Forced normalization: An overlooked entity in epileptic patients.

Area of Science:

• Neurology
• Psychiatry
• Neurophysiology

Background:

• The forced normalization phenomenon describes acute psychosis following epileptic seizures, coinciding with normalized electroencephalogram (EEG) findings.
• This case involves a 56-year-old female presenting with personality changes, maladaptive behaviors, and cognitive impairment post-seizure.

Observation:

• Levetiracetam exacerbated the patient's maladaptive behaviors and precipitated visual hallucinations and déjà vu.
• A post-ictal EEG 24 hours after the seizure showed complete normalization of epileptiform activity.

Findings:

• Switching levetiracetam to phenytoin and initiating quetiapine therapy led to the complete resolution of psychotic symptoms.
• This suggests a complex interplay between antiepileptic drugs, psychosis, and EEG normalization.

Implications:

• This case highlights the importance of recognizing and managing forced normalization syndrome.
• Careful medication management, including avoiding certain antiepileptics and considering antipsychotics, is crucial for favorable outcomes.