Acute psychosis and EEG normalisation after vagus nerve stimulation

Neurostimulation therapy for epilepsy

“…Previously, this was reported in association with various AEDs, but Gatzonis et al [27] also described this phenomenon with VNS. A 35-year-old man with highly medication-resistant epilepsy was experiencing multiple, daily complex-partial seizures of left frontotemporal origin.…”

Major Psychiatric Disorders Subsequent to Treating Epilepsy by Vagus Nerve Stimulation

“…However, in a population of 50 surgically treated patients with epilepsy, 8 of the 19 patients who were intact psychiatrically prior to surgery developed a de novo dysphoric disorder, with psychotic symptoms in 2 patients (34). One of the two patients reported in the literature who developed psychotic episodes on seizure suppression by VNS had no previous psychiatric history (29).…”

“…Search of the literature indicates that only two cases of psychiatric complications with the treatment of epilepsy by VNS have been reported: a 16-year-old male with daily convulsions and a history of previous psychosis who became acutely psychotic "after an incredible 2-week seizure-free period" (28); and a 35-yearold male with frequent seizures of left frontotemporal origin and no history of psychiatric disturbances who became psychotic when his seizures were reduced from several per week to only one in 2 weeks (29). We report here on 7 from a series of 81 patients with epilepsy who manifested severe psychiatric symptoms following major reduction in seizure frequency or complete seizure control after left-sided VNS was used as an adjunct to AED treatment.…”

Treatment-emergent psychiatric adverse events of antiepileptic drugs in epilepsy: how can we avoid them?

“…Since the early observations of Landolt, several authors have documented a number of patients with alternative psychosis [22]. Notably, this phenomenon is not restricted to drug-induced seizure control, but is also probably implicated in de novo psychosis following epilepsy surgery and during vagus nerve stimulation [23], suggesting that the mechanism underlying seizure control is more significant than the mechanism of action of the drug. The pathophysiology of forced normalization is still largely unclear.…”