A case of forced normalization due to perampanel

Yuta Eguchi , Nobutsune Ishikawa , Hiroki Izumo , Yuichi Tateishi , Yoshiyuki Kobayashi , Satoshi Okada
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Abstract

Background

Forced normalization (FN) refers to the onset of psychiatric symptoms following an electroencephalogram (EEG) documented reduction in epileptic activity, cessation of clinical seizures, or both in patients with epilepsy. FN is mainly triggered by anti-seizure medication (ASM). Many ASMs have been implicated in the development of FN. However, few studies have reported perampanel (PER) induced FN.

Case report: A 10-year-old boy with a history of brain tumor resection was diagnosed with focal epilepsy based on the seizure type and EEG findings. Levetiracetam was irritable and ineffective. Lacosamide provided only partial effectiveness, leading us to prescribe PER as an add-on therapy. Approximately a week after initiating PER, the seizures resolved. However, the patient experienced concomitant emotional and cognitive instability, loss of appetite, and depression. The epileptic discharges ceased a month after starting PER, and we concluded that the FN was attributable to PER. Psychiatric symptoms gradually improved over a few months after the PER dose reduction.

Discussion

Patients with structural etiology and focal epilepsy are vulnerable to FN, putting our patients at a high risk for FN. Administration of a new ASM is the most common trigger for FN. This report is the first to describe FN induced by PER. Like other ASMs, psychiatric symptoms, seizure frequency, and EEG changes should be assessed when administering PER. Clinicians should be aware that discontinuing or reducing the dosage of the triggering medication can improve FN symptoms.

一个因 perampanel 而被迫正常化的案例
背景强迫正常化(FN)是指癫痫患者在脑电图(EEG)记录到癫痫活动减少、临床发作停止或两者同时停止后出现精神症状。FN 主要由抗癫痫药物(ASM)引发。许多抗癫痫药物都与 FN 的发生有关。然而,很少有研究报道过哌帕奈尔(PER)会诱发 FN:病例报告:一名有脑肿瘤切除史的 10 岁男孩根据发作类型和脑电图结果被诊断为局灶性癫痫。左乙拉西坦刺激性强且无效。拉科酰胺仅有部分疗效,因此我们开具了 PER 作为附加疗法。开始使用 PER 约一周后,癫痫发作得到缓解。然而,患者同时出现了情绪和认知不稳定、食欲不振和抑郁等症状。开始服用 PER 一个月后,癫痫放电停止,我们认为 FN 可归因于 PER。讨论结构性病因和局灶性癫痫患者易患 FN,因此我们的患者是 FN 的高危人群。服用新的 ASM 是引发 FN 的最常见诱因。本报告首次描述了 PER 诱导的 FN。与其他 ASM 一样,在使用 PER 时应评估精神症状、发作频率和脑电图变化。临床医生应注意,停用或减少诱发药物的剂量可改善 FN 症状。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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