Forced Normalization in Patients with Epilepsy


Vilnius University, Center for Neurology, Vilnius, Lithuania


Seizure disorders and psychiatric presentations are complex, interrelated conditions. There is a higher incidence of psychosis (9%) in people with seizures, when compared to the general population (1%). A relationship between seizure control and psychotic symptoms in some patients with intractable epilepsies was described in the middle of the 20th century by H. Landolt. Multiple reports have appeared in the literature since then. The observation that the EEG recordings of these patients normalized during the psychotic episode led to coin the term “forced normalization” to describe this phenomenon. Some believe that this antagonism between psychosis and epilepsy may explain the therapeutic effect of electroconvulsive therapy (ECT) for psychotic disorders. This phenomenon, also known as “alternative psychosis,” is by no means common. The case report and literature overview is presented.