Functional Seizure Terminology — MRCPsych Paper B MCQ

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EasyLiaison PsychiatryFunctional Seizure TerminologyMRCPsych Paper B

A 35-year-old woman presents to the emergency department with recurrent seizure-like attacks. During specialist assessment, a typical involuntary attack is captured on video-EEG. Positive clinical features support a functional event, and there is no ictal epileptiform correlate. Which is the currently preferred diagnostic term?

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Correct answer: D — Functional/dissociative seizure (FDS)

The preferred term is functional/dissociative seizure. The 2025 ILAE Task Force proposed this combined label because it is compatible with functional neurological and dissociative frameworks and avoids implying that the symptoms are fabricated. Functional seizures are genuine, involuntary events and do not require a preceding psychiatric diagnosis or identifiable psychological stressor. Psychogenic non-epileptic seizure remains recognisable but is not the newly preferred unifying label. “Hysterical” and “non-organic” are outdated and potentially stigmatising. A factitious seizure is intentionally produced to adopt the sick role; conscious production is not a feature of functional/dissociative seizures. Capturing a typical event without an ictal EEG correlate supports the diagnosis when interpreted alongside positive clinical features and specialist assessment.

Reference: Hingray C, Popkirov S, Kozlowska K, et al. Functional/dissociative seizures: Proposal for a new diagnostic label and definition by the ILAE task force. Epilepsia. 2025;66(11):4162-4182. https://pubmed.ncbi.nlm.nih.gov/40884444/