Previously unrecognized periods of diminished arousal were observed. These seemed to be of two types: In one, preceding verbal automatisms with focal motor activity were present. Despite a normal waking EEG, consideration to partial complex seizures was given. Seizures secondary to subcortical involvement have been reported,3 and the thalamus, including the reticular nucleus2 and the anterior nucleus,4 may play a role. Gabapentin was initiated at 300 mg p.o. tid, adjunctive to valproic acid. Residual periods of prolonged somnolence, often of quick onset, remained. Ascending projections from the reticular formation, which collects information from multiple sensory modalities, terminate in the thalamus, especially the intralaminar nuclei, and are involved in arousal.1 Modafinil 100 mg p.o. bid was started. A sleep study was conducted and detection of significant central apnea prompted use of continuous positive airway pressure (CPAP). Significantly greater alertness resulted with the above measures.