Phenytoin Augmentation of Levetiracetam Treatment: A Case of Forced Normalization With Emergence of Psychosis

Esang, Michael; Kotapati, Vijaya Padma; Ahmed, Saeed

doi:10.7759/cureus.2432

Cited by 2 publications

(3 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There is a clear predominance of patients with developmental delay (60 %) while Calle-López reported 24.2 % of patients with forced normalization with developmental delay [11]. In previous reports, some patients had Lennox-Gastaut syndrome or congenital encephalopathy [23][24][25], but in other cases the absence of developmental delay/ absence of neurologic comorbidity is clearly stated [26][27][28][29][30][31]. Some other cases do not report the previous neurological status, being therefore unknown [19,32,33].…”

Section: Discussionmentioning

confidence: 99%

Forced normalization: case series from a Spanish epilepsy unit

Barrios

Martín

Godoy

et al. 2020

Seizure

View full text Add to dashboard Cite

Introduction: Forced normalization is a clinical situation of singular relationship betweenepilepsy and psychosis, in which a patient shows behavioural and psychiatric symptoms coinciding with a reduction or termination of seizures and a total or partial normalization ofelectroencephalogram. Behavioural symptoms (frequently psychosis) or mood disturbances may appear. More information about this phenomenon, risk factors and prognostic variables is needed. Materials and methods: We conducted a systematic review of allthe patients followed at the specific Epilepsy Office in Virgen de la Victoria hospital, in order todetect and analyse the cases of forced normalization and to describe the clinical variables relatedto it. Results: We present a 10 patient case series, 6 women and 4 men with an average age of 51.5 years. Demographic data, neurological diagnosis, type of seizures, psychiatric comorbidity,related Antiepileptic Drugs (AEDs), pharmacoresistance, polytherapy, concomitant AEDs,therapeutic management and prognosis were analysed. Conclusion: This is a hospital-based studyabout the characteristics of forced normalization in patients with epilepsy. It is one of thelargest series reported in 30 years, to our knowledge. Psychiatric comorbidity and developmentaldelay seem to be strongly associated with forced normalization in our series, or this relationshipcould be biased by the special characteristics of an Epilepsy Office which proportionately assistsmore cases of refractory epilepsy, commonly associated with disabilities and comorbidity. Theprognosis is favourable. Our data could establish a starting point for the design of larger prospective and experimental studies.

show abstract

Section: Discussionmentioning

confidence: 99%

Forced normalization: case series from a Spanish epilepsy unit

Barrios

Martín

Godoy

et al. 2020

Seizure

View full text Add to dashboard Cite

show abstract

“…There were also reports of FN caused by valproic acid (VPA), phenytoin (PHT), and zonisamide (ZNS)[ 4 , 5 , 9 ]. In recent years, studies on the relationships between FN and ASMs have focused more on levetiracetam (LEV)[ 11 , 12 ]. In 2018, Esang et al [ 12 ] systematically discussed the clinical features and treatment strategies for FN and explored its relationship with ASMs, which made the clinical diagnosis and treatment of FN more rational.…”

Section: Historical Evolution Of Fnmentioning

confidence: 99%

“…Based on the patient's clinical course, this author believes that she developed FN by taking PHT. Esang et al [ 12 ] reported a 26-year-old female patient with no history of mental illness. Her family members described that she had been diagnosed with epilepsy in 2016 and received LEV treatment, which was initially effective; however, she had frequent seizures 1 year later, and then PHT (0.1 g tid) was added.…”

Section: Clinical Features Of Fnmentioning

confidence: 99%

Effects of antiseizure medications on alternative psychosis and strategies for their application

Yin¹,

Wu²,

Peng³

et al. 2022

WJP

View full text Add to dashboard Cite

Forced normalization (FN) is a unique phenomenon that is often seen in the treatment of epilepsy. FN is characterized by abnormal mental behavior and disordered emotions in epilepsy patients despite a significantly improved electroencephalogram and successful seizure control; the occurrence of FN seriously affects patients’ quality of life. The causes of FN include antiseizure medications (ASMs), epilepsy surgery and vagus nerve stimulation, with ASMs being the most common cause. However, with the timely reduction or discontinuation of ASMs and the use of antipsychotic drugs, the overall prognosis is good. Here, we perform an extensive review of the literature pertaining to FN, including its epidemiology, possible mechanisms, clinical features, treatment and prognosis.

show abstract

Phenytoin Augmentation of Levetiracetam Treatment: A Case of Forced Normalization With Emergence of Psychosis

Cited by 2 publications

References 7 publications

Forced normalization: case series from a Spanish epilepsy unit

Forced normalization: case series from a Spanish epilepsy unit

Effects of antiseizure medications on alternative psychosis and strategies for their application

Contact Info

Product

Resources

About