Terminology for psychogenic nonepileptic seizures: Making the case for “functional seizures”, 2020, Asadi-Pooya et al

[Andy]

Purpose
The purpose of the study was to review the literature on the terminologies for psychogenic nonepileptic seizures (PNES) and make a proposal on the terminology of this condition. This proposal reflects the authors' own opinions.

Methods
We systematically searched MEDLINE (accessed from PubMed) and EMBASE from inception to October 10, 2019 for articles written in English with a main focus on PNES (with or without discussion of other functional neurological disorders) and which either proposed or discussed the accuracy or appropriateness of PNES terminologies.

Results
The search strategy reported above yielded 757 articles; 30 articles were eventually included, which were generally of low quality. “Functional seizures” (FS) appeared to be an acceptable terminology to name this condition from the perspective of patients. In addition, FS is a term that is relatively popular with clinicians.

Conclusion
From the available evidence, FS meets more of the criteria proposed for an acceptable label than other popular terms in the field. While the term FS is neutral with regard to etiology and pathology (particularly regarding whether psychological or not), other terms such as “dissociative”, “conversion”, or “psychogenic” seizures are not. In addition, FS can potentially facilitate multidisciplinary (physical and psychological) management more than other terms. Adopting a universally accepted terminology to describe this disorder could standardize our approach to the illness and facilitate communication between healthcare professionals, patients, their families, carers, and the wider public.

Paywall, https://www.epilepsybehavior.com/article/S1525-5050(19)31338-1/fulltext
Sci hub, https://sci-hub.se/10.1016/j.yebeh.2019.106895

 

[rvallee]

While the term FS is neutral with regard to etiology and pathology (particularly regarding whether psychological or not), other terms such as “dissociative”, “conversion”, or “psychogenic” seizures are not.

Right. But persuading by lying is blatantly unethical. It is not neutral, only pretends to be and with the explicit purpose of deceiving the patient. They do mean 100% psychogenic and just lie about it precisely to fool the patients into accepting something that isn't even what they mean.

That it can be done does not remove the immorality involved here. You can convince people dying of cancer that they are dying because of their bad attitude. It does not make it true or ethical, just that you can successfully abuse the massive power imbalance of medical practice and bully sick people into reporting they believe a lie. As long as you don't frame it honestly, obviously. As we can see from reactions to those admissions, FND patients are very confused when they hear what FND proponents actually mean. So are they really convinced? Sounds more like perfidy, having someone sign a blank contract then filling it after the fact isn't acceptable in legal practice, it certainly should not be in medical practice.

In addition, FS can potentially facilitate multidisciplinary (physical and psychological) management more than other terms.

It's all about persuasion. If you claim to persuade someone that they have some vague psychological thing by telling them you mean otherwise, did you really convince them? Or did it just allow you to report a lie by lying about lying? You can get people to sign a statement that there clearly are 5 lights if you tell them that it's a typo that will be corrected later to 4.

All this is doing is making a very strong case to make it explicitly forbidden to lie to patients, including by omission, exaggeration or using misleading rhetoric. Current practice somehow assumes no one would ever do that with malicious intent. And yet here there is this sub-field of medical practice that is essentially built on doing exactly that.

Almost weird to add the note that this is the author's opinion. The whole field is nothing but people's personal opinions.