Alternative psychosis (forced normalisation) in epilepsy

Vongani Titi Raymond Ntsanwisi, Solomon T Rataemane, Dali S Magazi


Abstract Forced normalization is a paradoxical relationship between seizure activity and behavioural problems. A 20 year old male with recurrent refractory tonic clonic epilepsy experienced forced normalization, whilst on medication with multiple anti- epileptic drugs (AEDs).(Valproate Sodium, Carbamazepine, and Topiramate). A reduction in the seizure burden correlated with sudden behavioural changes manifesting with aggressive outbursts and violence.. The present case may help clarify the mechanism of forced normalization whilst providing some helpful hints regarding the diagnosis and treatment of symptoms observed in recurrent refractory seizures.


Forced normalization;Alternative psychosis;Episodic dyscontrol syndrome,Kindling phenomenon;Long-term potentiation;Refractory epilepsy

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Submitted: 02 December 2010
Published: 01 June 2011

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South African Journal of Psychiatry    |    ISSN: 1608-9685 (PRINT)    |    ISSN: 2078-6786 (ONLINE)