Forced normalization after turning off vagus nerve stimulation in Lennox–Gastaut syndrome

Abstract

Forced normalization is the development of psychiatric symptoms in a patient experiencing remission of seizures. We present a case of Lennox Gastaut syndrome in which forced normalization developed after vagus nerve stimulation was stopped.The patient had drug resistant epilepsy and failed anti-seizure drugs, vagus nerve stimulation, and a partial callosotomy.The patient had multiple types of seizures including drop attacks, absences, and tonic–clonic seizures. He tried vagus nerve stimulation for two years without success. Forced normalization developed after the vagus nerve stimulator was turned off.This is the first case to our knowledge to describe forced normalization after turning off the vagus nerve stimulator.

Pilot study of focused ultrasound for drug‐resistant epilepsy

“…35 The phenomenon is more common in patients with intellectual disability and DRE, and after neuromodulation (e.g., VNS for patients with Lennox–Gastaut syndrome). 36 , 37 , 38 …”

Vagus nerve stimulation as a potential modulator of periictal psychotic episodes: A report of four cases

“…In contrast, one study has shown an antipsychotic effect after VNS implantation [12] . Recently, Lee et al [14] reported the first case of forced normalization after turning off VNS in a patient suffering from Lennox-Gastaut syndrome.…”

Forced normalization: case series from a Spanish epilepsy unit

“…There is a clear predominance of patients with developmental delay (60 %) while Calle-López reported 24.2 % of patients with forced normalization with developmental delay [11]. In previous reports, some patients had Lennox-Gastaut syndrome or congenital encephalopathy [23][24][25], but in other cases the absence of developmental delay/ absence of neurologic comorbidity is clearly stated [26][27][28][29][30][31]. Some other cases do not report the previous neurological status, being therefore unknown [19,32,33].…”