-Case Reports-

A Girl with Idiopathic Epilepsy Showing Forced Normalization after Levetiracetam Administration

Yasuhiko Kawakami^1,2, Tetsuya Okazaki², Masato Takase², Osamu Fujino¹ and Yasuhiko Itoh¹

¹Department of Pediatrics, Nippon Medical School
²Department of Pediatrics, Nippon Medical School Tama Nagayama Hospital

Background: Forced normalization has been reported in association with almost all anti-epileptic drugs.
Patient: We report on a 9-year-old girl with idiopathic epilepsy who showed forced normalization after administration of levetiracetam (LEV). She initially presented with generalized tonic-clonic seizures when she was 4 years old. Diffuse sharp and slow wave complexes (SWCs) were observed on electroencephalography (EEG). We prescribed sodium valproate (VPA) and benzodiazepines, but the seizures and EEG findings worsened gradually. Although subsequent administration of LEV stopped the seizures, the patient became subject to episodes of rage and violent behavior. Forced normalization was confirmed by the disappearance of SWCs on EEG. We reduced the dose of LEV and tried in various ways to resolve the situation, but finally we had to abandon LEV.
Conclusions: To the best of our knowledge, this is the first report of a patient with idiopathic epilepsy but without disabilities in everyday life showing forced normalization associated with LEV administration.

J Nippon Med Sch 2015; 82: 250-253

Keywords
idiopathic epilepsy, forced normalization, levetiracetam

Correspondence to
Yasuhiko Kawakami, Department of Pediatrics, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama, Tokyo 206-8512, Japan
kawakami@nms.ac.jp

Received, December 17, 2014
Accepted, March 9, 2015