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Clobazam was then added but it was ineffective and stopped after a few weeks. Since starting levetiracetam, she had reported only one nocturnal seizure. Levetiracetam had led to a severe and disabling sleep disorder because phenytoin had been tapered at the same time leading to an increase in the frequency of nocturnal seizures resulting in frequent arousals and poor sleep efficiency; possibly this had previously occurred with the introduction of lamotrigine. Since phenytoin had been the most effective antiepileptic drug, and all other medications she had tried had been either not tolerated or not effective, she again elected to take phenytoin.