I read with interest the recent commentary by O’Hanlon et al.1 The authors make a passionate argument for abandoning the term pseudoseizure and replacing it with psychogenic nonepileptic seizure. While I agree with the authors that the term pseudoseizure is misleading and implies that the patient is intentionally feigning an illness (in this case seizures), the authors' proposed terminology of psychogenic nonepileptic seizure is not free of controversy itself. It assumes that the patient's typical event is psychogenic in origin. The word seizure at the end of the term risks sending a mixed message to the patient and family (“You do not have a true seizure, but rather some other kind of seizure”), adversely reinforcing the disease process. If after investigations the patient's typical events are determined to be nonepileptic, the term nonepileptic event should be used. Events that are clearly physiological, such as tremors, myoclonus, dystonia, or other movement disorders, should be referred to as a physiological nonepileptic event until better characterized by additional testing. Psychogenic nonepileptic events should be the preferred term if typical events are clearly psychogenic in origin. Whether the underlying etiology is a conversion, somatoform, or factitious disorder can then be determined, further refining the diagnosis and guiding treatment forward.
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