Forced normalisation
Written and reviewed by Dr Ibrahim Imam, Consultant Neurologist. Last reviewed .
Forced normalisation. This is acute psychosis developing after seizure control and EEG normalisation. Fully referenced neurology checklist.
Pathology
- This is acute psychosis developing after seizure control and EEG normalisation
- It may be related to the biological antagonism between seizures and psychosis
- It may result from kindling of the mesolimbic dopaminergic system
- Kindling may be induced by anti-epileptic drugs (AEDs)
Epidemiology
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Diagnostic criteria
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Predisposing features
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Clinical features: psychosis
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Clinical features: others
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Associated anti-epileptic drugs (AEDs)
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Low risk anti-epileptic drugs (AEDs)
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Other reported triggers
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Differential diagnosis
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Treatment
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Outcome
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Synonyms
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References
- Pakalnis A, Drake ME Jr, John K, Kellum JB. Forced normalization. Acute psychosis after seizure control in seven patients. Arch Neurol 1987; 44:289-292.
- Kawakami Y, Itoh Y. Forced normalization: antagonism between epilepsy and psychosis. Pediatr Neurol 2017; 70:16-19.
- Amir N, Gross-Tsur V. Paradoxical normalization in childhood epilepsy. Epilepsia 1994; 35:1060-1064.
- Bragatti JA. Forced normalization revisited: new concepts about a paradoxical phenomenon. Front Integr Neurosci 2021; 15:736248.
- Wolf P. Acute behavioral symptomatology at disappearance of epileptiform EEG abnormality. Paradoxical or "forced" normalization. Adv Neurol 1991; 55:127-142.
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