Abstract

Background Functional gait disorder (FGD) is a subtype of functional neurological disorder (FND) characterized by abnormal walking patterns. Long-term symptom progression and factors influencing gait changes in FGD remain poorly understood. Objectives To investigate longitudinal changes in gait and associated symptoms over 12 months in individuals with FGD and examine whether changes in specific symptoms are associated with changes in gait. Methods Individuals with FND and altered gait completed an online survey at baseline and at 3-, 6-, and 12-month follow-up points. The survey collected data on symptom severity, gait changes, and standardised outcome measures. Analyses included descriptive statistics, linear mixed models, Kruskal–Wallis tests, and Spearman's rank correlations. Results Of 156 baseline respondents, 65 completed the 12-month follow-up. Sixteen (28.5 %) reported worsening gait, 17 (30.4 %) no change, 13 (23.2 %) improvement, and 10 (17.8 %) fluctuating gait. Linear mixed-model analyses showed no significant within-subject changes in motor or non-motor symptom severity from baseline to 12 months. Greater baseline functional seizure severity was strongly associated with poorer gait outcomes at 12 months (Rₛ = −0.750, p < 0.001, n = 17). Higher muscle rigidity severity at 12 months was also strongly associated with worse gait (Rₛ = −0.604, p < 0.001, n = 30). Conclusion This study provides insights into the natural course of functional gait disorder over time, based on participant self-report, revealing heterogeneous trajectories. Exploratory analyses found that functional seizure and muscle rigidity severity were associated with gait decline.