Underestimated Aspects of Epilepsy Treat- ment: Forced Normalization and Seizure Ag- gravation by Antiepileptic Drugs

After a detailed literature review, modern data about two underestimated aspects of epilepsy treatment forced normalization and seizure aggravation by Antiepileptic Drugs (AEDs) were summarized. Forced Normalization (FN) is a phenomenon, characterized by a manifestation of some kind of incidental behavioral disorder in patients with epilepsy in association with a relative EEG normalization. The pathogenesis of this condition remains unresolved. The most important hypothesis assumes that, during FN, the epilepsy is still active subcortically, perhaps with spread of discharge along unusual pathways. The main risk factors of FN include: usage of some AEDs, neurophysiological factors associated with impaired balance of the glutamatergic, dopaminergic and GABA-ergic activity and some special clinical characteristics of patients. The most typical manifestations of FN include behavioral disturbance, psychosis, dysphoric and conversion symptoms. The diagnosis FN is based on the modern diagnostic criteria proposed by Krishnamoorthy and Trimble. Although there is no consensus about the therapeutic approach, most investigators recommend reassessment of the type and dose of AEDs and a possible brief course of treatment with antipsychotics and antidepressants. Ekaterina Viteva1* 1Department of Neurology, Medical University-Plovdiv, Bulgaria *Corresponding author: Ekaterina Viteva, Department of Neurology, Medical University, 4002 Plovdiv, 15A Vasil Aprilov st., Bulgaria; Email: [email protected] Published Date: February 10, 2016