Ethosuximide systemic lupus

Non-dose-related or idiosyncratic adverse effects of ethosuximide are extremely uncommon. Skin rashes have been reported, including at least one case of Stevens-Johnson syndrome. A few patients have had eosinophilia, thrombocytopenia, leukopenia, or pancytopenia it is not entirely certain that ethosuximide was the causal agent. The development of systemic lupus erythematosus has also been reported, but other drugs may have been involved. 

The main adverse effects of ethosuximide include gastrointestinal disturbances, anorexia, dizziness, fatigue, drowsiness, headache, mood and behavioral disturbances, dyskinesias, and hiccups (1). Skin rashes (including Stevens-Johnson syndrome), systemic lupus eiythemato-sus, scleroderma, nephrotic sjmdrome, blood dyscrasias, liver dysfunction, and autoimmune thjroiditis are rare. 

Although ethosuximide is thought to be the least toxic of the succinimides, it can cause gastrointestinal disturbances and dose-related CNS effects, such as drowsiness, dizziness, ataxia, sleep disturbances and depression. Idiosyncratic hypersensitivity reactions include severe rashes, leukopenia, agranulocytosis (some fatal), systemic lupus erythematosus, and parkinsonian-like symptoms. In addition to being less toxic than trimethadione, ethosuximide offers a wider range of protection against different kinds of absence seizures. 

Immunologic Systemic lupus erythematosus with an increase in anti-double-strand DNA antibodies has been attributed to ethosuximide [104" ]. 

Crespel A, Velizarova R, Agullo M, Gehsse P. Ethosuximide-induced de novo systemic lupus erythematosus with anti-double-strand DNA antibodies a case report with definite evidence. Epilepsia 2009 50(8) 2003. 

Antinuclear antibodies were found in 14 of 70 children on ethosuximide and/or phenytoin, and in 5 of 23 on phenobarbitone alone. On frequent surveillance, none developed clinical signs of systemic lupus erythematosus. It is probably unnecessary therefore to discontinue the drugs in children with antinuclear antibodies, but careful observation is required. Five children with clinical systemic lupus-like disease were observed. In each case, symptoms appeared within 1 —6 months of starting ethosuximide. The syndrome included fever, malar rash, lymphadenopathy, arthropathy, pleural effusions, myocarditis and pericarditis (43 ). Scleroderma has also been attributed to ethosuximide therapy (51 ). All these cases were on other anticonvulsants as well, but ethosuximide seemed to be the precipitating drug. 

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