Case Report

Alternative psychosis (forced normalisation) in epilepsy

Vongani Titi Raymond Ntsanwisi, Solomon T Rataemane, Dali S Magazi
South African Journal of Psychiatry | Vol 17, No 2 | a281 | DOI: | © 2011 Vongani Titi Raymond Ntsanwisi, Solomon T Rataemane, Dali S Magazi | This work is licensed under CC Attribution 4.0
Submitted: 02 December 2010 | Published: 01 June 2011

About the author(s)

Vongani Titi Raymond Ntsanwisi,, South Africa
Solomon T Rataemane, Department of Psychiatry, University of Limpopo (MEDUNSA campus), PO Medunsa, 0204, South Africa
Dali S Magazi, Department of Neurology, University of Limpopo (MEDUNSA campus), South Africa

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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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