{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T14:26:23Z","timestamp":1787840783067,"version":"build-2784847793"},"reference-count":11,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>\n                    A\n                    <jats:sc>BSTRACT<\/jats:sc>\n                  <\/jats:title>\n                  <jats:p>Valproic acid (VPA) is a well-established antiseizure medication typically prescribed to maintain serum levels between 50 and 100 \u03bcg\/mL. This case report presents a 25-year-old male with idiopathic generalized epilepsy who achieved long-term seizure freedom while on significantly subtherapeutic VPA levels. The patient initially maintained seizure control on a 750 mg once-daily regimen, with a measured VPA level of 35 \u03bcg\/mL and a normal sleep-deprived EEG. Following a reduction to 500 mg daily due to medication-related tremors, seizure control persisted and a repeat EEG remained normal. However, after a further reduction to 250 mg daily, a subsequent EEG revealed new-onset generalized epileptiform discharges. Despite reverting promptly to the prior 500 mg dose, the patient experienced a seizure 3 days later. He remained seizure-free for 1 year following this episode while continuing on the 500 mg dose. This case highlights two important clinical observations: First, seizure freedom can be sustained at subtherapeutic serum VPA levels in certain patients; second, EEG abnormalities may serve as an early biomarker of increased seizure risk following dose adjustments. To our knowledge, such a pattern has not been previously documented. This case emphasizes the utility of EEG in guiding treatment decisions and monitoring subclinical changes in patients with idiopathic generalized epilepsy.<\/jats:p>","DOI":"10.4103\/jfmpc.jfmpc_1182_25","type":"journal-article","created":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T12:01:39Z","timestamp":1774008099000},"page":"996-999","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Seizure freedom on subtherapeutic levels of valproic acid"],"prefix":"10.4103","volume":"15","author":[{"given":"Mazen A.","family":"Basheikh","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, University of Jeddah, Jeddah, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,3,20]]},"reference":[{"key":"R1-20260325","doi-asserted-by":"crossref","first-page":"1375","DOI":"10.1016\/S0140-6736(21)00246-4","article-title":"Valproate 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seizure","volume":"34","author":"Schreiner","year":"2003","journal-title":"Clin Electroencephalogr"}],"container-title":["Journal of Family Medicine and Primary Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/jfmpc.jfmpc_1182_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T13:28:54Z","timestamp":1787837334000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/jfmpc.jfmpc_1182_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2]]},"references-count":11,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/jfmpc.jfmpc_1182_25","relation":{},"ISSN":["2249-4863","2278-7135"],"issn-type":[{"value":"2249-4863","type":"print"},{"value":"2278-7135","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2]]},"assertion":[{"value":"2025-06-30","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication 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