Abstract
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.
Highlights
Forced normalisation is a paradoxical relationship between seizure activity and behavioural problems
The case may help clarify the mechanism of forced normalisation while providing some helpful hints regarding the diagnosis and treatment of symptoms observed in recurrent refractory seizures
A 20-year-old man with recurrent refractory tonic-clonic epilepsy was referred to the liaison psychiatry registrar at George Mukhari Hospital by the neurology registrar after he had an altercation with the nursing staff in the neurology ward
Summary
A 20-year-old man with recurrent refractory tonic-clonic epilepsy was referred to the liaison psychiatry registrar at George Mukhari Hospital by the neurology registrar after he had an altercation with the nursing staff in the neurology ward. The patient had been treated for recurrent refractory epilepsy by the neurology department since 1996. He was on multiple AEDs. He was on multiple AEDs His current drug regimen was sodium valproate 1 000 mg in the morning and 1 500 mg at night, carbamazepine 400 mg twice a day and topiramate 50 mg twice a day. The patient admitted to taking alcohol occasionally at social functions He drank only beer, three or four 350 ml cans at a sitting. There was a positive family history of epilepsy, his deceased maternal aunt having been affected According to his mother, the patient had been delivered vaginally at term, the labour had been prolonged and he had.
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