Department of Neurology

Absence seizures resistant to Zarontin

Q: My 6 1/2 year old daughter has been having generalized absence seizures for almost exactly two years. When they first began they were 10-12 times per hour. We put her on Zarontin and only 5 mls a day was enough to control her seizures for the first year or more. Gradually in the last year we have had to increase it to 15 mls and are now in the mid to high blood levels for the prescribed therapeutic range. During the last month, however, her seizures have started becoming noticeable again, and are occurring 2-10 times per day. We will be meeting with a neurologist to discuss this in several months time (waiting list) but were wondering why the drug that was working is no longer working? Does this have any implication on whether she will outgrow her seizures or is this an indicator that somehow things are progressing and getting worse, or what? Her other neurological indicators are normal, in fact she was tested for cognitive abilities at a grade 3 level and is very athletic and active. Lastly, how effective has valproic acid been in treating this type of seizure and what are the possible side effects?

With thanks, Linda.

A: As children grow, their needs for medications usually increase due to their increased body size. This would not be a "drug resistance" per se. However, if her levels have not been dropping, she may be refractory to ethosuximide (Zarontin). Valproic acid (Depakote) would be a good choice in this situation. Its potential side effects are similar to other seizure medications, including drowsiness, and gait unsteadiness. It also can cause weight gain and tremor. In general, however, it is well tolerated.

If your daughter is having 2-10 seizures per day, they are undoubtedly interfering with her activities and learning. I would suggest that you insist on an evaluation in the immediate future.

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