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Development of forced normalisation psychosis with ethosuximide
Sean Apap Mangion1, Fergus Rugg-Gunn2
1Department of Telemetry, University College London, Institute of Neurology, London, UK.
BMJ Case Reports
|December 10, 2017
Summary
Ethosuximide effectively treated epilepsy but caused psychosis. Lowering the dose after olanzapine treatment resolved psychosis, allowing safe reintroduction of ethosuximide for epilepsy management.
Area of Science:
- Neurology
- Psychiatry
Background:
- Epilepsy management presents challenges, particularly with multidrug-resistant cases.
- Ethosuximide is a key antiepileptic drug for absence seizures.
Observation:
- A 50-year-old male with drug-resistant epilepsy experienced absence seizure cessation and EEG normalization upon starting ethosuximide.
- Within three weeks, the patient developed severe paranoid psychosis with hallucinations.
Findings:
- Psychosis resolved after discontinuing ethosuximide and initiating olanzapine.
- Reintroduction of ethosuximide at a reduced dosage was tolerated without psychotic relapse.
Implications:
- This case highlights the potential for ethosuximide-induced psychosis in epilepsy patients.
- Careful dose titration and monitoring are crucial when managing epilepsy with ethosuximide, especially in patients with psychiatric comorbidities.
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