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Forced normalization: A systematic review.

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Summary
This summary is machine-generated.

Forced normalization (FN) is a psychiatric condition that can occur after epilepsy treatment. Withdrawal of antiepileptic drugs (AEDs) often leads to symptom resolution, unlike surgery-triggered cases.

Keywords:
alternative psychosisantiepileptic drugsdissociationepilepsy surgerylimbic systemvagus nerve stimulation

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Area of Science:

  • Neurology
  • Psychiatry

Background:

  • Forced normalization (FN) is a phenomenon where psychiatric disturbances emerge after epilepsy treatment.
  • This condition is observed in patients previously experiencing uncontrolled epilepsy.

Purpose of the Study:

  • To describe the clinical characteristics of forced normalization.
  • To investigate the triggers and outcomes of FN.

Main Methods:

  • A systematic review of MEDLINE, EMBASE, Cochrane, and Scielo databases was conducted.
  • Data on clinical, electrographic, and imaging findings were gathered for 193 FN episodes.

Main Results:

  • Psychosis was the most common manifestation (86.4%), followed by mood disorders (25.8%).
  • Antiepileptic drugs (AEDs), particularly levetiracetam, triggered FN in 48.5% of cases, while epilepsy surgery triggered it in 31.8%.
  • Complete symptom resolution occurred in 65% of cases, with higher rates following AED withdrawal (87%) compared to surgery (28.5%).

Conclusions:

  • Forced normalization's pathophysiology is uncertain.
  • Antiepileptic drug withdrawal is associated with better outcomes than surgery-triggered FN.
  • While drug-triggered FN shows a positive treatment response, surgery-triggered FN has a less clear prognosis.