Cassiopeia - I don't think she'll change much.
But since we're tossing around ideas about a change to her E, why not just change everything else about her? Her ult is nice, but it doesn't fit her theme because she is not Medusa. She is similar, but naaah, that isn't her.
I like the idea of making her inflict different types of poison effects to enemies. Having 3-4 types of poison in her kit sounds exciting. Why not take it a step further and have her inject poison into minions or jungle monsters that lay dormant until they're killed.
It can play off like Twisted Fate's card select. The difference is you wouldn't get an indicator as to which poison she is putting into her target.
Example....
Q: Noxious Blast - Cassiopeia injects a neutral or enemy target with a volatile poison. If the target dies or if the poison lingers for more than x amount of seconds, the host will explode, inflicting enemy targets in the area with a DoT poison.
The problem therein would be that she would rely on minions to deal her damage. However, why not give her a passive that allows her to summon X amount of uncontrollable snakes that will seek out the nearest enemy champion/enemy/neutral. She can inject 1/2 amounts of poison into her snake and will explode when it gets near an enemy/neutral or expires in its traveling time.
At least that way she has a dynamic passive that makes her feel like "Oh shit, we really need to kill her so her passive doesn't come up." She's only a threat when she's allowed to focus down one person. At least this way it would justify camping her or killing her because she is a threat.. and not because she's an easy target.
I mean, it's all complete conjecture and I feel she should just get a whole rework at this point in her LoL Career. I want her to feel dynamic. I want her to feel sneaky. I want her to feel like she contributes in a different way. I don't want her to be a Mage ADC who function badly at both roles.