Treatment of epileptic falling spells with ethosuximide

We used ethosuximide as an adjunctive anticonvulsant drug in 19 children with multiple seizure types in whom the primary and most troubling seizure was falling to the ground. All patients were having multiple, daily falls, intractable to phenobarbital, valproic acid, and clonazepam. Seizures were characterized and quantitated by video-electroencephalographic telemetry. Twelve children became completely free of epileptic falls on ethosuximide. Four children showed a 50-75% decrease in the number of falls while 3 showed no change in frequency of falls. All children had an abnormal electroencephalogram (EEG) prior to starting ethosuximide with generalized bursts of spike and wave in a frequency range of 1-4 cycles per second (cps). The only EEG abnormality common to those patients who became free of epileptic falls with ethosuximide treatment was a generalized, synchronous 4 cps discharge. Our experience suggests that ethosuximide may be a valuable adjunctive treatment for epileptic falling spells that occur in the context of multiple seizure types.