Breaking the Seizure Code: Challenges in Identifying and Managing Functional and Dissociative Seizures Publisher



Khorshidian F
Source: Progress in Neurology and Psychiatry Published:2026

Abstract

Functional and dissociative seizures (FDS), formerly known as psychogenic non-epileptic seizures (PNES), closely mimic epileptic seizures but are not caused by abnormal epileptiform activity in the cerebral cortex. This resemblance poses significant challenges for accurate diagnosis and effective management. Misdiagnosis is common and often results in delayed appropriate treatment, thereby increasing the overall burden on patients. This review spotlights cutting-edge strategies to distinguish FDS from epilepsy, emphasizing innovative diagnostics and holistic therapies to transform patient outcomes. A narrative review was conducted using systematic searches of PubMed, Scopus, and PsycINFO (2000–2025). Data on clinical features, diagnostics, comorbidities, and therapies were thematically synthesized to highlight challenges and guide clinical practice. FDS intricately blend neurological symptoms with psychological origins, making diagnosis challenging. Video-EEG combined with psychiatric evaluation is essential. Treatment shifts focus from medication to psychological therapies, requiring multidisciplinary care. Education is a vital therapeutic tool in FDS management. By helping patients and families understand that FDS are real, treatable conditions—not fabricated—stigma is reduced, fostering acceptance. Establishing a strong therapeutic alliance based on empathy, transparency, and shared decision-making turns treatment into a collaborative, motivating process, improving adherence and outcomes. FDS are complex, straddling neurology and psychiatry, with diagnostic and treatment challenges. Accurate diagnosis using video-EEG and psychiatric evaluation is crucial to avoid mismanagement. Effective care demands multidisciplinary psychological treatments, patient education, and strong therapeutic alliances. Future research should enhance diagnostics and therapies through clinical trials and biomarker studies. © 2026 The Author(s). Progress in Neurology and Psychiatry published by John Wiley & Sons Ltd.