2024 American Academy of Neurology Abstract Website

Objective:

To present three pediatric patients with Hispanic ethnicity with DIL secondary to Ethosuximide

Background:

Ethosuximide is a first-line antiseizure medication for childhood absence epilepsy, generally safe but very rarely associated with DIL. We report a case series of 3 Hispanic girls who developed DIL while on Ethosuximide therapy with in one year of our observation at University of Texas Medical Branch.

Design/Methods:

Retrospective Observational Descriptive Study

Results:

Patient A, a 10-year-old Hispanic female diagnosed with childhood absence epilepsy, was started on Ethosuximide 250 mg BID. After 2 months, she experienced fever, rash, and joint pain, and her work-up indicated aplastic anemia with a positive ANA, anti-dsDNA, anti-histone ab, and low complement levels, leading to a diagnosis of DIL. Ethosuximide was stopped, and treatment with Prednisone and Hydroxychloroquine resulted in symptom resolution and normalization of lab findings. Subsequent follow-up over 6 months showed no recurrence of seizures while off antiseizure medications.

Patient B, a 12-year-old Hispanic female also diagnosed with childhood absence epilepsy, received Ethosuximide 250 mg BID. After 3 months, she developed fever, fatigue, and joint pain, and her lab results showed a positive ANA, anti-dsDNA, anti-histone ab, and low complement levels, leading to the diagnosis of DIL. Bone marrow biopsy confirmed autoimmune aplastic anemia. Her symptoms and lab work-up normalized with discontinuation of Ethosuximide and steroid treatment.

Patient C, an 8-year-old Hispanic female with childhood absence epilepsy, was prescribed Ethosuximide. After two months, she developed a malar rash, arthralgias, and walking difficulties. Blood testing was not conducted promptly, however, her symptoms resolved quickly and completely after the discontinuation of Ethosuximide.

Conclusions:

While Ethosuximide causing DIL is very rare, our case series highlights the importance of monitoring closely Hispanic females for drug-induced autoimmune disorders when on Ethosuximide. Further investigation is warranted to better understand this association and potential biological underpinnings of such association.