Alternative psychosis (forced normalisation) in epilepsy

Forced normalisation is a paradoxical relationship between seizure activity and behavioural problems. A 20-year-old man with recurrent refractory tonic-clonic epilepsy experienced forced normalisation while on medication with multiple anti- epileptic drugs (valproate sodium, carbamazepine and topiramate). A reduction in the seizure burden correlated with sudden behavioural changes manifesting with aggressive outbursts and violence. 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.