Nonepileptic seizures under levetiracetam therapy: a case report of forced normalization process

Francesca Anzellotti, Raffaella Franciotti, Holta Zhuzhuni, Aurelio D'Amico, Astrid Thomas, Marco Onofrj Department of Neuroscience and Imaging, Aging Research Centre, Gabriele d'Annunzio University Foundation, Gabriele d'Annunzio University, Chieti, Italy Abstract: Nonepileptic seizures (NES) apparently look like epileptic seizures, but are not associated with ictal electrical discharges in the brain. NES constitute one of the most important differential diagnoses of epilepsy. They have been recognized as a distinctive clinical phenomenon for centuries, and video/electroencephalogram monitoring has allowed clinicians to make near-certain diagnoses. NES are supposedly unrelated to organic brain lesions, and despite the preponderance of a psychiatric/psychological context, they may have an iatrogenic origin. We report a patient with NES precipitated by levetiracetam therapy; in this case, NES was observed during the disappearance of epileptiform discharges from the routine video/electroencephalogram. We discuss the possible mechanisms underlying NES with regard to alternative psychoses associated with the phenomenon of the forced normalization process. Keywords: nonepileptic seizures, forced normalization, levetiracetam, behavioral side effects