Functional seizures: Sanitized terminological shifts may seem progressive but can be harmful
Late last year, an ILAE Task Force proposal (Hingray et al., 2025) was published, urging that the term “psychogenic nonepileptic seizures (PNES)” be replaced with the new and improved “functional/dissociative seizures (F/DS).” It is my understanding that some of the ILAE task force members fought hard to include the “dissociative” “D” to make sure the psychological foundations of PNES were represented.
A group of professionals who work directly with patients diagnosed with PNES and I sent a letter to the editor regarding the proposal. We brought up some concerns we had regarding unintended consequences this rebranding might have. The main issue we brought up was that we worried that the adoption of “functional” (even with the inclusion of “dissociative”) could suppress the psychological components of PNES and block access to proper treatment pathways. Sadly, instead of being allowed to have a healthy debate on the topic, our letter was rebuffed as we were informed by the powers that be that they “did not believe” that this name change posed a risk of “obscuring the psychological underpinnings of PNES.”
However, just a month after receiving this response from the journal, this concern played out on a national stage. I was attending the American Epilepsy Society meeting where I heard several presenters calling PNES or “functional dissociative seizures” with the non-psychological term, “functional seizures.” A week later, in December 2025, the American Academy of Neurology happily announced their first ever Guidelines for the “Management of Functional Seizures,” note that they did not call them “Functional dissociative seizures.” Management of Functional Seizures
Professionals in the field of neurology are overwhelmingly choosing to abandon PNES but are also dropping the “D” that stands for “dissociative” in F/DS.
Instead, neurologists are favoring the sanitized “functional seizure” term. There are several reasons that the “D” may soon be lost despite the best intentions of some of the members of the ILAE Task Force. In the most basic sense, “functional seizures” rolls off the tongue much easier than “functional dissociative seizures.” Second, and far more troubling, is that “dissociative” (just like PNES), alludes to those pesky “psychological underpinnings” which is precisely what the adoption of “functional” is covering up. Although neurology and the ILAE and FDS Society ostensibly claim and I think they honestly believe that these name changes are moving the field towards a more modern and biopsychosocial view of this disorder, thus benefiting patients, they actually risk harming psychiatric patients and widening the divide between psychiatry and psychology. The message they are sending by suppressing any mention of psychology (or “dissociation”) is that functional seizures aren’t “just psychological.” And referring to it as “just psychological” translates into: “psychological” = “faked,” “voluntary,” “embellished,” and most importantly, “less than neurological.”
Ultimately, a name change alone doesn’t combat stigma. And the new and improved “functional seizure” name won’t not only fail in combating stigma but will likely inhibit access to proper treatment when the psychological roots of the disorder are downplayed. I encourage neurologists and the editors of their journals to be open to conversing about these concerns with their psychology and psychiatry colleagues instead of barreling ahead with a feel-good option that has not been carefully evaluated and voted on by all the stakeholders.