Three children with a syndrome of obesity and overgrowth, atypical psychosis, and seizures: A problem in neuropsychopharmacology

Three children presented with a complex syndrome of atypical psychotic and extremely immature behavior, obesity and overgrowth, borderline retardation , and seizures (prominent in two). Weight overgrowth exceeded height overgr owth and was stratospheric (up to 8 SD above mean). Obesity seemed related to lack of satiety. The cases fit no known condition: hypothalamic damage, Sotos' syndrome, and Prader-Willi syndrome were excluded. Empirical treatme nt with anticonvulsants (carbamazepine and acetazolamide) together with psy chotropic agents (selective serotonin reuptake inhibitors and risperidone) controlled seizures, improved behavior, and stopped weight gain in each pat ient. We have not found this syndrome previously described. The etiology is unknown: perinatal encephalopathy could be a factor in the two patients wi th prominent seizures; in the third, familial major affective disorder is i mplicated. Medication responses suggest a low-serotonin state underlying th e lack of satiety, an imbalance of serotonin and noradrenergic modulation i n the hypothalamus, and epileptogenic disorders (or affective disorder resp onsive to anticonvulsants in one case) involving these same systems.