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February 1988

Forced Normalization-Reply

Author Affiliations

Department of Neurology University Hospitals The Ohio State University Columbus, OH 43210-1228

Arch Neurol. 1988;45(2):138-139. doi:10.1001/archneur.1988.00520260024009

In Reply.  —We appreciate Dr Vaillancourt's letter, which emphasizes the continuum of psychiatric manifestations of epilepsy, of which our recent series of "forced" normalization is an example. The patients described by Demers-Desrosiers and colleagues1 are complimentary to ours. It is likely that patients with temporal lobe epilepsy can acquire clinical psychosis through abrupt discontinuation of antiepileptic medications with worsening of the electroencephalographic tracing, abrupt cessation of epileptiform discharge and electroencephalographic normalization on institution of antiepileptic drug therapy, or by the chronic effects on limbic and mesolimbic structures of an epileptogenic focus in the frontal or temporal lobe. The first of these, referenced in Dr Vaillancourt's letter, might only partly facetiously be called "forced abnormalization," and rightly represent the antipode of the "forced normalization" that we2 and Landolt3 observed. These phenomena may be due to sudden changes in dopaminergic tone in structures involved in both epileptogenesis and psychosis, while the

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