I am pleased to announce the publication of our Letter to the Editor in Seizure: European Journal of Epilepsy:“A call for reflection on unintended consequences: Should ‘functional/dissociative seizures’ replace ‘psychogenic nonepileptic seizures’?”
by Lorna Myers, Anton Scamvougeras, Lenka Kramska, and Julia Doss.
Read it here: https://authors.elsevier.com/a/1nKCV3mqOkYIit
The Background on this Letter: The ILAE Proposal and Our Response
In late 2025, the ILAE Psychiatry Commission’s task force (Hingray et al.) published a proposal in Epilepsia advocating replacement of the longstanding term “psychogenic nonepileptic seizures” (PNES) with “functional/dissociative seizures” (F/DS or FDS). The proposal highlighted valid concerns: the word “psychogenic” can contribute to stigmatization, and “nonepileptic” defines the condition only negatively. The task force argued for a more integrative, biopsychosocial label that could reduce stigma and improve clarity.
We submitted a letter to Epilepsia on November 13, 2025, discussing potential unintended consequences of this name change and calling for reflection. Our letter was a constructive commentary on that proposal. Our goal was simple: to generate thoughtful discussion and debate about the real-world implications of such a major terminological shift—particularly for patient understanding, stigma reduction, interdisciplinary communication between neurology and psychiatry/psychology, and everyday clinical practice.
What Happened Next
Just 5 days later, our letter was rejected. The reviewer’s feedback stated that the entire field of Functional Neurological Disorders (FND) had moved beyond the “narrow” view of psychogenicity, which had been “systematically dismantled by the evidence.”
And then, just eight days after that rejection (November 26, 2025), Epilepsia published a supportive Letter to the Editor titled “Functional/dissociative seizures: Progress not perfection,” which strongly endorsed the proposal.
This sequence raised important questions for us: Was the new terminology being genuinely proposed for open discussion, or was it effectively being mandated? We wondered whether the journal was fully committed to the spirit of healthy scientific debate on a topic with such significant downstream effects.
There is Still Hope for Healthy Scientific Debate Thanks to Seizure: European Journal of Epilepsy
We are profoundly grateful to the editors of Seizure: European Journal of Epilepsy for publishing our letter allowing us the opportunity to express these concerns. Their decision supports the kind of rigorous, inclusive dialogue that advances the field responsibly.
Why This Discussion Matters
Terminology is never just semantics in medicine—especially for conditions that sit at the intersection of neurology and psychiatry. Here’s why we believe this conversation deserves careful attention:
- Patient understanding and acceptance: How a diagnosis is named shapes how patients perceive their condition, engage with treatment, and explain it to family, employers, or teachers. A term that downplays or obscures the established psychological and dissociative components risks leaving patients confused about why evidence-based psychological treatments (such as CBT-informed approaches) are central to care.
- Stigma: While the goal of reducing stigma is excellent, we must ensure new language doesn’t inadvertently create new problems—such as minimizing the very factors that make targeted psychological intervention effective or supporting the stigma the name change is aiming to combat by suppressing the “psych” component. Furthermore, some clinicians already seem to be adopting simplified versions like “functional seizures” that drop the psychological emphasis entirely and that is worrisome.
- Interdisciplinary communication: Neurologists, epileptologists, psychiatrists, psychologists, and other allied professionals need shared, precise language. There is a risk that the gap between neurology and psychiatry may only widen more as a result.
- Clinical practice and research: Terminology influences referral patterns, treatment pathways, research funding priorities, diagnostic coding, and service development. Unintended consequences here could affect real patients for years to come.
Our letter does not reject change outright. It calls for reflection—for pausing to weigh potential downsides alongside the intended benefits, and for ensuring all stakeholders (including those working directly with patients who carry these diagnoses) have a voice in the process.
Moving Forward Together
Scientific progress thrives on open, respectful debate—not on the premature closure of discussion. We hope our letter, now available in Seizure, contributes to exactly that kind of constructive exchange.We encourage readers to read both the original ILAE proposal, our letter, and the thoughtful response from the ILAE FDS task force that has since appeared. Let’s continue the conversation with curiosity, flexibility, and a shared commitment to improving outcomes for the people we serve.
Myers L, Scamvougeras A, Kramska L, Doss J. A call for reflection on unintended consequences: Should ‘functional/dissociative seizures’ replace ‘psychogenic nonepileptic seizures’? Seizure. 2026. https://doi.org/10.1016/j.seizure.2026.02.009 (or the direct ScienceDirect link above).Thank you to everyone who has engaged with this important topic. We look forward to your thoughts in the comments or through continued scholarly dialogue.