Purpose

Forced normalization (FN) indicates psychotic episodes associated with seizure remission and disappearance of epileptiform activity on EEG. FN is likely to occur when frequent seizures are abruptly terminated by anti-epileptic drugs (AEDs) or epilepsy surgery.

Methods

We describe an atypical case of a patient with FN induced by lacosamide (LCM).

Results

A 23-year-old female patient with Lennox-Gastaut syndrome (LGS) was administered AEDs for LGS and hospitalised with weight loss and abnormal behaviour. Her condition fulfilled the FN criteria, which was considered to be induced by LCM. After a reduction in LCM dose, her abnormal behaviour and appetite improved. During LCM use, the patient developed no seizures, and the high amplitude diffuse sharp and slow wave complexes that were frequently observed before LCM disappeared on EEG. The LCM dose was tapered to 150 mg per day, and she became calmer with socially appropriate behaviours, although a few mild focal seizures relapsed.

Conclusion

LCM was effective for treating LGS in this patient and induced FN. Initially, it was difficult to recognise FN in cases of psychiatric disorders, especially in patients with intellectual disability. Patients with FN induced by LCM are rare, and only four patients have been previously reported who were treated by antipsychotic drug for psychosis.

中文翻译：

---

使用拉考沙胺强制 Lennox-Gastaut 综合征正常化：病例报告

目的

强制正常化 (FN) 表示与癫痫发作缓解和脑电图上癫痫样活动消失相关的精神病发作。当频繁的癫痫发作被抗癫痫药物 (AED) 或癫痫手术突然终止时，很可能发生 FN。

方法

我们描述了一个由拉考沙胺 (LCM) 诱导的 FN 患者的非典型病例。

结果

一名 23 岁的 Lennox-Gastaut 综合征 (LGS) 女性患者接受了 AED 治疗 LGS 并因体重减轻和行为异常而住院。她的病情符合 FN 标准，这被认为是由 LCM 引起的。在减少 LCM 剂量后，她的异常行为和食欲有所改善。在 LCM 使用期间，患者未出现癫痫发作，并且在 LCM 之前经常观察到的高振幅弥漫性锐波和慢波复合体在 EEG 上消失。LCM 剂量逐渐减至每天 150 毫克，尽管有一些轻度局灶性癫痫复发，但她的社交行为变得更加平静。

结论

LCM 可有效治疗该患者的 LGS 并诱导 FN。最初，在精神疾病的情况下很难识别 FN，尤其是在智力残疾的患者中。LCM 诱发的 FN 患者很少见，此前仅报道过 4 名患者因精神病而接受抗精神病药物治疗。