes in one day. During this time, he had also been experiencing increased pain in his left arm despite no new injury. Specialist CBT-informed talking therapy following the relapse was unsuccessful in relieving symptoms. However, following surgical removal of the plate in his left arm 2 years later, he has only experienced one mild sneeze in the subsequent 2 months, down from several distressing episodes a day prior to surgery. Despite the unusual phenomenology of this condition, a diagnosis of FMD could be made based on several factors. The suppressibility of the condition by forced abdominal contraction was a positive indication of a functional disorder. Furthermore, the irregular contraction of the diaphragm recorded in the attacks was inconsistent with differentials such as diaphragmatic flutter and tremor, in which contractions follow a regular course of oscillation.4 Although not necessary for diagnosis, risk factors can point to diagnosis of FND. Known risk factors in this case were comorbidity of another functional disorder (IBS), and history of surgery precipitating the initial attacks.1, 5 Relapse of disorder following treatment is common in FND,6 as seen in our case. Manifestations of FND have been reported post-anesthesia.7 In this case, surgery was a precipitant for the sneezing spells. The recent alleviation of symptoms following subsequent surgery draws parallels with recently reported improvement in FND symptoms following comatose states.8 Functional sneezing has previously been reported; however, it has not previously been considered as a subtype of FMD.9, 10 Most previously reported cases were in girls. The description of sneezes is like that in our case, though reported symptom duration was significantly less. Increasing knowledge of the spectrum of FND symptoms can reduce delays in diagnosis. There was a significant lag between onset of symptoms and diagnosis in this case. Had the diagnosis been made sooner, treatment could have been initiated earlier leading to less morbidity for the patient. (1) Manuscript Preparation: A. Writing of the first draft, B. Review and Critique. A.L.: 1A, 1B J.C.: 1B B.J.P.: 1B Ethical Compliance Statement: The authors confirm that the approval of an institutional review board was not required for this work. Written patient consent was obtained for inclusion in this case report for publication. We confirm that we have read the Journal's position on issues involved in ethical publication and affirm that this work is consistent with those guidelines. Funding Sources and Conflict of Interest: No specific funding was received for this work. The authors declare that there are no conflicts of interest relevant to this work. Financial Disclosures for the Previous 12 Months: J.C. has received funding from Bial, Novartis, Orphalan and Merck Serono for lectures. J.C. and B.J.P do medical expert reporting in personal injury and clinical negligence cases. Author disclosures are available in the Supporting Information. The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions. Data S1. COI_disclosure. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.