A 7-year-old boy is brought to the pediatric neurology clinic by his parents due to concerns about frequent staring spells. His teacher reports that he often appears to “zone out” multiple times a day, sometimes in the middle of a sentence or during classwork. These episodes last about 5-10 seconds, during which he does not respond to his name or external stimuli. His parents also noticed similar episodes at home, especially when he is watching television or reading. The episodes occur without warning, and after they end, the child immediately resumes activity as if nothing happened, showing no confusion, lethargy, or memory loss. There is no history of jerking movements, tongue biting, or loss of bladder control. His developmental history is normal, and there are no prior concerns about learning delays. However, his teacher is worried that his academic performance has declined due to frequent inattention. To evaluate the child, the neurologist performs an EEG, which reveals a classic 3-Hz spike-and-wave pattern, confirming the diagnosis of absence seizures (childhood absence epilepsy). After explaining the diagnosis to the parents, the neurologist prescribes a medication that specifically inhibits T-type calcium channels in the thalamus, aiming to control the child’s seizures and improve his focus in school. Which of the following medications was most likely prescribed?

A 7-year-old boy is brought to the pediatric neurology clinic by his parents, who report that he has been having frequent episodes of “zoning out” over the past 3 months. These episodes occur multiple times a day, often during school or while playing. During these episodes, he stops talking mid-sentence, stares blankly for about 5–10 seconds, and does not respond to his name being called. After the episode, he resumes his activities as if nothing happened and has no memory of the event. His teacher has also noticed these episodes and reports that they occur 5–6 times a day, sometimes disrupting his ability to follow lessons. The parents are concerned because the episodes seem to be increasing in frequency. There is no history of fever, head trauma, or developmental delays. The child’s physical and neurological examinations are normal. An EEG is performed during one of these episodes, which shows generalized 3 Hz spike-and-wave discharges. What is the EEG finding indicative of in this context?

A 6-year-old girl is brought to the clinic by her parents due to concerns about frequent episodes of staring spells. Her teacher reports that she sometimes appears to be daydreaming and does not respond when called on in class. The episodes last for about 10 seconds, occur multiple times a day, and immediately resolve without confusion. Her physical exam and neurological exam are normal. During evaluation, she is asked to hyperventilate for a few minutes, and an episode is provoked. Which of the following findings is most likely to be seen on her EEG?

A 6-year-old boy is brought to the pediatric neurology clinic by his parents due to concerns about frequent episodes of brief staring spells. His teacher first noticed that he often appears to be “daydreaming” and does not respond when called on in class. The episodes last 5-10 seconds and occur multiple times a day. Afterward, he immediately resumes normal activity without confusion. His parents have also observed these episodes at home, particularly when he is watching television or reading quietly. There have been no convulsions, jerking movements, or loss of muscle tone during these events. The child has no history of head trauma, fever, or developmental delays. His family history is unremarkable for epilepsy or neurological conditions. The parents express concerns about how these seizures might impact their child’s learning and school performance. They ask if there are any triggers they should avoid to reduce the frequency of seizures. They ask if there are any triggers that they should be aware of. Which of the following is a common trigger for absence seizures?

A 7-year-old girl is brought to the pediatric clinic by her teacher, who reports that she frequently “zones out” and “spaces out” during class. She stops talking mid-sentence, stares blankly for about 10 seconds, and then resumes her activities as if nothing happened. The teacher notes that the episodes last a few seconds and occur multiple times a day. The child’s parents state that she does not respond when spoken to during these episodes but resumes activity immediately afterward. They have not noticed any jerking movements or confusion following the spells. The child has no history of head trauma, fever, or focal neurological deficits. Her development and academic performance are normal, but she has been increasingly distracted in school. Physical Examination •Normal neurological exam •No focal deficits •No postictal confusion Clinical Workup •EEG: Shows a classic 3-Hz spike-and-wave pattern •Hyperventilation Test: Provokes a seizure episode What is the most likely diagnosis?

A 28-year-old woman with a long-standing history of mesial temporal lobe epilepsy (MTLE) presents to the neurology clinic for preconception counseling. She has been on carbamazepine for seizure control for several years and has remained seizure-free for the past two years. She and her partner are planning to start a family, and she is concerned about the effects of her medication on her pregnancy and the baby’s health. She asks whether she should continue taking carbamazepine, reduce the dose, or switch to a different medication. She also expresses concerns about possible birth defects and whether her epilepsy might worsen during pregnancy. Which of the following statements about managing this patient’s epilepsy during pregnancy is most accurate?

A 35-year-old man with a history of childhood febrile seizures presents with recurrent episodes of altered consciousness,characterized by olfactory auras, followed by impaired awareness and post-ictal confusion. His wife describes episodes where he stares blankly, makes chewing movements, and does not respond for about a minute. Afterward, he is confused and asks repetitive questions. Despite treatment with levetiracetam, carbamazepine and lamotrigine, he continues to have weekly seizures. MRI reveals hippocampal atrophy. Which of the following is the best next step in management?