Functional Dissociative Seizures

Functional dissociative seizures (FDS) are episodes of impaired awareness or behaviour that resemble epileptic seizures but occur without associated epileptiform activity. FDS is as common as multiple sclerosis, yet it is often misdiagnosed, leading to significant healthcare and social costs. Diagnosis is primarily clinical, supported by video-EEG and structured history-taking, with a focus on semiological features and subjective symptoms. Aetiological models range from biopsychosocial to emerging neurobiological frameworks involving interoception, agency, and predictive processing. Management centres on clear communication of the diagnosis, psychoeducation, and tailored psychological therapies, with cognitive behavioural therapy showing some benefit. Comorbidities, particularly psychiatric and functional somatic syndromes, are common and influence prognosis. Despite limited long-term outcome data, early diagnosis and appropriate intervention, along with a nuanced, multidisciplinary approach, may improve function and reduce healthcare utilisation.