Paradoxical Normalization in Childhood Epilepsy

Summary: We report 5 children aged 2·5 to 9 years with refractory epilepsy who, in the wake of a change in anti-epileptic drug (AED) regimen, developed paradoxical normalization (PN). Their acute psychiatric symptoms were associated with abrupt seizure cessation and normalization of the EEG. The latency periods between first seizure and advent of psychosis ranged from 1·9 to 7·0 years. Behavioral manifestations were schizophrenialike psychosis in 1, autistic withdrawal in 3, and organic mental syndrome not otherwise specified in 1. PN has heretofore been reported only in adolescents and adults after prolonged periods of poorly controlled seizures. The hypothesized precipitating factors relate to drug-induced changes in neurotransmitter systems.