Forced Normalization (FN) is a psychiatric phenomenon in which a long term episodic epilepsy or migraine disorder is treated, and, although the electroencephalogram (EEG) appears to have stabilized, acute behavioral, mood, and psychological disturbances begin to manifest. If, or when, treatment for the disorder is halted, the disturbances go away, but the episodic spikes on the EEG reappear.[1] H. Landolt coined the term 'Forced Normalization' in 1953 in response to a change he witnessed in epileptic EEGs, which monitor electrical activity in the brain. These changes were followed by abrupt behavioral changes in the patient.[2] Landolt concluded that forced normalization is "the phenomenon characterized by the fact that, with the occurrence of psychotic states, the electroencephalography becomes more normal or entirely normal, as compared with previous and subsequent EEG findings." Forced normalization, as described by Landolt,[3] was therefore an electrophysiological phenomenon with the electroencephalograph at its helm.
Tellenbach's description of "alternative psychosis" or the reciprocal relationship between abnormal mental states and seizures differed from Landolt's in its clinical rather than EEG description.[4] Subsequently, this concept was refined by Wolf,[5] who suggested that the term "paradoxical normalization" was more appropriate and closer to what Landolt intended, wherein both inhibitory processes and epileptic processes (subcortical and restricted) are active at the same time.[citation needed]
Researchers have been rallying for the broadening of the FN diagnostic criteria to include more episodic disorders than just epilepsy. It was recently discovered that FN can and has occurred in instances of chronic migraine attacks.[6] This called into question not only the diagnostic criteria, but also which treatments will treat the most patients the most efficiently.