ABSTRACT
I counseled her mother on the typical benign prognosis of absence epilepsy, and started the patient on valproate. Her spells improved for a few weeks, but then relapsed. She was having three to 12 events a day. Ethosuximide was added; she again improved for a few weeks but then regressed again. She developed a sleep disturbance with restlessness, squirming and hallucinations. Ethosuximide was discontinued and her symptoms improved. A few months later, she was having dozens of seizures a day. A repeat trial of ethosuximide improved her symptoms but was associated with stomach upset and vomiting. She developed behavioral problems with uncharacteristically whiny and sometimes aggressive behavior. This improved when valproate was stopped and clonazepam was added. However, clonazepam was associated with behavioral side effects including crying and mood swings, and it was discontinued after a brief trial. She was having up to 20 absence spells a day.
